Human Papillomavirus Diagnostics

HPV diagnostics – usually by molecular biological HPV detection (gene probe test) – using a cervical smear – has the highest sensitivity (percentage of diseased patients in whom the disease is detected by the use of the test, i.e., a positive test result occurs) of all currently available detection methods. HPV diagnostics is used to detect infection with DNA viruses from the group of human papillomaviruses (HPV), which cause warts, for example. Note: The detection of infection is not to be equated with HPV-related disease, as HPV is a facultative pathogen. Facultative pathogens are pathogens that require a weakened immune status or other deficiencies of their host to cause disease.HPV diagnostics should be performed concomitantly as part of the cytological examination on the occasion of gynecological cancer screening and serves to improve the early detection of cervical cancer (cervical carcinoma).HPV viruses are also involved in other cancers of the lower genital tract. Note: Sexual intercourse with an HPV-infected partner can deposit infected cells, free virus, or infected semen in the female genital tract without resulting in infection of the woman. Therefore, if an HPV test is performed shortly after intercourse, the result may be false-positive.

HPV infection

Scientific studies have shown that permanent infection with so-called high-risk HPV types – types 16 and 18 – is significantly involved in the development of cervical cancer, while low-risk HPV types lead to non-malignant changes that also disappear on their own.The frequency peak for detectable HPV infections is between the ages of 20 and 25. Depending on the frequency of partner change, HPV DNA detection can be detected in up to 50% of young women.Of HPV positive women, 5-10% develop cytological abnormalities, i.e. abnormalities on cytological examination. This is characteristic of a facultative pathogen.If HPV infection persists in the lower genital tract for several years, precancerous lesions – for example, dysplasia – may develop. Less than 1% of persistent HPV infections led to cervical cancer after an average of 15 years.Furthermore, researchers at Heidelberg University Hospital showed that malignant tumors of the vagina (vagina) can also originate in cancer cells of the cervix. This revealed similarities in the genetic material of tumor cells of the vagina (vagina) and human papillomaviruses.Since only a few of those infected develop cervical cancer, other cofactors – causative factors – are important in addition to HPV infection, such as:

  • Genetic factors
  • Smoking
  • Drugs such as cannabis (hashish and marijuana), cocaine, etc.
  • Promiscuity (sexual contacts with relatively frequently changing different partners).
  • Poor genital hygiene
  • Other sexually transmitted diseases such as HIV/AIDS or genital herpes.
  • Immunodeficiency (immune deficiency)
  • Immunosuppressive drugs

Clinical picture

The following clinical pictures are known:

  • Condylomata acuminata – called cow’s or wet nipples – in the area of the vulva (outer vagina), vagina (inner vagina) and portio (part of the cervix that protrudes into the vagina – also called the cervix) and cervix uteri (cervix).
  • Cancer precursors of cervical carcinoma (cancer of the mouth of the uterus) and cervical carcinoma (cancer of the cervix).
  • Condylomata acuminata – outside the genital tract in the anal area (rectal outlet) is rare infestation of the urethra (urethra).
  • Laryngeal papillomas in newborns and infants.

Note!HPV types 16 and 18 are also thought to be responsible for about 15% of head and neck squamous cell carcinomas. A newly developed serological method makes it possible to detect 95% of these carcinomas that have been growing for a long time without symptoms.HPV diagnostics should be performed concomitantly as part of gynecological cancer screening.

Laboratory Diagnostics

1st-order laboratory parameters-obligatory laboratory tests.

  • Human pallioma virus DNA detection (from biopsy material)HPV types are divided into two groups based on their potential to induce malignant genital disease:
    • HIGH RISK types: 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68
    • LOW RISK types: 6, 11, 42, 43, 44
  • Histological examination (from biopsy material).
  • Serological HPV examination (whole blood or serum).

Laboratory parameters 2nd order – depending on the results of the history, physical examination, etc. – for differential diagnostic clarification.

  • Bacteria
    • Chlamydia trachomatis (lymphogranuloma venereum) – Serology: chlamydia trachomatis,
    • Neisseria gonorrhoeae (gonorrhea) – genital swab for pathogen and resistance, specifically for Neisseria gonorrhoeae.
    • Treponema pallidum (syphilis) – antibodies against Treponema pallidum (TPHA, VDRL, etc.).
    • Ureaplasma urealyticum
  • Viruses
    • HIV (AIDS)
    • Herpes simplex virus type 1/2 (HSV type 1 u. 2)
  • Mycoses / parasites
    • Candida albicans a.o. Candida species genital smear – pathogen and resistance.
    • Trichomonas vaginalis (trichomoniasis, colpitis) – antigen detection.

Vaccination protection

Scientific studies have already tested vaccines that can reliably protect against infection with both high-risk virus types 16 and 18, as well as other virus types. The results were 94 to 100 percent protective. Scientists hope this will be effective in preventing cervical cancer (protection against cervical cancer):

  • The tetravalent agent against HPV 6, 11, 16 and 18 shows 98% efficacy.
  • The bivalent agent against HPV 16 and 18 shows 91% efficacy against incident infections, 100% efficacy against persistent infections, and 90% efficacy against HPV 16-, 18-associated CIN; placebo-controlled, long-term immunogenicity data are available for the bivalent vaccine for more than 9 years to date (as of 2012)
  • In long-term follow-up, there is no evidence to date of a decline in vaccine protection after vaccination against HPV 16 and 18 (as of 2014).
  • For more data on this topic, see below “HPV vaccination“.

Important note!Even women vaccinated against HPV must go regularly to cancer screening, because the vaccination is not directed against all cancer-causing (oncogenic) viruses. However, vaccinated women are much less likely to have abnormal findings than other women.

Benefits

Cervical smear testing – using an HPV genetic probe test – as part of cancer screening, for example, is an important preventive examination for your health that can prevent misdiagnoses with serious consequences. It is now possible to protect yourself from infection with HPV viruses through reliable vaccination protection.