Center of Excellence for HPV and Cervical Cancer

The laboratory diagnosis of HPV (Human Papillomavirus) is one of the centers of excellence at the Germano de Sousa Center for Laboratory Medicine. We have a specialized department for conducting HPV tests, the Laboratory of Molecular Biology and Pathology (see specialty area), staffed by a team of specialized technicians led by Dr. José Germano de Sousa.

On this page, we aim to provide all the essential information on the topic of HPV and cervical cancer.

The human papillomavirus is a virus capable of causing lesions on the skin or mucous membranes, and it has more than 200 different serotypes. Most subtypes are associated with benign lesions, such as skin warts, but certain types are frequently found in specific neoplasms. They are thus classified into two groups: those with a low risk of causing cancer and those with a high risk of causing cervical cancer.

Several studies reveal an association between HPV and the development of cervical carcinoma, warts, and other anogenital conditions. It is therefore extremely important to study this virus, as cervical carcinoma is one of the types of cancer that has been increasing the most in recent years. It is a silent virus that shows no symptoms. It affects 300 million women worldwide.

Germano de Sousa HPV e Cancro do Colo do Útero

HPV is the second most common cancer among women.

Infection with the human papillomavirus (HPV) is the primary cause (and a necessary cause) of cervical cancer.

The main carcinogenic high-risk HPV (hrHPV) genotypes are:

16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, and 68. The infection must become chronic and persistent.

In contrast, HPV types 6 and 11, found in most genital warts (or genital condylomas) and laryngeal papillomas, do not appear to pose any risk of progression to malignancy, although they may be found in a small proportion of malignant tumors.

Genital HPV is transmitted through sexual contact and can cause clinically significant lesions in the vagina, cervix, penis, and anus. Subclinical infections, however, are found only in the cervix. Although the rare presence of the virus has been demonstrated on the skin, in the larynx (vocal cords), and in the esophagus, the development of any type of clinical or subclinical lesion in other regions of the body is quite rare.

HPV infects sexually active women and men. Although most infections are asymptomatic and reversible, a significant minority of infected women will develop persistent cervical infections and are at risk of developing cervical cancer (CC).

Several studies indicate that the incubation period—from infection to the development of disease (clinical and/or subclinical)—is not well understood. However, they suggest that this period ranges from 3 weeks to 8 months, with an average of 3 months, provided that conditions conducive to its development are present. In most cases, disease development is related to each individual’s immune response and the viral load (amount of virus) at the site of infection.

hrHPV genotypes are detected in 99.7% of cervical cancers.

If an HPV infection persists in the lower genital tract for several years, a precancerous condition (intraepithelial neoplasia) may develop. However, less than 1% of persistent hrHPV infections progress to cancer, with a median interval of 13 to 15 years.

The presence of cofactors is essential for the development of cervical cancer. Immunosuppression, HIV infection, tobacco use, chronic cervicitis (e.g., chlamydia, HSV-2), multiparity (>3), oral contraceptives (long-term use), and genetic factors that prevent the immune system from suppressing or clearing the HPV infection.

There is indirect evidence that a genital HPV infection can persist for life and that a latent infection can be reactivated in the presence of immunosuppression (e.g., HIV infection) or other poorly understood circumstances.

Condoms do not protect against HPV infection, but their use is recommended because of their effectiveness in preventing other sexually transmitted infections.

It is one of the most preventable
human cancers In Portugal, 15 out of every 100,000 women are diagnosed each year
In Portugal, 3–5 out of every 100,000 women die each year

To prevent HPV infection, you should visit your gynecologist regularly and undergo routine screenings to detect HPV infection and its persistence. If you experience any of the following symptoms, see your gynecologist: itching, discharge, abnormal bleeding (outside of your menstrual period), and pain during sexual intercourse. You should limit the number of sexual partners.

Consult your doctor about the HPV vaccine.

There is a vaccine for HPV subtypes 16 and 18 and another for subtypes 6, 11, 16, and 18. These vaccines are preventive, not therapeutic, so it is best to receive them before becoming sexually active. The vaccine is given in three doses over a six-month period.

Screening and Diagnosis

There are several criteria for selecting tests:

The HCII test is a screening test to identify clinically relevant hrHPV infections.
COBAS 16/18 + HR Test—Enables the simultaneous detection of 14 high-risk HPV types and specifically identifies types 16 and 18.
Genotyping should be performed when there are persistent hrHPV infections or co-infections. It has higher specificity and allows for the identification of high-risk genotypes. Different therapeutic approaches.
The E6/E7 mRNA test should be performed when there are persistent infections with high-risk HPV genotypes. This test has high clinical sensitivity and high specificity for CIN2+/CIN3+. It has high potential as a marker of oncogenic transformation. It allows differentiation between transient infections and persistent infections with oncogenic potential.

Our laboratory performs all three types of tests; please consult your primary care physician.

The greatest potential in HPV diagnosis lies in Primary Screening (for women over 30), combined with cytology, which increases sensitivity and extends the screening interval for low-risk women. In Portugal, 900 cases of cervical cancer are diagnosed annually.

Treatment

The HPV virus can be cleared spontaneously, without the person even knowing they were infected.

There are several forms of treatment, but the goal of any of them is to destroy the infected tissue. Once the diagnosis is made, treatment can be medical (with medications) or surgical: chemical cauterization, electrocauterization, cryotherapy, laser therapy, or conventional surgery in cases of established cancer.

In the case of cervical carcinoma, medical follow-up is especially important, since the treatments used are more specific and rigorous. Multidisciplinary therapies involving surgery, radiation therapy, and chemotherapy are indicated for the treatment of this neoplasm.