Molecular genetic study aimed at identifying the DNA of highly oncogenic human papillomavirus genotypes associated with the risk of developing cervical cancer.
Synonyms Russian
Human papillomavirus (HPV) genotypes 31 and 33.
English synonyms
Human Papillomavirus (HPV), DNA, High Risk, Genotypes 31 and 33.
Research method
Real-time polymerase chain reaction.
What biomaterial can be used for research?
Rectal scraping, urogenital scraping.
General information about the study
Human papillomavirus is a DNA virus from the papovavirus family, associated with the development of genital warts, warts, precancerous changes in the anogenital area, and cervical cancer. There are more than 100 types of HHV, about 30 of which can infect the genital tract, and about 14 genotypes increase the risk of cancer of the cervix, rectum, penis, and certain other tumors (for example, oropharyngeal carcinoma).
Oncogenic papilloma viruses contain E6/E7 proteins in their DNA, which are capable of suppressing the processes of apoptosis (programmed death) in cells with altered genetic material. Genotypes 1, 2, 3, 5 are considered non-oncogenic, and genotypes 6, 11, 42, 43, 44 are considered papillomaviruses of low oncogenic risk. High oncogenic risk HPVs include genotypes 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59 and 68.
The main route of their spread is sexual. Vertical (from mother to child) and contact-household transmission of infection is possible. Several types of HPV can enter the human body at the same time. Infection usually occurs after the onset of sexual activity between the ages of 16 and 25. When infected with oncogenic genotypes of the virus between 25 and 35 years of age, intraepithelial lesions sometimes occur, and after a few years cancer develops. In 70% of cases during the first year and in 90% of cases 2 years after infection, self-healing is possible.
Cervical cancer is the third most common malignant tumor in women (after breast cancer and colon cancer). The incidence of invasive cervical cancer in the world is 15-25 per 100,000 women. Cervical neoplasms occur mainly in middle-aged women (35-55 years), are rarely diagnosed in women under 20 years of age, and in 20% of cases are detected in women over 65. The 5-year survival rate for localized (local) cervical cancer is 88%. , while the survival rate for advanced cancer does not exceed 13%. In addition to infection with oncogenic HPV genotypes, risk factors include smoking, chlamydial or herpes infection, chronic inflammatory gynecological diseases, long-term use of contraceptives, cases of cervical cancer in the family, early onset of sexual activity, frequent change of sexual partners, insufficient dietary intake of vitamins A and , immunodeficiencies and HIV infection. Although the human papillomavirus does not always lead to neoplasms, it is associated with more than 93% of cervical cancer cases.
In many countries around the world, there are special preventive screening programs to exclude cervical cancer, which can significantly reduce the number of deaths. The risk of developing invasive cancer is 5-10 times higher in women who have never been screened. If changes are detected in the material from the cervix, it is recommended to exclude papillomavirus infection and determine the genotype of the virus, with the help of which the risk of tumor development can be assessed and treatment tactics can be developed.
Polymerase chain reaction (PCR) detects human papillomavirus (HPV) DNA in more than 90% of cancers and 75-85% of intraepithelial neoplasia with severe dysplasia.
Determination of the DNA of various genotypes of the human papillomavirus must necessarily be carried out taking into account the results of a cytological examination of a smear from the cervix or histological material from an area with dysplasia, metaplasia or signs of malignancy.
What is the research used for?
- To screen for infection with human papillomavirus genotypes 31 and 33.
- To assess your risk of developing cervical cancer.
- As an additional examination for cervical cancer screening.
- For differential diagnosis of HPV genotypes.
When is the study scheduled?
- When detecting cytological changes in a smear for atypia, in a Papanicolaou smear.
- For condylomas and other morphological changes in the genital tract.
- When screening for cervical cancer (as an additional study).
- When clarifying the genotype of the human papillomavirus.
What do the results mean?
Reference values: negative.
Reasons for the positive result:
- the presence of HPV genotypes 31 and 33 in the studied material, which is associated with a high risk of developing cervical cancer and other neoplasms of the anogenital area.
Reasons for negative results:
- the absence of HPV genotypes 31 and 33 in the studied material, which does not exclude the possibility of infection with HPV of other genotypes.
How is HPV treated in women?
Combination therapy includes removal of formations and the use of various systemic nonspecific antiviral and immunomodulatory drugs. Doctors at the clinic consider preventive vaccination against HPV to be an effective method of preventing infection (especially if carried out before sexual contact of any kind) and it perfectly complements the main treatment regimen.
1. Local therapy
Aimed at eliminating the formations themselves and atypically changed epithelium. The most popular are cryodestruction, thermocoagulation, chemical coagulation, laser destruction, and removal of condylomas using radiosurgery. Most often, these methods eliminate the manifestations of HPV on the labia minora and single and multiple formations in the anus (in women and men). Each has a number of advantages and disadvantages. So, local treatment of papilloma virus is:
a) elimination of genital warts using one of the above methods. b) local impact on visible growths (ointments, suppositories). c) in the intralesional administration of drugs with antiviral activity.
2. General therapy
The second part of the therapeutic measures is to reduce the concentration of the human papillomavirus in the woman’s body. Its amount is directly related to the state of the body’s immunity - the better it is, the less virus there is. Therefore, the most promising way is to strengthen the immune system. The HPV treatment regimen includes the following:
a) elimination of concomitant infections; b) restoration of normal microflora of the vagina/intestines; c) correction/stimulation of immunity, HPV vaccination.
All these measures together make it possible to reduce the viral load in the body and prevent the emergence and progression of new formations.
3. Traditional medicine
Experiments on treating HPV at home are quite common. However, activities of this kind can be very dangerous: the results of the use of traditional medicine, various magical rituals and self-medication in general most often result in injuries, burns, rapid spread of condylomas to other areas and malignant degeneration of formations.
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HPV Clinic
The World Health Organization (WHO) has developed recommendations on how to prevent and control HPV-induced genital cancer in women through vaccination and screening. In May 2022, WHO named the three main measures for the prevention of cervical cancer: vaccination against HPV, medical screening and timely treatment of background and precancerous cervical diseases.
Which doctor should I contact? In Moscow, for all questions related to HPV in women, you can contact our clinic on Kutuzovsky Prospekt. For you a complete list of necessary services, expert specialists for women and teenage girls. The doctor selects an HPV treatment regimen individually for each patient, based on diagnostic results and general health. Our gynecologists do not miss important symptoms of HPV infection during examination - condylomas and papillomas, which, unfortunately, often happens in other clinics. We have the technical capabilities for this. Do you want to make sure and see the finds for yourself? Please, we will show it on the monitor screen (read more in the material “Video colposcopy”).
Prices for HPV treatment
Basic range of clinic services for women:
✘ Appointment with a doctor with examination for HPV - 2500 ₽; ✘ HPV treatment (price for prescription regimen) - 3000 ₽; ✘ Consultation with a teenage doctor - 2500 ₽; ✘ High-risk HPV types - from 650 ₽; ✘ Analysis for the number of HPV oncotypes - 950 ₽; ✘ Colposcopy/vulvoscopy - 1500 0 ₽; ✘ Digen test (HPV DNA set) - 6200 ₽; ✘ Panavir dropper (with placement) - 5500 ₽; ✘ Allokin Alpha injection (with injection) - 3500 ₽; ✘ Taking a smear for human papillomaviruses - 450 rubles.
Given the widespread prevalence of the disease, doctors treating HPV recommend that both women, girls and adolescents contact and be tested for their presence.
Who is recommended for HPV genotyping?
In our country, typing is prescribed not for preventive purposes, as in the West, but for medical reasons.
Many women do not get screened.
Therefore, the incidence of cervical cancer and mortality from it in the country remains high.
Typically, women come to the doctor if they have warts on the genitals or have received abnormal results from a cytological examination of a cervical smear.
But most international organizations recommend testing for HPV even without any symptoms or preliminary research.
That is, carry it out to everyone without exception.
According to FIGO recommendations, HPV testing is carried out once every 5 years until the age of 65 years.
WHO recommends testing at least once for all women aged 30-49 years.
The need for HPV testing is also provided for by Russian Ministry of Health Order 572n dated November 1, 2012.
Direct genotyping (determining the exact type of HPV) is not mandatory.
But if possible, it is recommended to carry out typing for at least types 16 and 18 as the most dangerous among all existing ones.
The use of alternative studies is also permitted.
The Digene test is widely used.
It is based on the hybridization of DNA sections with RNA probes.
They are subsequently captured by antibodies with a fluorescent label.
If the results are positive, quantitative indicators are given.
There are also tests based on the detection of HPV RNA.
In particular, the Aptima test is capable of detecting 14 highly oncogenic types with partial genotyping.
What will the doctor tell you before the test?
By contacting a specialist, the client receives the most complete consultation regarding screening and the specifics of its implementation. The patient will receive comprehensive information on how to undergo HPV screening. In women, material is collected in a hospital setting. The gynecologist makes a scraping from the cervical canal.
For male patients, PCR analysis is performed in the same way.
Some other methods of diagnosing the virus involve simply taking a blood test.
What do you need to do to complete the study?
Each patient should prepare before the test: before going to the doctor, you need to carry out normal hygiene procedures, but do not use too much detergent or antibacterial agents or lotions.
We will not have a successful analysis if the patient uses medications during the last three days before collecting the material.
Men are prohibited from urinating for 2 hours before the collection of material.
Is it possible to do HPV without genotyping?
Of course, such an analysis can be done.
It is also quite informative.
HPV genotyping costs are higher, and such costs are not always necessary.
In any case, as a result of the test, the type will be determined or not, the doctor will find out whether the HCV papillomavirus is present in the body.
If it is present, and if it is present in high concentrations, in any case the patient must:
- treatment;
- dynamic observation.
And this is necessary, regardless of the specific type of virus detected.
HPV HCR genotyping
HCR stands for high carcinogenic risk.
Thus, this study differs in that only highly oncogenic viruses are detected.
For example, you will not receive a conclusion: 6, 11 or another type with low oncogenicity has been detected.
Testing may not be carried out on them.
Situations when typing specifically for BCR viruses is required:
- reduced immunity (including due to HIV);
- “bad” results of oncocytology analysis;
- clinical signs of cervical dysplasia.
That is, the analysis is done when the risk of cancer in a particular patient is assessed as high.
It may not matter whether other viruses are present among those that almost never cause cancer.
Why is HPV genotyping needed?
HPV is a heterogeneous virus.
This means that there are many forms of it.
In fact, this is a whole family of viruses, varying in their level of pathogenicity.
When infected with different types of HPV, the risk of cancer increases to varying degrees and different symptoms occur.
About 40 types of HPV are transmitted sexually.
Fourteen of them are viruses of high oncogenic risk.
Thus, genotyping is used to find out what type of virus persists in the patient.
This is important for assessing oncogenic risk.
Patients with different types of HPV are managed completely differently.
If with low-oncogenic viruses a person can have warts removed and sent home, then detection of highly oncogenic types requires dynamic monitoring.
The role of drug therapy is increasing.
It is important for a person to get rid of carriers of the virus as soon as possible in order to prevent precancerous processes and cancer.
HPV genotyping: quantitative analysis
It is not enough for a doctor to know only the type of virus.
Information about its quantity is also needed.
The unit of measurement is the amount of DNA in 100 thousand epithelial cells.
There should be less than 10 to the 5th power.
If this threshold is reached or exceeded, this concentration of virus is considered clinically significant.
Oncogenic viruses in such quantities provoke intraepithelial neoplasia.
And then cancer develops against its background.
Why does a doctor need to know the amount of virus:
- to understand whether he is dangerous;
- give a prognosis for the further development of the infection;
- evaluate the effectiveness of treatment;
- plan further management of the patient (including the observation method, when periodic examinations and tests are carried out).
The analysis is carried out for 10-14 highly oncogenic types.
To determine quantitative indicators, real-time PCR is performed.
It makes it possible to differentiate clinically significant concentrations of the virus from resolving or transient forms of infection.
Causes of papilloma virus infection
The main reason for the spread of the virus is unprotected intimate relationships. At the same time, representatives of the fair sex, as statistics show, are more susceptible to infection. Thus, the probability of infection in men through sexual contact is 25-70%. The risk of infection in women reaches 80-90%.
In addition, the virus can be transmitted in the following cases:
- blood transfusions;
- at birth - from mother to child;
- through household items - personal hygiene products;
- as a result of cuts, wounds and the like.
HPV genotyping: what does this analysis provide?
This is the process of determining the type of virus.
It is based on determining a section of DNA, that is, the genotype of the pathogen.
Research objectives:
- determination of oncogenic types of virus;
- establishing the degree of oncogenic risk for a particular patient (the virus is determined in combination with other research methods);
- determination of therapeutic tactics.
As a result of the test, the doctor receives the following information:
- whether the virus that persists in the human body is highly oncogenic;
- what type of virus it is (even within the group of oncogenic HPVs there are viruses that, to a greater or lesser extent, increase the likelihood of cancer);
- in what concentration it is contained (if there are few viruses, it is likely that the body will soon get rid of them on its own).
