The results of cryotherapy and local application of povidone-iodine in the eradication of persistent highly oncogenic HPV

Janina Markowska1, Beata Sterlińska-Tulimowska2, Wacław Śmiertka3 Received: 09.06.2016 Accepted: 23.06.2016 Published: 29.07.2016 © Curr Gynecol Oncol 2016, 14 (2), p. 104–108 DOI: 10.15557/CGO.2016.0012 Wyniki stosowania krioterapii i aplikacji powidonu jodowanego w eradykacji przetrwałej infekcji wysokoonkogennymi typami HPV The results of cryotherapy and local application of povidone-iodine in the eradication of persistent highly oncogenic HPV


AIM OF THE STUDY
The aim of the study was the evaluation of eradication of HPV HR efficacy in women subjected to repeated cryotherapy sessions with intravaginal treatment using the povidone-iodine preparation.

MATERIAL AND METHODS
Treatment covered 128 women aged 24 to 67 (37.5 on average) with abnormal cytology results: in 77 patients ASC-US was detected, in 30 patients LSIL was identified.Clinically, the cervix either manifested no pathological lesions, or ectropion type lesions were detected and also the presence of highly oncogenic HPV strains was noted.Cytology was estimated using the Bethesda system, HPV genotyping was conducted at the Department of Molecular Genetics marking 25 types of highly oncogenic and 12 types of HPV strains manifesting low oncogenic potential with the use of reverse transcription polymerase chain reaction (RT-PCR).The following schedule of treatment was employed: 1. cryotherapy with liquid nitrogen for 3 minutes, using a cervical probe of a size corresponding to the size of the vaginal part of the cervix and the orifice, covering the lesion (if ectropion was present) on the mucosal surface, and orifice with a transitory zone and the endocervix; 2. intravaginally applied povidone-iodine (Betadine) globules, also with an antiviral effect and applied daily for 14 nights consecutively, administered so deeply that the drug contacted the uterine cervix; 3. repeated cryotherapy after 2 months, applied for 3 minutes; 4. repeated exposure to povidone-iodine, as applied earlier; 5. HPV DNA marking after 2 months.

WNIOSKI
Krioterapia połączona ze stosowaniem powidonu jodowanego jest efektywna zarówno w profilaktyce, jak i w eradykacji przetrwałej infekcji wysokoonkogennymi typami HPV na szyjce macicy. of ectropion, colposcopy was performed (in another center) and biopsy of the endocervix and the cervical mucosa.In two patients CIN 1 was diagnosed; one of the patients was 24 years old, the other one 40 years old.In 45 (35%) patients, individual HPV types were demonstrated, most frequently including: • HPV 16 -in 18 (40%) patients; • HPV 31 -in 7 (15.5%)patients; • HPV 58 -in 9 (20%) patients; • HPV 39, 51, 33, 61 and 52 -in individual cases.In 29 (22.6%)patients, two types of the virus were detected, most commonly type 16 and type 18.In the remaining 54 (42.1%) patients, multiple HPV types were detected, including 68, 73 and 66.In 7 women, the second cryotherapy (bleeding ectropion) was additionally preceded by destructive coagulation using the LEEP system.In all the patients treated with cryotherapy and in the 7 patients subjected to cryodestruction, DNA determination failed to demonstrate HPV.In 76 women who reported for follow-up visits after 3 to 6 months post-treatment, DNA determination did not demonstrate the presence of HPV.In 10 women aged over 40, and declaring no procreative plans due to persistent cervical erosion type lesions, electroconization was conducted and histopathological examination demonstrated glandular erosion with no presence of koilocytes.

DISCUSSION
A persistent and recurring infection with highly oncogenic HPV strains leads to the development of precancerous conditions and to cervical cancer in some women.However, in no cases was an infection with multiple HPV strains found to increase the risk of developing such lesions (7,8,16) .According to Bosch et al., out of all highly oncogenic HPV types, type 16 is biologically most active (4) .Moscicki et al. expressed the opinion that apart from type 16, type 18 leads to the progression of CIN 2 lesions to CIN 3 lesions in 15% of the women with prolonged persistent infection (3 years) with HPV (9) .Even though HPV infection undergoes a spontaneous regression in most patients, women with the infection complain of a lowered quality of life.Numerous attempts to apply substances such as zinc-citrate (CIZAR), or vitamin K 3 or encouraging results of applying As 2 O 3 in vitro point to the efficacy of HPV eradication.The method applied by the authors is simple, economic, safe and effective.

CONCLUSIONS
The method using cryotherapy with the application of povidone-iodine is effective both in the prophylaxis as well as in the eradication of persistent infections with highly oncogenic HPV strains in the uterine cervix.