Papilloma virus – HPV: sintomi, prevenzione e classificazione
L’infezione da papilloma virus è una delle più frequenti condizioni patologiche trasmissibile soprattutto per via sessuale o per contatto di mucosa. Si calcola che quasi la totalità della popolazione una volta nella vita venga a contatto con questo virus. Se ne conoscono più di 100 sottotipi in grado di causare affezioni della pelle o delle mucose. In statistiche che arrivano fino al 70 /90% non si hanno manifestazioni patologiche, l’infezione si risolve spontaneamente in un più o meno breve lasso di tempo. Al momento sono stati identificati oltre 100 tipi di HPV: più del 90% delle lesioni condilomatose genitali sono associate ai tipi di HPV 6 e 11. I sottotipi di HPV caratterizzati dal rischio oncogenico più elevato sono invece il 13, 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68.
Tratto da http://www.my-personaltrainer.it/salute/hpv.html
SINTOMI
In alcuni casi porta alla comparsa di verruche o condilomi (proliferazioni benigne); può portare lesioni del collo dell’utero nel restante 4% ; una progressione della malattia che può portare il tumore della portio o cervice uterina (3500 casi in Italia all’anno e nel mondo e più di 400mila… ) Il papilloma virus è altresì responsabile di tumore del cavo orale, dell’esofago, della laringe, del pene e dell’ano.
PREVENZIONE
I metodi di prevenzione si basano essenzialmente nell’utilizzo del preservativo, nell’esecuzione dell’esame citologico cervico-vaginale il cosiddetto pap test, gratuito ogni 3 anni anni; semplice ed indolore, non richiede nessuna preparazione da parte della paziente tranne evitare rapporti o lavande nelle ore precedenti l’esame; si prelevano mediante il posizionamento di uno speculum intravaginale e l’utilizzo di un cytobrush alcune cellule dellaesocervice – la parte esterna del collo dell’utero- e della endocervice o canale cervicale. Negli ultimi anni è partita una campagna di vaccinazione preventiva gratuita alle ragazze di età inferiore ai 12 anni con protezione non totale ma sulla maggior parte dei ceppi che sono responsabili del 70% dei tumori del collo dell’utero. La presenza del virus o l’evidenza di una già avvenuta alterazione cellulare (displasia) richiede la successiva genotipizzazione del papilloma mediante tecniche di patologia molecolare per stabilire se sia un virus ad alto rischio (responsabili della quasi totalità dei tumori cervicali) o a basso rischio e della colposcopia, osservazione diretta con un microscopiodopo applicazione di apposite soluzioni che evidenziano l’estensione della lesione. Completa l’iter diagnostico un’ eventuale biopsia dell’area evidenziata con l’asportazione di un piccolo frammento e successivo esame istologico.
CLASSIFICAZIONE
La classificazione attuale suddivide le lesioni in basso e alto grado;per le prime è sufficiente un attento monitoraggio e alcuni studi evidenziano l’utilità della somministrazione di ovuli vaginali riepitelizzanti; per le seconde si possono effettuare delle escissioni mediante anse ad alta frequenza in day hospital o la classica conizzazione mediante il bisturi a lama fredda. Qualora la lesione fosse invece un carcinoma avanzato è necessaria l’asportazione dell’utero e delle ovaie. E’ pertanto fondamentale l’individuazioneprecoce di una lesione che permetta di avere ottimi risultati sia sul progredire della stessa lesione, sia sulla possibilità di future gravidanze.
Le informazioni riportate devono essere considerate come suggerimenti e consigli di carattere generale, non devono in alcun modo sostituire il parere del medico e degli specialisti ai quali bisogna rivolgersi per qualsiasi problema.
(Tratto da un intervista al dottor Massimo Winkler specialista presso l’Istituto Auxologico Italiano IRRCS Milano)
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