Genitalne HPV infekcije u trudnoći

Karla Kovačević, Mihael Skerlev, Hrvoje Vrčić, Petra Kovačević, Suzana Ljubojević Hadžavdić

Humani papiloma virusi (HPV) su mali, epitelotropni DNK virusi. Dosadašnji podatci ukazuju na postojanje više od dvjesto genotipova virusa, od kojih oko četrdeset uzrokuje infekcije genitalnog područja. S obzirom na onkogeni potencijal, razlikujemo genotipove visokog (HPV 16, HPV 18, itd.) i genotipove niskog rizika (HPV 6, HPV 11, itd.). Genitalni HPV najčešće se prenosi kontaktom s inficiranom kožom ili sluznicom. Ostali načini prijenosa uključuju neizravni kontakt s kontaminiranim predmetima te autoinokulaciju. HPV uzrokuje različite promjene genitalne regije poput kondiloma, intraepitelnih neoplazija i invazivnih karcinoma cerviksa, vulve, penisa ili anusa. Također, HPV može prouzročiti lezije u područjima izvan genitalne regije kao što su usna šupljina, ždrijelo, grlo i jednjak. Ne postoji suglasnost vezana uz prevalenciju HPV-a tijekom trudnoće, pa ona varira u različitim zemljama između 5,5% i 65%. Vertikalni prijenos HPV-a označava mogućnost prijenosa HPV-a s majke na dijete tijekom trudnoće. Do perikonceptualnog prijenosa HPV DNA dolazi u vrijeme fertilizacije, dok se antenatalni prijenos događa isključivo za vrijeme trudnoće. No, većina HPV infekcija novorođenčadi nastaje perinatalnim prijenosom tijekom porođaja. Incidencija anogenitalnih kondiloma u trudnoći iznosi između 11,6% i 28,2%. Oni predstavljaju rizik od kontaminacije novorođenčeta HPV-om tijekom porođaja. Porastom učestalosti pojavljivanja anogenitalnih kondiloma u odraslih uočen je i usporedni porast incidencije anogenitalnih kondiloma u djece. HPV u djece može uzrokovati i rekurentnu respiratornu papilomatozu koju karakterizira nastajanje multiplih papiloma glasnica. Rijetko dolazi do totalne opstrukcije dišnog puta ili progresije u karcinom.

Human papilloma viruses (HPV) are small, epitheliotropic DNA viruses. More than two hundred different HPV genotypes are known today, of which around forty types cause genital infection. According to their oncogenic potential the viruses are divided in high-risk HPV genotypes (HPV 16, HPV 18, etc.) and low-risk genotypes (HPV 6, HPV 11, etc.). Genital HPV is most frequently transmitted through contact with infected skin or mucous membranes. Other routes of transmission are via contaminated fomites and autoinoculation. HPV causes genital warts, intraepithelial neoplasia and invasive carcinoma of cervix, vulva, penis or anus.Also, HPV can cause lesions in non-genital areas such as oral cavity, pharynx, throat and esophagus. There is no consensus regarding the prevalence of HPV during pregnancy, so it varies in different countries between 5.5 % and 65 %. The otential route of HPV transmission from mother to child during pregnancy is known as vertical transmission. Periconceptual transmission of HPV DNA occurs during fertilization, while prenatal transmission happens only during pregnancy. Most infant HPV infections occur via perinatal transmission during delivery. The incidence of anogenital warts in pregnancy is between 11.6 % and 28.2 %. Anogenital warts increase the risk of infant HPV contamination during delivery. As the incidence of anogenital warts increased in adults, increased incidence was also reported in children. HPV can cause recurrent respiratory papillomatosis in children, a disease characterized with laryngeal papillomatosis. In rare cases, total obstruction of airway or progression in carcinoma can occur.