Human

papilloma
virus
Reported by: Festin AJ
 Human Human papillomavirus is the
most common sexually
transmitted infection. Most
sexually active men and women
being exposed to the virus at
papilloma some point during their lifetime

virus
 Structure
• small, non-enveloped, icosahedral DNA
viruses that have a diameter of 52–55
nm.
• single double-stranded DNA molecule of
about 8000 base-pairs (bp) that is bound
to cellular histones
• a protein capsid composed of 72
pentameric capsomers.
• capsid contains two structural proteins —
late 1 and Late 2 — which are both virally
encoded.
Classification
• the International Committee on the Taxonomy of

Viruses (ICTV) as two separate families —

Papillomaviridae and Polyomaviridae.

• HPV is divided into High risk HPV and Low risk HPV. Low-

risk types cause warts and high-risk types can cause

lesions or cancer.
Types
 Pathogenesis
• HPV infection is limited to the basal cells of stratified
epithelium

• it infects epithelial tissues through micro-abrasions or other

epithelial trauma that exposes segments of the basement
membrane

• HPV virion associates with receptors such as alpha

integrins, laminins, and annexin A2
 Symptoms
• HPV may not cause symptoms at once, but they can appear years later. Some types can
lead to warts, while others can cause cancer.

Warts
• Common symptoms of some types of HPV are warts, especially genital warts.

• Genital warts may appear as a small bump, cluster of bumps, or stem-like protrusions.
They commonly affect the vulva in women, or possibly the cervix, and the penis or
scrotum in men. They may also appear around the anus and in the groin.

• They can range in size and appearance and be large, small, flat, or cauliflower shaped,
and may be white or flesh tone.

• HPV6 and HPV11 are common causes of genital warts and laryngeal papillomatosis.
 Symptoms
Other warts associated with HPV include common warts, plantar, and
flat warts.

• Common warts - rough, raised bumps most commonly found on

the hands, fingers, and elbows.

• Plantar warts - described as hard, grainy growths on the feet; they

most commonly appear on the heels or balls of the feet.

• Flat warts - generally affect children, adolescents, and young

adults; they appear as flat-topped, slightly raised lesions that are
darker than normal skin color and are most commonly found on
the face, neck, or areas that have been scratched.
Common Warts
Plantar Warts
Flat Warts
 Symptoms
• Anogenital warts

• Anal dysplasia (lesions) : pre cancerous condition in anal canal

• Genital cancers

• Epidermodysplasia verruciformis (Treeman syndrome, a high risk skin cancer)

• Focal epithelial hyperplasia (benign neoplamic condition in mouth)

• Mouth papillomas (benign epithelial tumor)

• Oropharyngeal cancer

• Laryngeal papillomatosis (aerodigestive benign cancer)

 Symptoms
Cancer

• Other types of HPV can increase the risk of developing cancer. These cancers include
cancer of the cervix, vulva, vagina, penis, anus, and oropharynx, or the base of the
tongue and tonsils. It may take years or decades for cancer to develop.

• early all cervical cancer is due to HPV with two types, HPV16 and HPV18, accounting
for 70% of cases

• These cancers in common involve sexually transmitted infection of HPV to the

stratified epithelial tissue.

• Individuals infected with both HPV and HIV have an increased risk of developing
cervical or anal cancer.
 Symptoms: Cervical
Cancer
As in many cancers, there may be no signs or symptoms of
cervical cancer until it has progressed to a dangerous stage.
However, if symptoms do occur they may include:

• Abnormal vaginal bleeding

• Pain in very advanced stages

• Any bleeding from the vagina other than during menstruation.

• Abnormal vaginal discharge

 Transmission
• HPV is transmitted through intimate skin-to-skin contact.

• having vaginal, anal, or oral sex with someone who has the virus.

• It is most commonly spread during vaginal or anal sex.

• common that nearly all men and women get it at some point in their
lives.

• can be passed even when an infected person has no signs or

symptoms.

• can develop symptoms years after being infected, making it hard to

know when you first became infected.
In most cases, HPV goes away on its own and does not cause any health problems. But when
HPV does not go away, it can cause health problems like genital warts and cancer.
Transmission
 Diagnosis
The traditional methods of viral diagnosis such as electron
microscopy, cell culture, and certain immunological methods are
not suitable for HPV detection. HPV cannot be cultured in cell
cultures.

The important methods to diagnose HPV infection are:

• Colposcopy and acetic acid test

• Biopsy

• DNA test (PCR, Southern Blot Hybridization, In Situ

Hybridization)

• Pap smear
Diagnosis
Colposcopy: a procedure that allows illuminated
stereoscopic and magnified viewing of the cervix.

PCR-based methods: HPV DNA can be amplified

selectively by a series of reactions that lead to an
exponential and reproducible increase in viral sequences
present in the biological specimen.

serological assays: ELISA or western blot analysis

 Diagnosis
Biopsy: If the biopsy results show pre-cancer (dysplasia) or cancer,
then treatment is recommended. The dysplasia may be mild,
moderate, or severe.

PAP smear or PAP test: It is a screening test. Apart from

premalignant and malignant changes, viral infections like HPV
infection and Herpes can also be detected.

Acetic acid Test: A vinegar solution applied to HPV-infected genital

areas turns them white. This may help in identifying difficult-to-see
flat lesions.
 Diagnosis: PAP smear test
• Early precancerous changes detected on the Pap smear

• A woman may have cervical cancer and not know it because she may
not have any symptoms.

• A Pap smear is usually part of a pelvic exam and accompanied by a

breast exam

• A sample of mucus and cells will be obtained from the cervix and
endocervix using a wooden scraper or a small cervical brush or
broom.

• the sample is rinsed into a vial and sent to a lab for slide
preparation
and examination.
 Treatment
There is currently no specific treatment for HPV infection.

However warts can be treated.

• Salicylic acid. Over-the-counter treatments that contain salicylic acid work by removing
layers of a wart a little at a time.

• Imiquimod (Aldara, Zyclara). This prescription cream might enhance your immune
system's ability to fight HPV. Common side effects include redness and swelling at the
application site.

• Podofilox (Condylox). Another topical prescription, podofilox works by destroying

genital wart tissue. Podofilox may cause pain and itching where it's applied.

• Trichloroacetic acid. This chemical treatment burns off warts on the palms, soles and
genitals. It might cause local irritation.
 Treatment
Surgical and other procedures

If medications don't work the following methods can be used

to remove warts

• Freezing with liquid nitrogen (cryotherapy)

• Burning with an electrical current (electrocautery)

• Surgical removal

• Laser surgery

"condom use may reduce the risk for genital human papillomavirus (HPV) infection"
 Vaccination
Three vaccines are available to prevent infection by some HPV
types. All protect against initial infection with HPV types 16 and 18,
which cause most of the HPV-associated cancer cases.

Gardasil: protects against HPV types 6 and 11, which cause 90% of
genital warts. quadrivalent vaccine

Cervarix: bivalent, and is prepared from virus-like particles (VLP) of

the L1 capsid protein.

Gardasil 9: nonavalent, it has the potential to prevent about 90% of

cervical, vulvar, vaginal, and anal cancers.
 Prevention
• Vaccination

• Avoid skin-to-skin contact by not having sex with strangers.

• Use condoms and/or dental dams every time you have

vaginal, anal, or oral sex.

• Though condoms and dental dams are not as effective

against HPV as they are against other STDs like chlamydia

and HIV, safer sex can lower your chances of getting HPV.
Presence of human papillomavirus in
semen in relation to semen quality

Luttmer, R., Dijkstra, M.G., Snijders,  P.J.F., Hompes, 

P.G.A., Pronk, D., Hubeek, I., Berkhof, J.,
Heideman, D.A., & Meijer, C.
 Introduction
Study question:

Is the presence of human papillomavirus (HPV) in semen associated

with impairment of semen quality?

What is known already?

HPV is commonly detected in semen samples. Whether the presence

of HPV is related to impairment of semen quality, remains unclear.
 Study design, size, duration
This cross-sectional study included a cohort of 430 males.

• Male attendants of the fertility clinic of VU University Medical Center in

Amsterdam, NL
Acc to nat’l Dutch guidelines, couples who seek fertility evaluation
because of an inability to conceive after more than one year of regular sexual
intercourse are offered a diagnostic work-up which includes a basic semen
analysis. 

• September 2012-January 2014

• Written consent for anonymous additional testing of their semen sample
• Excluded - men with a history of vasectomy or testicular cancer
 Participants/materials, setting, methods

• Male partners in couples seeking fertility evaluation provided one semen

sample per person.
• Semen samples were tested for HPV-DNA using GP5+/6+-PCR.
• Sperm concentration was counted, and motility was assessed in a Makler
counting chamber at a magnification of ×200.
• The presence of antisperm antibodies was assessed by a mixed agglutination
reaction (MAR)-test.
 Statistical analysis

1. Overall comparison of all mutually exclusive HPV-subgroups (both

hrHPV and lrHPV-positive, exclusively hrHPV-positive, exclusively
lrHPV-positive and HPV-negative samples respectively) was
performed by one-way ANOVA with post hoc Fisher's least
significant difference (LSD) testing.

2. HPV-positive subgroups (both hrHPV and lrHPV-positive, exclusively

hrHPV-positive and exclusively lrHPV-positive, respectively) were
each compared with the HPV-negative group using a post
hoc Dunnett's test.

3. Linear regression was used for adjustment of the relation between

HPV-positivity and semen volume for the duration of sexual
abstinence.
 Statistical analysis
4. Semen parameters were compared between the overall HPV-
positive and HPV-negative group using independent samples' t-
tests.

5. The percentages of semen samples with a positive MAR-test

were compared between the groups using Fisher's exact test or
Dunnett's test when appropriate.

6. Two-sided P-values <0.05 were considered statistically

significant.
Results

• Overall HPV was detected in 14.9% (64/430) of semen

samples
a. 2.1% (9/430): with both high-risk (hr) HPV and low-risk
(lr) HPV types
b. 8.8% (38/430) with exclusively hrHPV types
c. 4.0% (17/430) with exclusively lrHPV types
Results
RESULTS
Table 2. Participant characteristics and semen parameters in the total study
population and in strata of HPV presence.
 Results

The presence of HPV in semen was not associated with the

age of the participants, seminal pH, semen volume, total sperm
count, sperm concentration, progressive motility or the presence
of antisperm antibodies.
 Conclusion

• This study confirmed earlier findings that HPV-DNA is commonly

present in semen of men seeking fertility evaluation.

• No association of seminal HPV presence with semen parameters was

observed.

• Screening for HPV in semen should currently only be considered for

donor semen to prevent unnecessary viral transmission to the female
genital tract, but not for diagnostic settings in assisted reproduction.
 Limitations

• Absence of data on sperm morphology, which was not tested in each primary
semen analysis, but performed only on the physician's request.

• MAR-testing was performed for IgG only: might have underestimated the
number of samples with antisperm antibodies (both in HPV-positive and HPV-
negative samples)

• This study did not observe an association between HPV presence in semen
and impairment of semen quality.

• Cannot exclude an effect of seminal HPV on early embryo development and

clinical reproductive outcomes
Now, let’s go back to the study question…

Study question:

Is the presence of human papillomavirus (HPV) in semen associated

with impairment of semen quality?

Summary answer?

In a large cohort of males seeking fertility evaluation, no associations

were observed between seminal HPV presence and semen parameters.
 References:

Luttmer, R., Dijkstra, M.G., Snijders,  P.J.F., Hompes,  P.G.A., Pronk, D.,

Hubeek, I... & Meijer, C. (2016). Presence of human papillomavirus in
semen in relation to semen quality. Human Reproduction, 31 (2),280-
286. https://doi.org/10.1093/humrep/dev317

Tille, P. (2017). Bailey and Scott’s Diagnostic Microbiology. 14th Edition.