A Current Overview of HPV Infection: Causes, Effects and Prevention

Öz

Human papillomavirus (HPV) infection is a significant public health problem. The prevalence of HPV around the world has been reported as 43% in adults aged 18-59 years. The main risk factors for the transmission of HPV infection are; sexual intercourse at an early age, having an uncircumcised male sexual partner, having more than one sexual partner, low socioeconomic level, multiparity, long-term use of oral contraceptives, immune deficiency, and smoking. HPV can be transmitted directly or indirectly from contaminated surfaces, lesions on the skin and mucous membranes, and the birth canal. However, the most common transmission is sexual. Definite protection from HPV is achieved with the HPV vaccine. Since the risk of HPV infection is high in adolescence, it is essential to get the vaccine in early adolescence, especially before the person starts sexual intercourse. The HPV vaccine program is available in 81 countries around the world. While vaccination programs are common in Europe and America, they are relatively low in other continents. In Turkey, the HPV vaccine is not included in the national vaccination calendar and individuals have access to the vaccine on their own. Especially in developing societies, the level of awareness about HPV prevention, screening, treatment, and vaccination is low. It is critical to identify risky behaviors to be protected from HPV infection, prevent transmission, and raise public awareness. Nurses, who are in close contact with the community, play a key role as educators and consultants in raising public awareness of HPV infection and vaccination.

Anahtar Kelimeler

• Human Papilloma Virüs
• Cervical Cancer
• Nursing

HPV Enfeksiyonuna Güncel Bir Bakış: Nedenleri, Etkileri ve Korunma

Öz

Human papilloma virüs (HPV) enfeksiyonu toplum sağlığını tehdit eden önemli bir sorunudur. Dünyada HPV prevalansı 18-59 yaş arası yetişkinlerde %43 olarak bildirilmiştir. HPV enfeksiyonunun bulaşması ile ilgili başlıca risk faktörleri; erken yaşta cinsel ilişki, sünnetsiz erkek cinsel partnere sahip olma, birden fazla cinsel partnere sahip olma, düşük sosyoekonomik düzey, multiparite, uzun süreli oral kontraseptif kullanımı, immün sistem yetmezliği ve sigara kullanımı olarak gösterilmektedir. HPV kontamine yüzeylerden, cilt ve mukozadaki lezyonlardan ve doğum kanalından olmak üzere direkt veya indirekt olarak bulaşabilmektedir. Bununla birlikte en yaygın bulaş cinsel yolladır. HPV’den tam ve kesin korunma HPV aşısı ile olmaktadır. HPV enfeksiyonun yerleşme riski adölesan dönemde yüksek olması nedeniyle, aşının özellikle kişi cinsel ilişkiye başlamadan ve HPV’ye maruz kalmadan, erken adölesan dönemde yapılması önemlidir. HPV aşı programı dünyada 81 ülkede bulunmaktadır. Avrupa ve Amerika kıtalarında aşılama programları yaygınken, diğer kıtalarda nispeten daha düşüktür. Türkiye’de ise HPV aşısı ulusal aşı takviminde yer almamaktadır ve bireyler kendi teminleriyle aşıya erişim sağlamaktadır. Özellikle gelişmekte olan toplumlarda, HPV’nin önlenmesi, taranması, tedavisi ve aşı hakkında farkındalık düzeyi düşüktür. HPV enfeksiyonundan korunmada riskli davranışları belirlemek, bulaşı önlemek ve toplumun aşıya ilişkin bilinçlenmesini sağlamak önemlidir. Sağlık ekibinin bir üyesi olarak toplumla yakın temas halinde olan hemşireler HPV enfeksiyonu ve aşı konusunda toplumsal farkındalığı artırmada eğitimci ve danışman olarak anahtar rol oynamaktadır.

Anahtar Kelimeler

• Human Papilloma Virüs
• Serviks Kanseri
• Hemşire.
• Cervical Cancer
• Nursing.

Kaynakça

1. Şahbaz A, Erol O. HPV aşı uygulamaları. Turk Jinekoloji ve Obstet Dern Derg. 2014;11(2):126–30.
2. de Sanjosé S, Brotons M, Pavón MA. The natural history of human papillomavirus infection. Best Pract Res Clin Obstet Gynaecol. 2018;47:2–13.
3. Alp Avcı G. İnsan Papillomavirusunun Genomik Yapısı ve Proteinleri. Mikrobiyal Bul. 2012;46(3):507–15.
4. Patel R V., Yanofsky VR, Goldenberg G. Genital warts: A comprehensive review. J Clin Aesthet Dermatol. 2012;5(6):25–36.
5. Valentino K, Poronsky CB. Human Papillomavirus Infection and Vaccination. J Pediatr Nurs [Internet]. 2016;31(2):e155–66. Available from: http://dx.doi.org/10.1016/j.pedn.2015.10.005
6. Bruni L, Diaz M, Castellsagué X, Ferrer E, Bosch FX, De Sanjosé S. Cervical human papillomavirus prevalence in 5 continents: Meta-analysis of 1 million women with normal cytological findings. J Infect Dis. 2010;202(12):1789–99.
7. Crosbie EJ, Einstein MH, Franceschi S, Kitchener HC. Human papillomavirus and cervical cancer. Lancet [Internet]. 2013;382(9895):889–99. Available from: http://dx.doi.org/10.1016/S0140-6736(13)60022-7
8. Bruni L, Albero G, Serrano B, Mena M, Collado J, Gomez D, et al. Human Papillomavirus and Related Diseases Report. ICO/IARC Inf Cent HPV Cancer (HPV Inf Centre) [Internet]. 2021; Available from: www.hpvcentre.com

9. Mcquillan G, Kruszon-Moran D, Markowitz LE, Unger ER, Paulose-Ram R. Prevalence of HPV in Adults Aged 18–69: United States, 2011–2014 Key findings Data from the National Health and Nutrition Examination Survey. NCHS Data Brief [Internet]. 2017;280(april):8. Available from: https://www.cdc.gov/nchs/data/databriefs/db280.pdf
10. Rodríguez-álvarez MI, Gómez-Urquiza JL, Husein-El Ahmed H, Albendín-García L, Gómez-Salgado J, Cañadas-De la Fuente GA. Prevalence and risk factors of human papillomavirus in male patients: A systematic review and meta-analysis. Int J Environ Res Public Health. 2018;15(10).
11. Gargano JW, Unger ER, Liu G, Steinau M, Meites E, Dunne E, et al. Prevalence of genital human papillomavirus in males, United States, 2013-2014. J Infect Dis. 2017;215(7):1070–9.
12. Colpani V, Falcetta FS, Bidinotto AB, Kops NL, Falavigna M, Hammes LS, et al. Prevalence of human papillomavirus (HPV) in Brazil: A systematic review and meta-analysis. Vol. 15, PLoS ONE. 2020.
13. Jiang L, Tian X, Peng D, Zhang L, Xie F, Bi C, et al. HPV prevalence and genotype distribution among women in Shandong Province, China: Analysis of 94,489 HPV genotyping results from Shandong’s largest independent pathology laboratory. PLoS One. 2019;14(1):1–14.
14. Kesheh MM, Keyvani H. The prevalence of hpv genotypes in iranian population: An update. Iran J Pathol. 2019;14(3):197–205.
15. Okunade KS. Human papillomavirus and cervical cancer. J Obstet Gynaecol (Lahore) [Internet]. 2020;40(5):602–8. Available from: https://doi.org/10.1080/01443615.2019.1634030
16. Han JJ, Beltran TH, Song JW, Klaric J, Choi YS. Prevalence of genital human papillomavirus infection and human papillomavirus vaccination rates among US adult men national health and nutrition examination survey (NHANES) 2013-2014. JAMA Oncol. 2017;3(6):810–6.
17. Vinodhini K, Shanmughapriya S, Das BC, Natarajaseenivasan K. Prevalence and risk factors of HPV infection among women from various provinces of the world. Arch Gynecol Obstet. 2012;285(3):771–7.
18. Itarat Y, Kietpeerakool C, Jampathong N, Chumworathayi B, Kleebkaow P, Aue-Aungkul A, et al. Sexual behavior and infection with cervical human papillomavirus types 16 and 18. Int J Womens Health. 2019;11:489–94.
19. Kolawole OM, Olatunji KT, Durowade KA, Adeniyi AA, Omokanye LO. Güney batı nijerya’da bir üçüncü basamak sağlık kuruluşuna başvuran kadınlar arasında pap smear testi paterni, human papilloma virus infeksiyonu prevalansı ve risk faktörleri. TAF Prev Med Bull. 2015;14(6):451–7.
20. Yöntem M, Gümüş A, Abalı R, Öznur M, Erci F, Erdoğdu BS. Human Papilloma Virüs ( HPV ) Varlığının Cinsel Aktif Kadınlarda Moleküler Metodlarla Değerlendirilmesi. 2019;217–21.
21. La Vecchia C, Boccia S. Oral contraceptives, human papillomavirus and cervical cancer. Eur J Cancer Prev. 2014;23(2):110–2.
22. Xu H, Egger S, S Velentzis L, L O’Connell D, Banks E, Darlington-Brown J, et al. Hormonal contraceptive use and smoking as risk factors for high-grade cervical intraepithelial neoplasia in unvaccinated women aged 30–44 years: A case-control study in New South Wales, Australia. Cancer Epidemiol [Internet]. 2018;55(March):162–9. Available from: https://doi.org/10.1016/j.canep.2018.05.013
23. Brankovic I, Verdonk P, Klinge I. Applying a gender lens on human papillomavirus infection: Cervical cancer screening, HPV DNA testing, and HPV vaccination. Int J Equity Health [Internet]. 2013;12(1):1–10. Available from: http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=emed11&NEWS=N&AN=2013143699
24. Fang JH, Yu XM, Zhang SH, Yang Y. Effect of smoking on high-grade cervical cancer in women on the basis of human papillomavirus infection studies. J Cancer Res Ther. 2018;14(8):S184–9.
25. Bhatia N, Lynde C, Vender R, Bourcier M. Understanding genital warts: Epidemiology, pathogenesis, and burden of disease of human papillomavirus. J Cutan Med Surg. 2013;17(SUPPL 2).
26. Çevik E, Çoşkun AM. HPV Enfeksiyonuna Güncel Yaklaşım ve Ebenin Rolü. Kadın Sağlığı Hemşireliği Derg. 2021;7(3):215–29.
27. Centers for Disease Control and Prevention (CDC) [Internet]. Genital HPV Infection - Fact Sheet. 2022. Available from: https://www.cdc.gov/std/hpv/stdfact-hpv.htm
28. Pierce Campbell CM, Lin HY, Fulp W, Papenfuss MR, Salmerón JJ, Quiterio MM, et al. Consistent condom use reduces the genital human papillomavirus burden among high-risk men: The HPV infection in men study. J Infect Dis. 2013;208(3):373–84.
29. Larke N, Thomas SL, Dos Santos Silva I, Weiss HA. Male circumcision and human papillomavirus infection in men: A systematic review and meta-analysis. J Infect Dis. 2011;204(9):1375–90.
30. İnce U, Akar M, Ildız N. Human Papilloma Virüs (Hpv) Güncel Tedavi ve Korunma Yöntemleri. Sağlık Bilim Derg. 2017;26(2):189–92.
31. Selçuk AK, Yanıkkerem E. Serviks Kanseri ve Human Papillomavirüs (HPV) Prevalansı ile HPV Aşı Programları. Kadın Sağlığı Hemşireliği Derg. 2018;4(2):40–55.
32. Patel C, Brotherton JML, Pillsbury A, Jayasinghe S, Donovan B, Macartney K, et al. The impact of 10 years of human papillomavirus (HPV) vaccination in Australia: What additional disease burden will a nonavalent vaccine prevent? Eurosurveillance [Internet]. 2018;23(41):30–40. Available from: http://dx.doi.org/10.2807/1560-7917.ES.2018.23.41.1700737
33. Drolet M, Bénard É, Pérez N, Brisson M, Ali H, Boily MC, et al. Population-level impact and herd effects following the introduction of human papillomavirus vaccination programmes: updated systematic review and meta-analysis. Lancet. 2019;394(10197):497–509.
34. HPV aşısı için mücadele eden kadınlar kazandı. cumhuriyet.com.tr [Internet]. 2022; Available from: https://www.cumhuriyet.com.tr/saglik/hpv-asisi-icin-mucadele-eden-kadinlar-kazandi-2006268. Erişim tarihi: 05.03.2023
35. Ulus B. HPV Aşı Uygulamalarında Güncel Yaklaşımlar. Turkiye Klin J Obs Womens Heal Dis Nurs-Special Top. 2015;1(2):47–50.
36. Ferrer HB, Trotter C, Hickman M, Audrey S. Barriers and facilitators to HPV vaccination of young women in high-income countries: A qualitative systematic review and evidence synthesis. BMC Public Health. 2014;14(1).
37. Serrano B, Brotons M, Bosch FX, Bruni L. Epidemiology and burden of HPV-related disease. Best Pract Res Clin Obstet Gynaecol [Internet]. 2018;47:14–26. Available from: https://doi.org/10.1016/j.bpobgyn.2017.08.006
38. Lewis RM, Markowitz LE, Gargano JW, Steinau M, Unger ER. Prevalence of Genital Human Papillomavirus among Sexually Experienced Males and Females Aged 14-59 Years, United States, 2013-2014. J Infect Dis. 2018;217(6):869–77.
39. Lacey CJN, Woodhall SC, Wikstrom A, Ross J. 2012 European guideline for the management of anogenital warts. J Eur Acad Dermatology Venereol. 2013;27(3):263–70.
40. Mayeaux EJ, Dunton C. Modern management of external genital warts. J Low Genit Tract Dis. 2008;12(3):185–92.
41. Hoque ME, Monokoane S, Van Hal G. Knowledge of and attitude towards human papillomavirus infection and vaccines among nurses at a tertiary hospital in South Africa. J Obstet Gynaecol (Lahore). 2014;34(2):182–6.
42. Jeyachelvi K, Juwita S, Norwati D. Human papillomavirus infection and its vaccines: Knowledge and attitudes of primary health clinic nurses in Kelantan, Malaysia. Asian Pacific J Cancer Prev. 2016;17(8):3981–6.
43. Makwe CC, Anorlu RI. Knowledge of and attitude toward human papillomavirus infection and vaccines among female nurses at a tertiary hospital in Nigeria. Int J Womens Health. 2011;3(1):313–7.
44. Erbaydar N, Çilingiroğlu N, Keskin C, Altunbaş M, Arslanoğlu E, Aydın O, et al. Human Papilloma Virus Aşısı Bir Üniversite Hastanesi Hemşireleri İçin Ne İfade Ediyor? Hacettepe Üniversitesi Hemşirelik Fakültesi Derg [Internet]. 2016;3(3):16–27. Available from: https://dergipark.org.tr/tr/pub/hunhemsire/issue/27605/331953
45. Bedford H, Firman N, Waller J, Marlow L, Forster A, Dezateux C. Which young women are not being vaccinated against HPV? Cross-sectional analysis of a UK national cohort study. Vaccine [Internet]. 2021;39(40):5934–9. Available from: https://doi.org/10.1016/j.vaccine.2021.07.094
46. Casalegno J sebastien, Le Bail Carval K, Eibach D, Valdeyron ML, Lamblin G, Jacquemoud H, et al. High Risk HPV Contamination of Endocavity Vaginal Ultrasound Probes: An Underestimated Route of Nosocomial Infection? PLoS One. 2012;7(10):8–11.