Diseases caused by human papillomavirus have been known for a long time. First of all, these are all types of warts that every sixth person on the planet suffers from. 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 defined 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 viruses that contain DNA and exhibit affinity for epithelial cells that form the skin and mucous membranes. Today, about 170 types of the virus 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 developing malignant tumors. Since the 1980s, studies have shown that human papillomavirus infection plays a role in the development of adenocarcinoma and squamous cell cervical cancer (the second type of tumor is more common). In 99% of cases, oncology patients are diagnosed with HPV infection and cells specially modified by the virus.
Papilloma virus penetrates epithelial cells. After penetrating its genome, replication (multiplication of the virus's DNA) begins. At this time, the cells divide atypically and change their structure, which can be seen during cytological analysis.
Papilloma virus manifests itself with specific changes in the epithelium:
- on the skin of the body (vulgar and flat warts, papillomas);
- in the epidermis and mucous membranes of the genitals (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 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 medium risk (30, 35, 45, 52, 56);
- is 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, because there is a risk of developing laryngeal papillomatosis in the newborn if it comes into contact with the mother's mucous membrane during childbirth. Therefore, women and men should undergo an HPV test when planning a pregnancy.
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 requires advanced diagnostics.
Methods of infection
The most common way of infection is sexual. Almost all sexually active adults are diagnosed with HPV. However, in most cases, the infection is transient - the body fights it, and after a year and a half, tests do not detect the virus. Only occasionally does HPV cause minor clinical manifestations and, very rarely, cancer develops years after infection (10-15).
Other ways of infection:
- Contact- by touch. This way you can get warts;
- Internal.The virus remains alive in the external environment for some time. Infection is possible in the bathroom, swimming pool and other public places. The pathogen penetrates through microspots in the skin.
- Vertical.The virus can be passed from mother to child during childbirth. In this case, a newborn baby sometimes develops papillomatosis of the larynx and upper respiratory tract. In some cases, the baby is affected by genital warts.
- Autoinfection.Human papillomavirus infection (HPV) can spread throughout the body from one place to another, for example by shaving or scratching warts.
Stages of development of infection
After infection, the latent phase begins - latent or PVI carriage. At the same time, the virus is inactive, does not manifest itself clinically and is not detected during cytological and histological examination, because it does not multiply its copies and does not change the epithelial tissue. However, its DNA can be detected by PCR analysis.
It is important!
It is not at all important that the latent stage turns 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 a person. However, during cytological analysis, atypical cells are detected, and single condylomas or small papillomas can be seen during the examination.
The third stage is clinical (manifest). Symptoms are pronounced and the disease requires treatment. More often, PVI occurs secretly or subclinically, and obvious symptoms appear under the influence of provoking factors.
The fourth stage (mutagenesis) is the sad result of PVI. During this period, cells become malignant and carcinoma begins to grow.
Causes of papillomavirus activation
PVI infection occurs very easily, but the human immune system fights it well, and often the virus disappears on its own. A persistent infection that worsens periodically 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, thyroid disease) and hormonal fluctuations (pregnancy, menopause);
- Constant stress, long-lasting psycho-emotional stress;
- Poor nutrition, strict diets, lack of vitamins, minerals and complete protein;
- Severe nutritional obesity and sedentary lifestyle;
- Taking drugs that suppress the immune system, exposure to radiation, chemotherapy;
- Primary and secondary immunodeficiencies, HIV;
- Initiation of sexual activity before the age of 16 and intimate contact without discrimination;
- Infection accompanied by other sexually transmitted infections;
- Gynecological procedures that cause mechanical damage to the mucous membrane of the cervical canal (abortion, curettage, spiral installation, etc. ).
The incubation period for PVI is highly variable. The pathogen 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 conditions of infection. A person can be infected with several types of viruses at once and can be constantly reinfected, for example, from a sexual partner.
HPV diagnosis
The first stage of diagnosis is always 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 clear, because these neoplasms are characteristic only of PVI.
Acetic acid test
If the disease is in the subclinical stage, small condylomas may not be visible visually. 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. 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 is required after six months, because the disease may develop. On the other hand, the virus can go into a latent state, and then the manifestations will disappear.
Shiller test
It is performed as part of an extended colposcopy after the acetic acid test. In this case, the fabric areas previously treated with vinegar are stained with iodine solution 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 staining occurs, its characteristic features indicate the diagnosis.
Cytological smear
It is otherwise called the PAP test after its inventor, the Greek physician Papanikolaou. For the test, a scraping is made from the mucous membrane of the cervix (urethra in men) to obtain epithelial cells for analysis. The biomaterial is drawn onto a glass slide, fixed with alcohol, stained and examined under a microscope.
The interpretation of the results is carried out by the doctor, because other information is also taken into account: the results of cytology, PCR analysis, tests for other infections, the presence of inflammation in the vagina, etc. Class 1-2 results are considered negative, that is, morphological changes caused by the virus were not 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 determines the presence of viral DNA in epithelial cells. The study can be carried out with the same biomaterial taken for cytological analysis. The polymerase chain reaction is carried out in a special device, where a predetermined gene sequence is repeatedly copied.
The PCR method is used to detect latent sexually transmitted infections, including HPV, so it is used as part of a screening examination. Genital warts often occur against the background of other venereal diseases. If positive PCR results are obtained, in-depth diagnostics are required.
Because DNA testing is so accurate, its use often leads to overdiagnosis. After all, the detected DNA of the virus does not mean that a person is sick. It could be a new infection that will go away on its own.
Therefore, the PCR test is expanded - a quantitative analysis is performed to find 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 performed to determine the exact type of pathogen. If oncogenic strains are detected, control tests are prescribed after 3-6 months.
Digene test
This method is screening (it is done for initial, primary diagnosis). It also detects viral DNA in tissues. At this time, the oncogenicity of viruses and their number are determined collectively. In combination with cytological smear, the Digene test is the accepted standard in many developed countries to determine the risk of clinically significant HPV infection and cancer.
Histological examination
This is an advanced diagnostic method. A woman is assigned when positive screening results are obtained: cytological analysis showed cells of class 3-4-5. A piece of tissue taken as a result of a biopsy is examined under a microscope.
The research makes it possible to identify cells specifically changed by the virus - koilocytes and dyskeratocytes, as well as cells with signs of a malignant tumor. Thus, histology makes it possible to determine the degree of neoplasia and to identify cancer at early stages when it can be successfully treated.
In some cases, tissues taken from skin and mucous membrane neoplasms are submitted for histological analysis when there is doubt about their nature and quality.
PVI treatment
In the latent phase of PVI, no treatment is required. Detected infection becomes only a reason for observation over time. It should be noted that it is impossible to kill the virus in the body with drugs, because it multiplies inside the cells.
An infected person is advised to:
- avoid factors that reduce immunity, take vitamins;
- recover from sexually transmitted infections, if detected, do not develop chronic diseases;
- leading a healthy lifestyle, giving up bad habits;
- having sex with a regular, reliable partner.
Treatment of human papillomavirus begins at the stage of subclinical manifestations. It is conservative at this stage. Immunomodulatory therapy is usually prescribed. Human interferon drugs or its inducers are used for this purpose.
Non-specific immunomodulators are also effective against HPV. Antiviral drugs are used.
Doctors often prescribe local drugs at the same time - ointments, gels and creams.
It is important!
Immunomodulatory treatment is prescribed by a doctor only based on the results of an immunogram, uncontrolled use of drugs can lead to the opposite result - a malfunction 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 drugs may be prescribed.
Vulgar warts can be removed at home using embalming agents sold in pharmacies.
Treatment prognosis
Contrary to the belief that the virus cannot remain in the body forever and it is impossible to fully recover, doctors give favorable forecasts. Usually, the infection subsides after an individually designed course of therapy, taking into account the oncogenicity of the virus and accompanying diseases.
Relapses occur but are relatively rare unless treatment is stopped. Some people experience one, sometimes several, but shorter and weaker relapses. Constant exacerbations are characteristic only for people with a long-term decrease in immunity due to HIV infection or serious chronic diseases.
Prevention of PVI
Preventive measures are divided into general and special. General recommendations to prevent infection:
- use barrier methods for contraception;
- having sex with a regular partner;
- Do not start sexual activity before the age of 18, because the immune system is not yet fully formed in teenagers;
- Avoid artificial termination of pregnancy.
To date, there is only one specific preventive method - 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 better to start vaccination in adolescence - 9-10 years old.
Reviews of patients
- "I had condylomas, I didn't know about them, " said the gynecologist after the examination. I asked if we will delete immediately, I agreed. Then he prescribed antiviral medicine for me and my husband. Expensive, but we decided: treat yourself to the end. I also did baths with chamomile, string and calendula. Everything has been clean for two years now. "
- "Doctors' attitude to treatment is different. 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 not to treat anything until the age of 30, especially before giving birththere is no need to do it. He only prescribed pills and suppositories. A year later the virus was still in the analysis, but after two years it was gone and the cervix was normal. But after 30, as the second doctor said, the body alreadydoes not recover itself".