1. Human Papilloma virus testing Research Center for Genetic Engineering and Biotechnology “Georgi D. Efremov”, MASA What is Human Papillomavirus? Human papilloma virus (HPV) is an epitheliotropic species-specific virus containing a small circular double- stranded DNA (approx. 8 Kb) within an icosahedral coat or capsid. Due to the target epithelial site HPV could be cutaneous (when they infect foot and hand epidermis and cause most likely warts) and mucosal (when they infect mostly transformation zones between squamous and glandular epithelia e.g., of the genital areas of both sexes almost exclusively through sexual contact). HPV is a sexually transmitted infection which is recognized as the major cause of cervical cancer, a disease that kills more than 200 000 women around the world each year. Most infections clear within 2 years, however, a minority persists and potentially could progress to cervical cancer. How can you get HPV? HPV is primarily spread through vaginal, anal, or oral sex, but sexual intercourse is not required for infection to occur. HPV is spread by skin-to-skin contact. Sexual contact with an infected partner, regardless of the sex of the partner, is the most common way the virus is spread. To decrease the chance of infection you should: Limit your number of sexual partners. Use condoms to reduce your risk of infection when you have vaginal, anal, or oral sex. Condoms cannot fully protect you against HPV infection. HPV can be passed from person to person by touching infected areas not covered by a condom. These areas may include skin in the genital or anal areas. Female condoms cover more skin and may provide a little more protection than male condoms. What are the symptoms of HPV infection? The majority of infections are self-limiting and asymptomatic (~80% of initial HPV infections remain asymptomatic after five years). HPV infection does not require cell death to complete infectious cycle and therefore causes no local inflammation or ulceration. Clinical manifestations of HPV infection include anogenital warts, recurrent respiratory papillomatosis, cervical cancer precursors (cervical intraepithelial neoplasia), and cancers, including cervical, anal, vaginal, vulvar, penile, and some head and neck cancer. Who should be tested? Most cases and deaths from cervical cancer can be prevented through detection of precancerous changes within the cervix by cervical cytology using the Pap test screening. HPV detection is recommended as an alternative and addition to the cytological findings of the cervical screening, to improve the sensitivity in detection of the precancerous lesions. Every woman with abnormal cytological findings should perform HPV testing., HPV testing should be repeated if previously HPV was detected, if the woman was previously treated for cancer or precancer or if the immune system have been weakened for some reason. Additionally, if the results of both tests are normal, these women should not have another Pap test or HPV test for at least 3 years. Risk factors for HPV infections? The most significant risk factor for HPV infection is sexual behavior. The total number of sexual partners and the number of recent partners appear to be the most consistent factors, particularly for infections with carcinogenic HPVs. Age at the time of the first sexual contact is a less constant factor of HPV infection. Other factors, such as STI history, hormonal factors (oral contraceptives or pregnancy), condom use, and smoking are occasionally associated with HPV infection. HPV tests performed at RCGEB Price (МКД) HPV PCR (detection and genotypization)3300 Literature: 1.Zur Hausen H. Papillomavirus infections: a major cause of human cancers. In: Zur Hausen H, editor. Infections causing human cancer. Weinheim: Wiley–VCH, 2006:145–243. 2.http://www.cdc.gov/vaccines/pubs/pinkbook/hpv.htmlhttp://www.cdc.gov/vaccines/pubs/pinkbook/hpv.html 3.Munoz N, Castellsague X, de Gonzalez AB, Gissmann L. Chapter 1: HPV in the etiology of human cancer. Vaccine. 2006; 24(suppl 3):S3/1–10. 4.Dictor M, Warenholt J. Single-tube multiplex PCR using type-specific E6/E7 primers and capillary electrophoresis genotypes 21 human papillomaviruses in neoplasia. Infect Agent Cancer. 2011; 6:1 doi: 10.1186/1750-9378-6-110.1186/1750-9378-6-1 Analyses methods performed at RCGEB HPV testing at RCGEB is performed by two analysis. HPV detection is performed by PCR analysis using MY09/MY11 primers for amplification, followed by allele specific oligonucleotide hybridization (ASO hybridization). The genotype of HPV in HPV DNA positive patients is determined by type specific fluorescent PCR by which 29 HPV genotypes can be detected or using a commercially available kit DR.HPV TM IVD Kit- DR. Chip Biotechnology Incorporation, Taiwan, that determines 27 HPV types. Material for testing Cervical swab samples in microbiological sterile tubes, cervical biopsies, and throat swab samples. Types of HPV There are more than 100 types of human papilloma virus, and more than 50 infect the cervical epithelium. Based on their oncogenic potential they are divided in three groups: high-risk HPV types (16, 18, 31, 33, 35, 39, 45, 51, 52, 55, 56, 58, 59, 68, 70, 73, 82, 83 and IS39), potentially high-risk HPV types (26, 53, 62 and 66), and low-risk HPV types (6, 11, 34, 40, 42, 44, 57, 31, 64, 67, 69, 72, 74, 81,84, CP6108, CP8061 and LVX100). RCGEB, 2013