Molecular identification of human papillomavirus, epstein-barr virus and cytomegalovirus in paraffin tissue of patients with anogenital warts

Anogenital warts are epidermal lesions caused by different genotypes of the human papillomavirus (HPV) that appear in the anogenital region. More than 90% of these lesions are caused by HPV 6 and HPV 11. HPV is primarily transmitted sexually. Anogenital warts are benign lesions that do not carry a risk of neoplastic change. However, in immunosuppressed patients, they may coexist with both premalignant lesions (such as vulvar, anal, and penile intraepithelial neoplasia) and malignant lesions, or these lesions may develop in the context of warts, and they can rarely be misdiagnosed as warts. Additionally, approximately 20% of individuals with anogenital warts may also have other sexually transmitted infections. Epstein-Barr virus (EBV) is a common gamma herpes virus that infects more than 90% of adults worldwide. EBV is primarily transmitted through saliva, but transmission via blood, organ transplantation, and sexually has also been reported. Human cytomegalovirus (CMV) is the prototype member of the betaherpesvirinae. Like all herpesviruses, it remains latent and persists throughout an individual's life. CMV can be transmitted through body fluids, blood, organ transplantation, and sexually. HPV, EBV, and CMV can all be sexually transmitted and can remain latent in epithelial cells. In the study, 24 tissue samples obtained from excised lesions diagnosed as anogenital warts between January 2020 and July 2023 were used as biological materials from the Department of Medical Pathology at Fırat University Hospital. In the group of patients with anogenital warts, viral investigations for HPV, CMV, and EBV were performed on 24 paraffin-embedded tissue biopsy samples using Real-Time PCR and pyrosequencing methods. For viral DNA extraction from the samples, the DSP virus pathogen kit (Qiagen, Germany) and the EZ1 Advanced (Qiagen) automated nucleic acid isolation device were utilized. In the PCR analysis, HPV was detected in 15 patients (62.5%), while 9 patients (37.5%) tested negative for HPV. Among the remaining 15 patients, HPV 6 was identified in 8 patients (53.3%), HPV 16 in 1 patient (6.7%), HPV 40 in 4 patients (26.7%), and HPV 87 in 2 patients (13.3%). Additionally, 2 patients (8.3%) had co-infection with HPV and EBV. EBV was not detected in 22 patients (91.7%), and none of the 24 patients tested positive for CMV. In conclusion, infections such as EBV and CMV that can be sexually transmitted may increase the risk of developing HPV infections. The presence of EBV and CMV should be investigated in patients with detected HPV. Since anogenital warts can be confused with precancerous lesions or can coexist with them, diagnostic excision should be performed in resistant patients. The aim of this study is to reveal the impact of co-infection on the treatment of resistant warts or precancerous conditions. Furthermore, it highlights the suspicion of cancer progression in cases of co-infection with anogenital warts. Keywords: Anogenital Warts, Human Papillomavirus, Epstein-Barr Virus, Cytomegalovirus.