Diseases caused by human papillomavirus have been known for a long time. First of all, these are all kinds of warts, from which every sixth person on the planet suffers. However, the pathogen itself has attracted the attention of scientists only in the last 30-40 years. The group of human papillomaviruses (Human papillomavirus - HPV) was identified as a separate species in 1971. Since then, scientists have classified HPV types and established their relationship with many pathologies, but research is still ongoing. At the same time, doctors are looking for more effective ways to fight this insidious virus.
What is HPV?
Human papillomavirus is a large group of DNA-containing viruses that show an affinity for the epithelial cells that form the skin and mucous membranes. Today, about 170 types of viruses have been discovered, and about 60 have been well studied.
Some papilloma viruses are dangerous because of their oncogenic activity, that is, they increase the risk of malignant tumors. Since the 1980s, research has been conducted that has proven that infection with human papillomavirus plays a role in the development of adenocarcinoma and squamous carcinoma of the cervix (the second type of tumor is much more common). In 99% of cases, oncology patients are diagnosed with HPV infection and cells that are specifically modified by the virus.
Papilloma virus attacks epithelial cells. After its penetration into the genome, replication (reproduction of the DNA virus) begins. In this case, the cells divide in an atypical way, and their structure changes, which can be seen if a cytological analysis is done.
The papilloma virus is manifested by specific changes in the epithelium:
- on the skin of the body (vulgar and flat warts, papillomas);
- on the epidermis and mucous membrane of the genital organs (genital warts, bowenoid papulosis, neoplasia of the cervix, cancer);
- on 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 rarely.
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);
- with high risk (16, 18, 31, 33, 39, 59, 64).
Common types 6 and 11 cause multiple anogenital warts and mild cervical neoplasia. Their detection in a pregnant woman requires attention, because there is a risk of developing laryngeal papillomatosis in a newborn after contact with the mother's mucous membrane during childbirth. Therefore, when planning a pregnancy, women and men must undergo an HPV test.
The detection of viruses from the third group in the analysis results requires special attention, because the risk of tissue degeneration is high, and the patient needs advanced diagnostics.
Methods of infection
The most common route of infection is sexual. Almost all sexually active adults have been diagnosed with HPV. However, most often the infection is transient - the body copes with it, and after a year and a half the virus is not detected on 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– by touch. This is how you can get warts;
- Domestic.The virus remains viable in the external environment for some time. Infection is possible in the bathroom, swimming pool and other public places. The causative agent penetrates through the microdamage of the skin.
- Vertical.The virus can be passed 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 (HPV) infection can spread throughout the body from one place to another, for example, by shaving or scratching the nipples.
Stages of infection development
After infection, the latent stage begins - latent or transmission of PVI. At the same time, the virus is inactive, does not manifest itself clinically and is not detected by cytological and histological examination, because it does not reproduce its copies and does not change the epithelial tissue. However, its DNA can be detected using PCR analysis.
Important!
It is not at all necessary for the latent phase 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 do not bother the person. However, during cytological analysis, atypical cells are revealed, and individual condylomas or small papillomas may be visible during examination.
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 cancer begins to grow.
Reasons for the activation of the papilloma virus
PVI infection occurs very easily, but the human immune system copes well with it, and often the virus disappears on its own. A persistent infection that periodically worsens and does not leave the body is a sign of a reduced immune response.
The following factors contribute to this:
- Age. Healthy adults are less likely to suffer from PVI. More often – children, teenagers and the elderly;
- Long-term chronic diseases that weaken the body;
- Endocrine pathologies (diabetes mellitus, thyroid diseases) 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 drugs 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;
- Simultaneous infection with other sexually transmitted infections;
- Gynecological procedures that lead to mechanical damage to the mucous membrane of the cervical canal (abortion, curettage, insertion of a spiral, etc. ).
The incubation period for PVI is highly variable. The causative agent can remain in a latent, inactive state for a long time (from 3 weeks to several years), so it is impossible to accurately determine the time and circumstances of infection. A person can be infected with several types of viruses at once and be constantly re-infected, for example, from a sexual partner.
Diagnosis of HPV
The first stage of diagnosis is always an examination by a doctor and collection of anamnesis. Women are examined by a gynecologist, men by a urologist or dermatovenerologist. When exophytic genital warts are detected, the diagnosis is obvious, because these neoplasms are characteristic only of PVI.
Acetic acid test
If the disease is in the subclinical stage, small condylomas may not be visually visible. Therefore, a test with acetic acid is carried out - after treatment with it, new growths become white and stand out against the background of the surface.
The same thing happens with the mucous membrane of the cervix (examined by colposcopy) - the identification of white areas on it indicates that the epithelium in this place has changed. A cytological swab is taken from this surface or a biopsy is performed.
If the acetic acid test is positive, observation and control is necessary after six months, because the disease can progress. On the other hand, the virus can go into a latent state, then the manifestations will disappear.
Schiller test
It is performed as part of an extended colposcopy after the acetic acid test. In this case, the fabric surfaces that were previously treated with vinegar are painted with a solution of iodine in glycerin. Normal cells absorb this solution and become uniformly brown. In atypical cells, glycogen accumulation processes are disturbed and they do not absorb the solution. Mosaic coloring occurs, its characteristic features point to the diagnosis.
Cytological smear
It is otherwise called the PAP test after the name of its inventor, the Greek doctor Papanikolaou. For testing, 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.
Interpretation of the results is done by the doctor, because other data are also taken into account: cytological results, PCR analysis, tests for other infections, presence of inflammation in the vagina, etc. Result of class 1-2. it is considered negative, i. e. 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 neoplasia or grade III cancer.
PCR analysis
A very sensitive test that detects the presence of viral DNA in epithelial cells. The study can be performed with the same biomaterial that was taken for cytological analysis. The polymerase chain reaction is performed in a special device, where a predetermined gene sequence is copied multiple times.
The PCR method is used to detect hidden sexually transmitted infections, including HPV, so it is used as part of a screening examination. Genital warts often 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 precise, its use often leads to overdiagnosis. After all, the detected DNA of the virus does not mean that the person is sick. It may be a new infection that will go away on its own.
Therefore, the PCR test was expanded - a quantitative analysis is performed to determine the concentration of the pathogen in the tissues, that is, the viral load (marked in the results with the letters lg). At the same time, genotyping is carried out in order to determine the exact type of pathogen. If oncogenic strains are found, control tests are prescribed after 3-6 months.
Digene test
This method is screening (primary, carried out for initial diagnosis). It also detects viral DNA in tissues. In this case, the oncogenicity of viruses and their number are collectively determined. The Digene test in combination with a cytological smear is the standard adopted today in many developed countries for the identification of 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 3-4-5 cell class. A piece of tissue obtained as a result of a biopsy is examined under a microscope.
The study allows us to identify cells specifically modified by the virus - koilocytes and dyskeratocytes, as well as cells with signs of malignancy. Thus, histology allows determining the degree of neoplasia and identifying cancer in the early stages, when it can be successfully treated.
In some cases, tissues taken from neoplasms on the skin and mucous membranes are submitted for histological analysis if there is doubt about their nature and quality.
Treatment of PVI
In the latent phase of PVI, no treatment is required. Over time, a detected infection becomes just a reason for observation. It is worth noting that it is impossible to kill the virus in the body with drugs, because it replicates inside the cells.
The infected person is advised to:
- avoid factors that reduce immunity, take vitamins;
- recover from concomitant sexually transmitted infections, if detected, do not develop chronic diseases;
- lead a healthy lifestyle, give up bad habits;
- live a sex life with a steady, trusted partner.
Treatment of human papillomavirus begins in the phase of subclinical manifestations. At this stage it is conservative. Immunomodulatory therapy is usually prescribed. Human interferon preparations or its inducers are used for this purpose.
Non-specific immunomodulators are also effective against HPV. Antiviral drugs are used.
Doctors often simultaneously prescribe topical medications - ointments, gels and creams.
Important!
Immunomodulatory treatment is prescribed only by a doctor based on the results of an immunogram, and uncontrolled use of drugs can lead to the opposite result - a malfunction of the immune system.
In the third phase, 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 cauterization 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 monitored by an oncologist.
Because PVI is often combined with other sexually transmitted infections, antibacterial, anti-inflammatory, and other medications may be prescribed.
Vulgar 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 forecasts. Usually, after a course of therapy, which is developed individually, taking into account the oncogenicity of the virus and accompanying diseases, the infection recedes.
Relapses occur but are relatively rare if treatment is not stopped. Some people experience one relapse, sometimes several, but shorter and weaker. Constant exacerbations are typical only for people with a prolonged 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 infection:
- use barrier methods of contraception;
- have sex with a regular partner;
- do not start sexual activity before the age of 18, because in adolescents the immune system is not yet fully formed;
- Avoid artificial termination of pregnancy.
For now, there is only one specific method of prevention - vaccination. Today it is possible to vaccinate against types 6, 11, 16 and 18 of the virus. Vaccination takes place in three stages, it is best to start vaccination in adolescence - from 9-10 years.
Patient reviews
- "I had condylomas, I didn't know about them, " said the gynecologist after the examination. I immediately asked if we would delete it, I agreed. Then she prescribed me and my husband to take antiviral medicine. Expensive, but we decided: to undergo treatment until the end. I also made baths with chamomile, string and calendula. Now everything is clean for two years. "
- "Doctors have different attitudes towards treatment. I was diagnosed with grade 1 dysplasia and HPV type 18. One doctor told me - just cauterize, otherwise there will be cancer later. Another said that there is no need to treat anything before the age of 30, especially before giving birth. She only prescribed tablets and suppositories. A year later the virus was still in the analysis, but two years later it was gone, and the cervix was normal. But after the age of 30, as another doctor told me, the body no longerit does not recover by itself. "