Understanding HPV (Human Papillomavirus)

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Understanding Human Papillomavirus (HPV)

Human papillomavirus (HPV) is one of the most common causes of
sexually transmitted diseases (STD) in the world. More than 100
different types of HPV exist, most of which are harmless. About 30
types are spread through sexual contact. Some types of HPV cause
genital warts—single or multiple bumps that appear in the genital
areas of men and women including the vagina, cervix, vulva (area
outside of the vagina), penis, and rectum. Many people infected with
HPV have no symptoms. (25).

There are high-risk and low-risk types of HPV. High-risk HPV may
cause abnormal Pap smear results, and could lead to cancers of the
cervix, vulva, vagina, anus, or penis. Low-risk HPV also may cause
abnormal Pap results or genital warts. (26).

Health experts estimate there are more cases of genital HPV infection
than any other STI in the United States. According to the American
Social Health Association, approximately 5.5 million new cases of
sexually transmitted HPV infections are reported every year. At least
20 million people in this country are already infected. (25, 26).

All types of HPV can cause mild Pap test abnormalities which do not
have serious consequences. Approximately 10 of the 30 identified
genital HPV types can lead, in rare cases, to development of cervical
cancer. Specifically, HPV 16 and HPV 18 have been found in 90% of
cases of cervical cancer. Research has shown that for most women (90
percent), cervical HPV infection becomes undetectable within two
years. Although only a small proportion of women have persistent
infection, persistent infection with "high-risk" types of HPV is the
main risk factor for cervical cancer.

Cervical intraepithelial neoplasia is also called "CIN." Sometimes it
may be called cervical dysplasia. CIN means that there is a change in
the cells on the surface of the cervix. The cervix is the bottom part
of the uterus. With CIN normal cells are replaced with cells that are
not normal (abnormal). Over time, it is possible for these abnormal
cells to turn into cancer. (3,4).

Any woman can have CIN. CIN itself is not cancer. But it can turn
into cancer of the cervix. Following are the 3 types of CIN:


CIN I (1). This is also called mild dysplasia.
CIN II (2). This is also called moderate dysplasia.
CIN III (3). This is also called severe dysplasia.


It is not known for sure what causes CIN but it may be caused by a
virus that is spread during sex. The virus that causes venereal warts
("HPV") is thought to play a role in many cases of CIN and cervical
cancer. You may be more likely to get CIN if you have many sex
partners or if your partner has many sex partners.

The following may put you at a higher risk of having CIN.


*Less than 20 years of age at time of first sex.
*Having a sexually transmitted disease (STD), like HPV, herpes, or
cytomegalovirus (CMV).
*A Pap smear test that is not normal.
*Cigarette smoking.


A Pap test can detect pre-cancerous and cancerous cells on the
cervix. Regular Pap testing and careful medical follow-up, with
treatment if necessary, can help ensure that pre-cancerous changes in
the cervix caused by HPV infection do not develop into life
threatening cervical cancer. The Pap test used in U.S. cervical
cancer screening programs is responsible for greatly reducing deaths
from cervical cancer. For 2004, the American Cancer Society estimates
that about 10,520 women will develop invasive cervical cancer and
about 3,900 women will die from this disease. Most women who develop
invasive cervical cancer have not had regular cervical cancer
screening. (26-29)

Although there is currently no medical cure for papillomavirus
infection, the lesions and warts these viruses cause can be treated.
Methods commonly used to treat lesions include cryosurgery (freezing
that destroys tissue), LEEP (loop electrosurgical excision procedure,
the removal of tissue using a hot wire loop), and conventional
surgery. Similar treatments may be used for external genital warts.
In addition, some drugs may be used to treat external genital warts.
More information about treatment for genital warts can be found in
the Centers for Disease Control and Prevention's (CDC) Sexually
Transmitted Diseases Treatment Guidelines 2002. Copies of the
guidelines are available at http://www.cdc.gov/STD/treatment


Alternative Medicine

A study of the clinical efficacy of green tea extracts (polyphenon E;
poly E and (-)-epigallocatechin-3-gallate [EGCG]) delivered in a form
of ointment or capsule in patients with human papilloma virus (HPV)
infected cervical lesions. Fifty-one patients with cervical lesions
(chronic cervicitis, mild dysplasia, moderate dysplasia and severe
dysplasia) were divided into four groups, as compared with 39
untreated patients as a control. Poly E ointment was applied locally
to 27 patients twice a week. For oral delivery, a 200 mg of poly E or
EGCG capsule was taken orally every day for eight to 12 weeks. In the
study, 20 out of 27 patients (74%) under poly E ointment therapy
showed a response. Six out of eight patients under poly E ointment
plus poly E capsule therapy (75%) showed a response, and three out of
six patients (50%) under poly E capsule therapy showed a response.
Six out of 10 patients (60%) under EGCG capsule therapy showed a
response. (34).

Overall, a 69% response rate (35/ 51) was noted for treatment with
green tea extracts, as compared with a 10% response rate (4/39) in
untreated controls (P<0.05). Thus, the data collected here
demonstrated that green tea extracts in a form of ointment and
capsule are effective for treating cervical lesions, suggesting that
green tea extracts can be a potential therapy regimen for patients
with HPV infected cervical lesions. (34).

Women who consume low amounts of foods rich in vitamin C, beta
carotene and folic acid have a higher incidence of CIN and HPV (14).
A diet rich in fruits, vegetables, whole grains and legumes (beans)
will provide generous amounts of these nutrients.

Antioxidants seem to reduce the risk of CIN (8) and cancer (21). Low
levels of vitamin A (16), vitamin C (15,16) and vitamin E (2,13) are
associated with a greater risk of CIN and possibly cervical cancer.
The amount of antioxidants in a daily multivitamin are reasonable and
safe.

Copper levels tend to be higher in women with CIN (9) or gynecologic
tumors (3). It may be wise to avoid taking copper supplements if
dealing with CIN.

Folic acid levels tend to be lower in women with dysplasia (7,10) and
HPV (4). Folic acid may help prevent CIN but does not appear to
eradicate existing CIN (24). Very high doses of folic acid have been
used in treatment but the amounts present in a B-complex supplement
or a daily multivitamin are reasonable for preventive purposes.

Pyridoxine (B6) levels tend to be low in cervical cancer (20). It is
interesting that birth control pills can lower B6 levels (1,17) and
birth control pills also seem to be a risk factor for CIN (4,5) which
can progress to cervical cancer if left untreated. Taking vitamin B6
in a daily multivitamin or B-complex supplement may be beneficial,
particularly if using birth control pills.

Riboflavin (B2) levels tend to be low in women with CIN (16).
Riboflavin vaginal suppositories have actually been shown to cause
regression of CIN (6).

Selenium levels tend to be lower in women with cervical cancer (2).
Selenium has been shown to reduce the incidence of experimentally
induced cervical cancer in laboratory animals (12). A dose of 200
micrograms daily of selenium is reasonable and safe (18). This amount
of selenium is often available in a daily multivitamin.

Zinc levels tend to be lower in women with CIN (9) or gynecologic
tumors (3). Taking 15 - 30 milligrams of zinc daily in a multivitamin
is reasonable.


STD information and referrals to STD Clinics
CDC-INFO
1-800-CDC-INFO (800-232-4636)
TTY: 1-888-232-6348


References

1. Bermond P: Therapy of side effects of oral contraceptive agents
with vitamin B6. Acta Vitaminol Enzymol 1982;4(1-2):45-54.

2. Bhuvarahamurthy V, Balasubramanian N & Govindasamy S: Effect of
radiotherapy and chemoradiotherapy on circulating antioxidant system
of human uterine cervical carcinoma. Mol Cell Biochem 1996 May 10;158
(1):17-23.

3. Brandes JM, Lightman A, Drugan A et al: The diagnostic value of
serum copper/zinc ratio in gynecological tumors. Acta Obstet Gynecol
Scand 1983;62(3):225-9.

4. Butterworth CE: Folate deficiency and cervical dysplasia. JAMA
1992;267:528-533.

5. Castaneda-Iniguez MS, Toledo-Cisneros R & Aguilera-Delgadillo M:
[Risk factors for cervico-uterine cancer in women in Zacatecas] Salud
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6. Chen RD: [Chemoprevention of cervical cancer--intervention study
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7. Fowler BM, Giuliano AR, Piyathilake C et al: Hypomethylation in
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8. Goodman MT, Kiviat N, McDuffie K et al:,,The association of plasma
micronutrients with the risk of cervical dysplasia in Hawaii. Cancer
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9. Grail A & Norval M: Copper and zinc levels in serum from patients
with abnormalities of the uterine cervix. Acta Obstet Gynecol Scand
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10. Grio R, Piacentino R, Marchino GL et al: Antineoblastic activity
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11. Ho GY, Kadish AS, Burk RD, Basu J, Palan PR, Mikhail M, Romney
SL: HPV 16 and cigarette smoking as risk factors for high-grade
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12. Hussain SP, Rao AR: Chemopreventive action of selenium on
methylcholanthrene-induced carcinogenesis in the uterine cervix of
mouse. Oncology 1992;49(3):237-40.

13. Kwasniewska A, Charzewska J, Tukendorf A, Semczuk M: Dietary
factors in women with dysplasia colli uteri associated with human
papillomavirus infection. Nutr Cancer 1998;30(1):39-45.

14. Kwasniewska A, Tukendorf A, Semczuk M: Content of alpha-
tocopherol in blood serum of human Papillomavirus-infected women with
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17. Masse PG, van den Berg H, Duguay C et al: Early effect of a low
dose (30 micrograms) ethinyl estradiol-containing Triphasil on
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18. Patterson BH & Levander OA: Naturally occurring selenium
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20. Ramaswamy PG & Natarajan R: Vitamin B6 status in patients with
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21. Reddy BS: Micronutrients as chemopreventive agents. IARC Sci Publ
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22. Roteli-Martins CM, Panetta K, Alves VA et al: Cigarette smoking
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