March 4 is marked as International HPV (Human Papillomavirus) Awareness Day. The virus is a Sexually Transmitted Infection (STI), which is infected by the skin or the mucous membranes (oral, genital or anal) and, when it presents precursor lesions not treated early, it can progress to cancer, in particular of the cervix.
Among the main forms of prevention is the HPV vaccine, offered by the Municipality of Aracaju, by the Unified Health System, for the vaccination of children and adolescents aged 9 to 14 years.
People living with HIV/AIDS, transplant patients and cancer patients who have a common immunosuppression condition, as long as they have a medical report with proof, are also vaccinated. In 2021, Aracaju had a total of 17,139 people vaccinated with the human papillomavirus (HPV) vaccine, as explained by the coordinator of the municipal vaccination program, Yuri Belchior.
“The HPV vaccine offered by SUS has a two-dose cycle, with a six-month application interval between them, and protects against the four most common virus types in the country. It is not a treatment, but a form of prevention. Therefore, we encourage vaccination before the start of sexual life”, guides the coordinator.
According to the municipal health department’s STI/AIDS program coordinator, Débora Oliveira, between 2018 and 2021, 433 cases of HPV were reported in the capital, with 120 reported last year.
“Patients who present with lesions caused by HPV infection are initially monitored by the Primary Care Network, in the Basic Health Units, and depending on the degree of the lesion, they begin to receive treatment in the Specialized Network, with a gynecologist or a urologist, at Cemar Siqueira Campos,” explains Débora.
diagnosis and treatment
When they need specialized care, patients are referred to the Medical Specialty Center of Aracaju (Cemar – Siqueira Campos); women are referred for follow-up to a gynecologist and men are seen at the Specialized Care Service (SAE) and, if necessary, referred to the urologist. According to gynecologist Ivi Gonçalves, the patients referred are those who have a cytological examination with an altered result.
“They perform this examination in primary care, and when there is a change, they are referred to Cemar to confirm the diagnosis by biopsy or repeat the examination and start treatment, if necessary. From examination of the slides, cellular changes caused by the presence of the virus can be detected. At Cemar, colposcopy examinations are carried out to identify the site of the lesion and perform a biopsy”, specifies the doctor.
Also according to the gynecologist, the type of treatment will depend on the degree of injury. When this is of low degree, it can only be followed or carried out with electrocoagulation. High-grade lesions are removed in an outpatient clinic, under local anesthesia.
“After that, we do the follow-up, that is, four slide reviews with negative results, within a six-month interval. With this, the patient is again followed by primary care, for her annual screening. In this case, she does this annual screening for five years,” adds Ivi.
Male HPV cases are treated at the Specialized Care Service (SAE), located inside the Cemar Siqueira Campos building. As with other STIs, this service is provided by professional nurses, where currently in the service the team is made up of four nurses, two per shift.
The service is performed on spontaneous request, without the need for referral, and in patients with simple condyloma (genital and perianal), cauterization is performed with the application of trichloroacetic acid (ATA) 80%, in the outpatient clinic of the unit.
“When there are cases of patients with condyloma in large numbers or requiring surgery, as well as patients with lesions suggestive of cancer, we refer them to the urologist. This appointment is made at the SAE, depending on the places available, and the service is provided at the university hospital, ”says the nurse at the Cemar polyclinic, Marta Regina Goes Santos.
HPV and cancer
According to Doctor Ivi Gonçalves, there are more than 200 types of HPV, 40 of which affect the genital, oral and anal areas. About 13 types are responsible for cervical cancer, the most common being strains 16 and 18, which are covered by the vaccine.
According to the National Cancer Institute (INCA), cervical cancer is the third most recurrent malignancy in women and the fourth leading cause of death in the female population due to the disease in the country.
“The relationship between the HPV virus and cervical cancer is very strong, because to have this type of cancer you must have been in contact with the virus, which is why prevention work is so important”, underlines the gynecologist Ivi Gonçalves.
Among the forms of prevention, in addition to the use of condoms during sexual intercourse, which also makes it possible to prevent other STIs, vaccination and regular preventive examinations are essential. “With the start of sexual life, the preventive examination will be the means of detecting precursor lesions, before they become invasive and evolve into cancer”, warns the doctor.
When not identified and treated early, these precursor lesions can develop into cervical cancer and can also affect the vagina, vulva, anus, penis, oropharynx, and mouth.