HPV Centre

Prevention is the primary tool to safeguard one’s health. Human Papillomavirus (HPV) infection affects many women and men at least once in their lifetime. It’s a viral condition not to be underestimated, as some more aggressive types can eventually lead to the development of tumors in various parts of the body.

In Europe, an estimated 50,000 new cases of HPV-related tumors are reported every year, with over 34,000 cases annually affecting the cervix. Globally, cervical cancer ranks as the second most common cancer in women.

The primary targets of HPV are the skin and the anogenital and oropharyngeal mucosa, with transmission mainly occurring through sexual contact. Infections are usually asymptomatic and resolve spontaneously due to immune system activation, in about 60-90% of cases within 1-2 years of infection.

For a more accurate diagnosis and comprehensive evaluation of each case, a multidisciplinary approach is recommended, involving various specialists depending on the patient, including gynecologists, otolaryngologists, proctologists, infectious disease specialists, urologists, and psychological support.

How to treat HPV infection?

A specific cure does not yet exist, which is why preventing complications through regular screening and participating in cervical cancer prevention programs is crucial for women aged 25 to 64, to identify alterations caused by the virus.

In particular, for women aged 25 to 29, it is important to undergo the Pap test, a simple and painless examination, annually to evaluate possible alterations of uterine cells, while for women aged 30 to 64, it is advisable to undergo the HPV test every 5 years. Additionally, there is a vaccine against some types of the virus, which are responsible for 70% of cervical cancer cases.

Where to start?

The first step to begin the path of treatment and prevention for HPV is certainly the HPV test and the specialist visit.

To detect the presence or absence of the Human Papillomavirus, it is necessary to:

• HPV test swab or;
• Thin Prep with liquid solution for viral DNA research.

For women, the Pap test is also recommended.

What to do in case of a positive HPV test?

A positive HPV test does not indicate a disease but rather the presence of HPV virus infection. To further investigate the health status of the affected area, a Pap test is also performed to assess any cellular abnormalities of the cervix. In case of further positivity, a colposcopy is carried out for a more specific investigation. After these tests, it is advisable to undergo a specialist consultation to understand the severity of the alteration and identify the most effective treatments.

What are the treatments for HPV?

There are several methods to address lesions resulting from HPV infection.

Among these are: colposcopy, excision, conization (LEEP, LLEZ, with cold knife or laser), loop electrosurgical excision procedure (LEEP), or destructive treatments such as laser vaporization and diathermy coagulation.

The goal of treatment is to eliminate potentially evolving lesions deeply and, consequently, reduce mortality from invasive neoplasms, while remaining as conservative as possible. These treatments should be performed under direct colposcopic control by an experienced operator to guide the intervention and achieve a specific and comprehensive treatment.

The choice of treatment, since these are techniques of equivalent effectiveness, is determined by understanding the advantages, disadvantages, and limitations of each technique, evaluated in relation to the patient’s age, desire for pregnancy, severity of cervical lesion, location, and surface area.

Why the otolaryngologist and the proctologist?

HPV infection, in addition to the uterine area, can also involve the oral and pharyngeal mucosa. Therefore, a specialist evaluation by an ear, nose, and throat (ENT) doctor is essential to specifically assess the oral health status.

At the same time, a visit to the proctologist is necessary to investigate whether HPV has affected the anal mucosa and to identify an appropriate treatment to address the infection.

Why the urologist?

Penile carcinoma is a rare condition. In this context, HPV represents one of the potential risk factors for the development of this condition. Screening for the prevention of this neoplasia may be useful in those who have presented with an HPV-related neoplasia or precancerous lesion in another body area or for those who have a persistent high-risk HPV infection, particularly HPV 16.

The available tools for urological screening are:

• HPV test;
• High-resolution balanoscopy and peniscopy: these examinations are conducted by observing the genital surface after the application of acetic acid and through lenses that allow adequate magnification of the image.

Why the infectologist?

In this multidisciplinary setting, the presence of the infectious disease specialist provides added value through counseling regarding HPV infection and other sexually transmitted infections, as well as through directing the diagnostic and healthcare path for the individual.

Why a specialized center for HPV?

A center for the treatment of HPV infection involving multiple specialists offers several advantages. The collaboration between professionals such as gynecologists, otolaryngologists, proctologists, and psychologists allows for a more comprehensive and personalized evaluation.

This multidisciplinary approach can improve diagnosis and enable more targeted treatment.

Thanks to comprehensive management in one place, each patient can feel guided in the treatment process and be accompanied with competence and professionalism from all perspectives.