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Examination of HPV as part of cervical cancer prevention
PETŘÍKOVÁ, Petra
Sexually transmitted HPV infection (human papillomavirus), or infection with human papillomavirus, is a decisive factor in cervix carcinoma etiology. Human papillomaviruses are considered to be the most frequent sexually transmitted infection worldwide. In women, the life-long risk of infection is 80%. High-risk genotypes (high-risk HR HPV 16, HPV 18) were classified among carcinogens. The risk of cervix carcinoma in a woman who is HR HPV positive is 100 to 400 times higher compared to a woman who is HR HPV negative. The first part of my thesis contains a brief theoretical overview of HPV history, structure and classification. The next part deals with the ways of HPV transmission and the incubation period of the pathogenic agent in question. The incubation period as well as the replication cycle of the virus depend on the extent of infection and on the status of the immune system. Increased occurrence of papillomavirus infection is found in persons with a damaged component of cell immunity. In the further part of the thesis I focused on the diagnostic procedures and tests proving HPV infection including its clinical manifestations. Continued HPV infection, together with other relevant factors (smoking, immunodeficiency, lack of vitamins, stress, vaginal infection and hormone influence), increases the probability of cervix carcinoma occurrence. Here I also mention the histopathological classification, prognosis and treatment of these tumors. Considering the occurrence of cervix carcinoma, the situation in the CR is not as favorable as in other advanced countries where the screening is more effective. For comparison, the incidence and mortality in the CR are presented within global scale. Further on I attempted to stress the importance of primary prevention, mainly vaccination. The parts of secondary prevention mentioned in the thesis are preventive examinations, colposcopy, oncological cytology, serological methods and HPV test. The aim of my thesis is to emphasize the importance of testing for human papilloma virus HPV tests carried out in high risk group of women aged over 35 years within the system of preventive examinations. However, nowadays these examinations are accomplished just in women with an abnormal cytological finding. My thesis summarizes the quantitative findings as regards HPV tests done on the basis of determining the nucleic acid of human papillomaviruses by hybridization method with enhanced signal using chemiluminiscence detection. The detection of HPV was achieved with the use of the sets hc2 High-Risk HPV DNA Test and hc 2 HPV DNA Test from QIAGEN company. The thesis includes results of the tests for high-risk types of human papillomaviruses (HPV 16/18/31/33/35/39/45/51/52/56/58/59/68) found in 767 women over the period from January 1 2010 to December 31 2013. The tests were carried out at the Medical Microbiology Ward of the Hospital Jindřichův Hradec, a joint-stock company. The group of women with already positive cytological finding was divided into six age categories to highlight the high-risk groups of women over 35 and over 65. As I myself belong to the high-risk group over 35, my intention was to prove the hypothesis that the cause of the cytological changes in women over 35 can be attributed to the dangerous types of human papillomavirus. Finally, after carrying out the analysis of the obtained results, I attempted to propose a solution which could be used in practice.
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