Diseases caused by the human papillomavirus have been known for a long time. First of all, these are all types of warts that one in six people on the planet suffer from. However, the pathogen itself has attracted the attention of scientists only in the last 30 to 40 years. The group of human papillomaviruses (Human papillomavirus - HPV) was identified as a separate species in 1971. Since then, scientists have classified the types of HPV and established their relationship with many pathologies, but research still continues. At the same time, doctors are looking for more effective ways to combat this insidious virus.
What is HPV?
Human papillomavirus is a large group of viruses that contain DNA and exhibit affinity for the epithelial cells that make up the skin and mucous membranes. Today about 170 types of viruses have been discovered and about 60 have been well studied.
Some papillomaviruses are dangerous due to their oncogenic activity, that is, they increase the risk of the formation of malignant tumors. Since the 1980s, research has shown that human papillomavirus infection plays a role in the development of adenocarcinoma and squamous cell cervical cancer (the second type of tumor is much more common). In 99% of cases, cancer patients are diagnosed with HPV infection and cells specifically modified by the virus.
The papillomavirus invades epithelial cells. After its penetration into the genome, replication (reproduction of the virus DNA) begins. In this case, the cells divide atypically and their structure changes, which can be verified by performing a cytological analysis.
The papillomavirus manifests itself in specific changes in the epithelium:
- on the skin of the body (vulgar and flat warts, papillomas);
- on the epidermis and mucous membranes of the genital organs (genital warts, bowenoid papulosis, cervical neoplasia, cancer);
- in the mucous membranes of other organs (oral cavity, larynx, bladder, rectum, bronchi, etc. ).
Changes in the first group are caused by non-oncogenic viruses. They are unpleasant, but not dangerous. The third group of manifestations is considered atypical and is recorded relatively infrequently.
All types of viruses are divided into three groups:
- with low oncogenic risk (3, 6, 11, 13, 32, 40, 41, 43, 44, 51, 61);
- with moderate risk (30, 35, 45, 52, 56);
- at high risk (16, 18, 31, 33, 39, 59, 64).
Common types 6 and 11 cause multiple anogenital warts and mild cervical neoplasia. Detecting them in a pregnant woman requires attention, since there is a risk of developing laryngeal papillomatosis in a newborn upon contact with the mother's mucous membranes during childbirth. Therefore, when planning a pregnancy, women and men should undergo an HPV test.
The detection of viruses of the third group in the analysis results requires special attention, since the risk of tissue degeneration is high and the patient requires advanced diagnostics.
Infection methods
The most common route of infection is sexual. Almost all sexually active adults are diagnosed with HPV. However, most of the time the infection is transient: the body copes with it and, after a year and a half, the virus is not detected in tests. Only occasionally does HPV cause minor clinical manifestations and, in extremely rare cases, cancer, which develops many years after infection (10-15).
Other routes of infection:
- Contact– through touch. This is how you can get infected with warts;
- Domestic.The virus remains viable in the external environment for some time. Infection is possible in a bathhouse, swimming pool and other public places. The pathogen penetrates through microdamage to the skin.
- Vertical.The virus can be transmitted from mother to child during childbirth. In this case, the newborn occasionally develops papillomatosis of the larynx and upper respiratory tract. In some cases, the baby is affected by genital warts.
- Autoinfection.Human papillomavirus (PVI) infection can spread throughout the body from one place to another, for example by shaving or scratching warts.
Stages of infection development
After infection, the latent stage begins: latent or carrier of PVI. At the same time, the virus is inactive, does not manifest itself clinically and is not detected during cytological and histological examination, since it does not reproduce its copies and does not modify the epithelial tissue. However, its DNA can be detected by PCR analysis.
Important!
It is not at all necessary for the latent stage to develop into a disease. Perhaps the person himself will remain only a carrier and will not have clinical manifestations.
In the second stage (subclinical), tissue changes have already begun, but they can still be minimal and not bother the person. However, when performing cytological analysis, atypical cells are detected, and during examination, single condylomas or small papillomas may be seen.
The third stage is clinical (manifest). The symptoms are pronounced and the disease requires treatment. More often, PVI occurs latently or subclinically and obvious signs appear under the influence of provoking factors.
The fourth stage (mutagenesis) is a sad consequence of PVI. During this period, the cells become malignant and the carcinoma begins to grow.
Reasons for the activation of the papillomavirus.
PVI infection occurs very easily, but the human immune system adapts well and the virus often disappears on its own. A persistent infection that periodically worsens and does not clear up from the body is a sign of a diminished immune response.
The following factors contribute to this:
- Age. Healthy adults are less likely to suffer from PVI. Most often – children, adolescents and the elderly;
- Long-term chronic diseases that weaken the body;
- Endocrine pathologies (diabetes mellitus, thyroid disease) and hormonal fluctuations (pregnancy, menopause);
- Constant stress, prolonged psycho-emotional stress;
- Poor nutrition, strict diets, lack of vitamins, minerals and complete proteins;
- Severe nutritional obesity and sedentary lifestyle;
- Taking medications that suppress the immune system, exposure to radiation, chemotherapy;
- Primary and secondary immunodeficiencies, HIV;
- Beginning of sexual activity before the age of 16 and indiscriminate intimate contacts;
- Concomitant infection with other sexually transmitted infections;
- Gynecological procedures that cause mechanical damage to the mucous membranes of the cervical canal (abortion, curettage, installation of a spiral, etc. ).
The incubation period of PVI is highly variable. The pathogen can remain in a dormant and inactive state for a long time (from 3 weeks to several years), making it impossible to accurately determine the time and circumstances of infection. A person can be infected with several types of viruses at once and constantly re-infected, for example, through a sexual partner.
HPV Diagnosis
The first stage of diagnosis is always an examination by a doctor and anamnesis. Women are examined by a gynecologist, and men by a urologist or dermatovenerologist. When exophytic genital warts are detected, the diagnosis is obvious, since these neoplasms are characteristic only of PVI.
acetic acid test
If the disease is in a subclinical stage, small condylomas may not be visually visible. Therefore, a test is carried out with acetic acid: after treatment with it, new growths turn white and stand out against the background of the surface.
The same happens with the mucous membrane of the cervix (examined by colposcopy): the identification of white areas indicates that the epithelium in this place has changed. It is from this surface that a cytological smear is taken or a biopsy is performed.
If the acetic acid test is positive, observation and control are required after six months, as the disease may progress. On the other hand, the virus can enter a latent state and then the manifestations will disappear.
Schiller test
It is performed as part of an extended colposcopy after an acetic acid test. In this case, the areas of fabric previously treated with vinegar are dyed with a solution of iodine in glycerin. Normal cells absorb this solution and turn uniformly brown. In atypical cells, glycogen accumulation processes are disrupted and they do not absorb the solution. Mosaic staining occurs, its characteristic features suggest a diagnosis.
cytological smear
It is also called a PAP test after the name of its inventor, the Greek doctor Papanikolaou. For the test, a scraping is taken from the mucous membrane of the cervix (urethra in men) in order to obtain epithelial cells for analysis. The biomaterial is applied to a glass slide, fixed with alcohol, stained, and examined under a microscope.
The interpretation of the results is carried out by a doctor, since other data is also taken into account: cytology results, PCR analysis, tests for other infections, the presence of inflammation in the vagina, etc. A class 1-2 result is considered negative, that is, no morphological changes caused by the virus were detected.
For grade 3, additional examination methods are prescribed, but grades 4 and 5 are a possible sign of grade III neoplasia or cancer.
PCR analysis
A very sensitive test that detects the presence of viral DNA in epithelial cells. The study can be carried out with the same biomaterial that was taken for cytological analysis. The polymerase chain reaction is carried out in a special device, where a predetermined genetic sequence is copied many times.
The PCR method is used to detect hidden sexually transmitted infections, including HPV, so it is used as part of a screening test. Genital warts usually appear against the background of other venereal diseases. If positive PCR results are obtained, in-depth diagnostics are required.
Because the DNA test is so accurate, its use often leads to overdiagnosis. After all, the DNA of a detected virus does not mean that a person is sick. It may be a new infection that will go away on its own.
Therefore, the PCR test is expanded: a quantitative analysis is performed to determine the concentration of the pathogen in the tissues, that is, the viral load (indicated in the results with the letters lg). At the same time, genotyping is performed to determine the exact type of pathogen. If oncogenic strains are found, control tests are prescribed after 3 to 6 months.
digene test
This method is screening (primary, performed for initial diagnosis). It also detects viral DNA in tissues. In this case, the oncogenicity of viruses and their number are determined collectively. The Digene test in combination with a cytology test is the standard adopted today in many developed countries to identify clinically significant HPV infection and cancer risk.
histological examination
This is an advanced diagnostic method. It is prescribed to a woman when positive screening results are obtained: cytological analysis showed a 3-4-5 cell class. A piece of tissue obtained as a result of a biopsy is examined under a microscope.
The study makes it possible to identify cells specifically modified by the virus: coilocytes and dyskeratocytes, as well as cells with signs of malignancy. Thus, histology makes it possible to determine the degree of neoplasia and identify cancer in the early stages, when it can be successfully treated.
In some cases, tissues removed from skin and mucosal neoplasms are subjected to histological analysis if there are doubts about their nature and good quality.
PVI Treatment
In the latent stage of PVI, no treatment is required. The detected infection becomes only a reason for observation over time. It is worth noting that it is impossible to kill the virus in the body with drugs, as it replicates inside cells.
An infected person is recommended to:
- avoid factors that reduce immunity, take vitamins;
- recover from concomitant sexually transmitted infections, if any are detected, do not develop chronic diseases;
- lead a healthy lifestyle, give up bad habits;
- live a sexual life with a permanent and trusted partner.
Treatment of human papillomavirus begins with the stage of subclinical manifestations. At this stage it is conservative. Immunomodulatory therapy is usually prescribed. For this, human interferon preparations or their inducers are used.
Nonspecific immunomodulators are also effective against HPV. Antiviral medications are used.
Doctors usually prescribe local medications at the same time: ointments, gels and creams.
Important!
Immunomodulatory treatment is prescribed only by a doctor based on the results of an immunogram; uncontrolled use of medications can lead to the opposite result - poor functioning of the immune system.
In the third stage, radical methods are included in the treatment regimen. You can get rid of genital warts, papillomas and warts using the following methods:
- chemical removal with cauterizing drugs;
- radio knife;
- electrocoagulation;
- laser destruction;
- cryodestruction.
The same methods are used in the treatment of benign pathologies of the cervix.
Surgical removal of tissue is indicated for diagnosed cervical cancer. In this case, the woman is treated and observed by an oncologist.
Since PVI is often combined with other sexually transmitted infections, antibacterial, anti-inflammatory, and other medications may be prescribed.
Common warts can be removed at home using mummifying agents sold in pharmacies.
Treatment prognosis
Contrary to the belief that the virus remains in the body forever and that a complete cure is impossible, doctors give favorable prognoses. Usually, after a course of therapy, which is developed individually, taking into account the oncogenicity of the virus and concomitant diseases, the infection disappears.
Relapses occur, but are relatively rare if treatment is not stopped. Some people experience a relapse, sometimes several, but shorter and weaker. Constant exacerbations are typical only for people with a long-term decrease in immunity due to HIV infection or serious chronic diseases.
Prevention of PVI
Prevention measures are divided into general and specific. General recommendations to avoid infections:
- use barrier contraceptive methods;
- having sexual relations with a regular partner;
- do not start sexual activity before the age of 18, since in adolescents the immune system is not yet fully formed;
- Avoid artificial termination of pregnancy.
So far there is only one specific prevention method: vaccination. Today it is possible to be vaccinated against types 6, 11, 16 and 18 of the virus. Vaccination is carried out in three stages; It is best to start vaccination in adolescence, between 9 and 10 years old.
Patient reviews
- "I had condylomas, I didn't know anything about them, " said the gynecologist after the examination. I immediately asked if we would remove it and I agreed. Then he prescribed me and my husband to take antiviral medication. Expensive, but we decided: to undergo the treatment until the end. I also made baths with chamomile, thread and calendula. Now everything has been clean for two years. "
- "Doctors have different attitudes to treatment. I was diagnosed with dysplasia grade 1 and HPV type 18. One doctor told me: just cauterize, otherwise there will be cancer later. Another said that it is not necessary to treat anything before the age of 30, especially before giving birth. She only prescribed pills and suppositories. A year later, the virus was still being tested, but two years later it was gone and the cervix was normal. But after 30, as the doctor told me second doctor, the body no longer recovers on its own.