HPV (Human Papilloma Virus) is a virus that causes changes in the cells of the skin and mucous membranes, such as warts and genital warts. Abbreviation: HPV (written in analyzes).
Over the past 50 years, more than 100 species of human papillomavirus have been discovered. Of which 80 species are pathogenic for humans.
The source of the I virus is the altered cells of a sick person. At the same time, visually, a sick person may not yet have manifestations on the skin in the form of warts (or genital warts). Despite the fact that there are no visual manifestations, they can be microscopic, such a person is contagious and can already transmit the virus to another person.
Earlier infection occurs in childhood. On the skin, through abrasions and scratches, the virus enters the body and causes warts in children.
The development of genital warts in adults is caused by certain types of HPV virus. Sexual transmission mechanism. The virus is transmitted from a sick person to his partner through microtrauma on the mucous membranes.
In most cases, human immunity is able to fight this virus itself. The mechanism of action is as follows - the virus entering the human body meets the cells of the immune system on its way, which in most cases destroy the virus.
If the immune system fails, the virus enters the cells of the basal layer of the epithelium of the skin or mucous membranes, then it integrates into the chromosomes of cells and changes their work. As a result, cells begin to rapidly divide and grow in certain areas of the skin, forming warts or condylomas.
Remember:
- types of HPV that cause the formation of warts enters the body in childhood through microdamage of the skin
- the types of HPV that cause the formation of genital warts enter the human body mainly through sexual intercourse
In some cases, human papillomavirus infection can lead to degeneration into cancer. All types of papillomaviruses are classified according to the degree of possible cancer development.
HPV classification by type of oncogenicity
1.Types of papillomavirus that never cause HPV cancer 1.2.3.4.5.10.28.49
2. Types of papillomavirus that have a low oncogenic risk (very rarely causing cancer) HPV 6.11.13.32.40.41.42.43.44.51.72
3. Types of papillomavirus that have an average oncogenic risk of HPV 26.30.35.52.53.56.58.65
4. Types of papillomavirus that have a high oncogenic risk (most often give rise to degeneration) HPV 16.18.31.33.39.45.50.59.61.62.64.68.70.73 Most often found in women.
Percentage incidence of cervical cancer
1.73-90% of cases find HPV 16.18 and 45
2.77-93% of cases find HPV 16.18.45.31.59
3.80-94% of cases find HPV 16.18.45.31.33.59
Also 61.62.68.70.73 HPV type are combined in precancerous conditions in urology and gynecology.
The most common types of HPV
50% human papillomavirus 16 (spelled HPV 16)
10% human papillomavirus 18 (HPV 18)
Clinic and symptoms
At an early stage, human immunity is strong enough to overcome the virus on its own at an early stage of development. After months, and possibly decades, people may develop symptoms of HPV infection.
A) Warts: cause HPV types - 1.2.3.4.5.10.28.49.
juvenile (or flat) warts - caused by types 3 and 5 of the virus. These are small flat bumps on the skin, occur mainly in children.
Spines (or plantar warts) - caused by types 1 and 2 of the virus,
vulgar warts on the fingers - caused by type 2 viruses.
B) Papillomatosis of the larynx. Multiple growths-papillomas on the larynx ligament. Sometimes appears in children born to women with genital warts. Caused by a type 11 virus.
C) Genital warts, in the anus, in the mouth and on the lips (types - 6. 11. 13. 16. 18. 18. 31. 35). The main mechanism of transmission in adults is sexual.
D) Bowenoid papulosis. Called by types - 16. 18. 31. 33. 42. 48. 51. 54. More often develops in men who constantly change sexual partners. Small flat warts (somewhat similar to flat warts) appear around the genitals.
E) Cervical intraepithelial neoplasia (or dysplasia) of the cervix and cervical cancer are more severe clinical manifestations of HPV infection in women. The most common manifestations of the malignant course of this infection.
Remember:
Erosion of the cervix and HPV are NOT the same thing.
Modern medicine with 100% confidence declares that cervical cancer is caused exclusively by papillomaviruses of types 16. 18. 31. 33. 35. 39. 40. 42. 43. 55. 57. 59. 61. 62. 66. 67.
E) Bowen's disease - cancer of the skin of the penis. It is caused by the types of the virus - 16 and 18.
G) Today, some foreign scientists believe that the human papillomavirus is the cause of cancer of any localization. Cancer is a malignant tumor of the epithelium of the skin or mucous membrane, therefore, the HPV virus, which causes dysplastic phenomena just in the epithelium, causes the appearance of cancer. And with cervical cancer it's 100% proven.
Remember:
Any viral infection that is constantly in the human body (and HPV refers to just such), is activated only with a decrease in immunity.
Diagnostics
1) PCR analysis. The main method for diagnosing papillomavirus is the PCR reaction. The most common types of analysis for HPV are 16, 18 types of the virus, as well as a number of other highly oncogenic types.
In men - from the mucous membrane of the penis. Material for analysis is taken from the mucous membrane of the vagina and cervix of a woman.
However, the PCR reaction can give a false result, and both a false positive and a false negative result. And this fact does not depend on the complexity of the equipment and on the quality of the reagents.
2) Digene test. This test is used to determine the presence of clinically relevant virus concentrations. Moreover, thanks to this test, it is possible to identify - a high degree of oncogenicity in viruses or low.
The Digene test is used in conjunction with a cytological examination of the cervix.
3) Examination by a gynecologist, urologist and dermatovenerologist if genital warts or other warts are found in the groin area.
4) Cytological examination of a smear taken during a gynecological and urological examination.
5) Histological examination of a microscopic piece of tissue. The doctor evaluates the degree of change in the tissue taken for examination.
Treatment
Necessarily!
1. Removal of manifestations - warts, genital warts, dysplasia (erosion) or cervical cancer.
2. Taking antiviral drugs.
3. Strengthening the immune system.
Self-medication can lead to progression!
1) Removal
Removal with chemically aggressive liquids
2) Antiviral drugs
3) Drugs that increase immunity
Remember: First, the doctor must make the correct diagnosis and only he can prescribe the correct treatment for you!
HPV and pregnancy
If papillomavirus infection is detected during pregnancy:
the first is to find a gynecologist and be observed with him until the very birth,
the most important thing is what a woman's manifestations are, the doctor's tactics will depend on this,
the virus does not affect the fetus in any way,
during childbirth, the child can become infected by passing through the birth canal (although this is extremely rare),
in the presence of pronounced manifestations on the cervix of the uterus, a pregnant woman may be offered a cesarean section,
in the absence of manifestations - childbirth in a natural way.
Prevention of HPV
Nature has come up with a wonderful mechanism of cure and prevention for a person, which then helps him not to get sick again. It's the immune system.
If a person has already had warts or papillomas once, then subsequently he develops immunity to this type of virus. Therefore, juvenile warts, spines and vulgar warts very rarely appear in adults.
Therefore, it is SO IMPORTANT to maintain your immunity at a high level.
The main directions of prevention of human papillomavirus infection
Only one sexual partner
Condom use during sexual intercourse
Personal hygiene measures in public places
A healthy lifestyle that supports high immunity
The correct mode of work and rest
Moderate physical education
Taking vitamins, fruits, juices
Vaccination against types 6, 11, 16, 18 - prevents the development of symptoms such as genital warts, neoplasia (dysplasia, or erosion) and cervical cancer, laryngeal papillomatosis. But the effect of the vaccine has not yet been fully understood. They began to put it only 8 years ago. In addition, it forms immunity not to all highly oncogenic types of papillomaviruses.
Papilloma is understood as a benign tumor of the skin, its structure contains blood vessels and connective tissue covered with epithelium, which grows upward and outward and the absent-mindedness of the papillae in different directions resembles cauliflower. If a person has many papillomas, this condition is called papillomatosis.
What is papilloma?
This is a type of tumor that develops from squamous epithelium and protrudes above the surface of the skin in the form of a papilla. They can be found on the skin, oral mucosa, nose, sinuses, pharynx, vocal cords, bladder, and genitals. Papilloma looks like a growth, up to 1-2 cm in size, in the form of a dense or soft tumor on the leg, its surface is uneven, reminiscent of cauliflower.
Papilloma of the skin can have a different color - they differ in color from white to dirty brown, if it is found on the skin of the face and neck, then this causes a cosmetic defect. There are other places of occurrence, for example, if papilloma occurs on the laryngeal mucosa, this can lead to impaired voice or breathing.
Description of human papillomavirus
Most often, the appearance of papillomas is caused by the human papillomavirus (HPV), which is a DNA virus that has the shape of an icosahedron, consisting of 72 capsomeres. Belongs to the Papovaviridae family. Possesses tropism for human epithelial cells (cells of the skin and mucous membranes). The genome of the virus consists of double-stranded, coiled DNA. The virus has no envelope, the diameter of the virion is 55 nm. It can exist for a long time on the surface of various objects, as well as in water and air.
A distinctive feature of HPV is its tissue specificity. Studied about 100 types of human papillomavirus, each of which affects specific tissues. Also, certain types are highly oncogenic, medium oncogenic and low oncogenic. The oncogenicity of HPV is understood as its ability to cause the transformation of the virus-infected epithelial layer into cancer.
The types of human papillomavirus are designated by numbers. The viruses of low oncogenic risk include types 6, 11, 42, 43, 44 and 73. Viruses of types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, 68 are classified as dangerous species capable, under certain conditions, of causing a malignant process. The most unfavorable types are 16 and 18 HPV types. They are responsible for the development of squamous cell carcinoma of the cervix and adenocarcinoma, respectively.
HPV does not multiply in cell culture. The introduction of the virus occurs in the basal cells of the epidermis, as well as the cells of the mucous membrane, where the virus accumulates and replicates. Further, the persistence of the virus occurs in various layers of epithelial tissue, followed by the activation of the mechanisms of carcinogenesis.
How papillomavirus is transmitted
For the penetration of the papillomavirus into the epithelial tissues, direct contact of the virus with the skin or mucous membranes is necessary.
Most often, infection occurs in the presence of microtraumas:
1. during traditional sexual contact with a person who not only has clinical or subclinical manifestations of HPV infection, but also with virus carriers.
2. during anal and oral sex.
There is a household route of infection, through the hands of an infected person, household items - but data on household infection are currently not confirmed. Infection can occur in public places such as baths, swimming pools. Self-infection (autoinoculation) is possible during shaving, epilation, nail biting in the presence of HPV manifestations of other localization.
Infection of newborn babies occurs during the passage of the birth canal of an infected mother as a result of aspiration of the contents of the vagina and cervical canal. In addition, there are known cases of infection of children born by cesarean section, which does not exclude the possibility of intrauterine infection. An airborne mechanism is not excluded, since in our practice we have repeatedly observed cases of infection of medical workers who performed surgical interventions on patients with HPV (radio wave coagulation, laser vaporization).
Infection during medical gynecological and urological examinations is possible only when using non-disposable medical instruments and gloves.
There is evidence that infection can occur in people who are engaged in butchering carcasses, processing meat and fish. In this case, a disease occurs, which is called "butcher's warts."
Previously, it was believed that the causative agent of this disease is transmitted strictly sexually, however, with the introduction of the polymerase chain reaction into everyday practice, data appeared on the possible transmission of this virus from mother to child during pregnancy and childbirth. It is unlikely, but the possibility of transmission of the virus through the blood, through the household and during breastfeeding is not completely ruled out. However, the main route of transmission of the papilloma virus is still the sexual route.
Penetrating into the human body, HPV spreads through the bloodstream and is fixed on the epithelial cells of the genitals, perineum or in the anus. The virus then enters the epithelial cell and invades its DNA, making the cell work differently. The damaged cell begins to grow and divide intensively, as a result of which, after a while, growth characteristic of the disease occurs.
The incubation period for human papillomavirus is usually 2-3 months, but still, under certain circumstances, this time can be reduced or increased up to several years.
The virus lives and manifests itself on the skin and mucous membranes and is transmitted from these areas by contact - by touch. Thus, HPV is not a sexually transmitted disease, and when infected, you should not blame your partner for cheating. Naturally, sexual intercourse is also the reason for the contact transmission of the virus, but the human papillomavirus could be transmitted to you in the household. In addition, HPV can live in the body for a long time, even from birth, and appear for the first time in the middle of life due to a decrease in immunity. So, you should not associate the first manifestation of the virus with a recent infection - it could have happened quite a long time ago, although you did not know it.
The virus is easily transmitted - both by the modes of transmission and by the frequency of infection. Therefore, its prevalence among people is very high. Most people are infected with the human papillomavirus and infect others; a third of women of childbearing age undergoing routine examination have external manifestations of papillomavirus infection - genital warts. Therefore, if you are diagnosed with human papillomavirus infection, do not be surprised. The presence of this virus in the human body is more common and expected than its absence.
Human papillomavirus infection
Human papillomavirus infection (PVI) is a disease caused by the human papillomavirus (HPV) that develops on the skin and mucous membranes.
With the introduction of the virus, cell proliferation is formed in the form of warts, papillomas, warts of various shapes. About 50% of sexually active people have acquired papillomavirus at least once in their life. In most cases, the infection either does not manifest itself in any way, or its symptoms disappear within 1 to 2 years. In some cases, self-healing is possible, although, as a rule, a chronic recurrent course of the disease is observed.
PVI is one of the most common urogenital sexually transmitted viral infections, characterized by the variety of its clinical manifestations. There are about 100 types of the virus, at least 30 of which affect the anogenital area.
Penetrating into the human body, papillomaviruses lead to the development of various tumors. Depending on the type of virus - introsomal or episomal - they can provoke the formation of a benign or cancerous form. Human papillomavirus infection is an inducing factor in the development of malignant lesions of the cervix (cervical cancer), vulva and vagina in women and penile tumors in men.
In addition to clinical and subclinical forms, with this type of infectious process, the so-called carriage is quite common, without bright manifest forms of the disease. Such forms are detected by chance, during the survey - this is 30% of the healthy population!
The papilloma virus can manifest itself anywhere: under the armpits, on the neck, under the breasts in women, on the eyelids. It also appears on the mucous membrane of the mouth, nose, paranasal sinuses, pharynx, on the vocal cords and in the bladder, and can affect the mucous membranes of the stomach and intestines. But most often, condylomas like to settle on the genitals.
In addition to the cosmetic inconvenience and discomfort that they can provoke, growing, papillomas are extremely dangerous with the likelihood of developing cancer, especially in women. Sometimes they cause bleeding, and located on the lining of the larynx, they lead to a violation of the voice or breathing.
Men and women are equally infected. Most often, human papillomavirus infects people with weak immune systems.
The risk of infection increases in those who lead a promiscuous sex life, have bad habits, for example, smoke a lot, abuse alcohol, as well as in women who use oral contraceptives for a long time. Recently, this virus has been activated in quite young people, not only after sexual intercourse, but also after various internal shocks - prolonged use of drugs, flu, gastrointestinal problems, when visiting the pool, on the beach - that is, where there is high humidity and the skin is practically unprotected by clothing.
You can also get infected from people with whom you live together or are in close contact - after all, any person can be a carrier of the virus.
During childbirth, the papilloma virus is almost guaranteed to pass from mother to child. Therefore, close people need to be treated all together at the same time, otherwise the disease will not get rid of.
Papillomavirus symptoms
It is characterized by papillomatous formations on the skin and external mucous membranes. The papilloma virus even takes part in the formation of calluses on the legs. The papillomavirus manifests itself in different ways during a person's life. First, these warts are common, juvenile warts, condylomas.
Following an ordinary wart on the skin, mucous membranes, papillomas on a thin stalk usually appear. Most often they occur under the armpits, on the neck, on the eyelids. Papillomas, moles and any other skin neoplasms must be removed prophylactically, without waiting for their degeneration into a disease.
The virus infects the lowest deep layer of the skin or mucous membrane, an increased multiplication of the cells of this layer occurs, which leads to the formation of growths. The virus itself does not multiply in the deep layers, its intensive multiplication occurs in the surface layers - in squamous cells, which, as they are pushed to the surface, stop dividing and become more suitable for virus reproduction.
Genital warts (Сondylomata acuminata). They are caused by the papillomavirus (HPV 6.11) type. The most common manifestation of human papillomavirus infection. The route of transmission is predominantly sexual.
Localization in men - the foreskin, coronal groove of the glans penis, in women - the vestibule of the vagina, labia minora and majora, anus.
Diagnostics of the human papillomavirus
Recent years have been marked by significant advances in the diagnosis and treatment of human papillomavirus infection, and a prophylactic vaccine against the human papillomavirus, Gardasil, has been created. Other vaccine preparations are under development. This made it possible to systematize data on papillomavirus and associated diseases and to come closer to creating a unified algorithm for managing HPV-infected patients, and to develop treatment tactics. All the ways of HPV infection have been studied, many mechanisms of the pathogenesis of the infectious process, morphological changes, and the state of the human immune system have been identified. Compliance with all preventive measures in order to reduce the number of diseases caused by papillomavirus is of great importance.
At the moment, there are still no uniform rules for the diagnosis and treatment of patients with PVI. Since the manifestations of papillomavirus are diverse and cover different localizations, doctors of various specialties are engaged in diagnostics. In this section, we will focus on the algorithms and method for diagnosing VPI of the urogenital zone.
The following are subject to examination:
1. Sexually active men and women of any age (especially those who have multiple sexual partners and early sexual debut).
2. Men and women who have symptoms of other infectious and inflammatory processes, such as gonorrhea, chlamydia, syphilis, HIV infection, etc.
3. Men and women who have been reliably proven to have risk factors for HPV infection.
4. Men and women with exophytic formations in the anogenital area and oral cavity.
5. Women with cervical pathology of any etiology.
6. Men and women undergoing routine examination before planning pregnancy.
Diagnosis of PVI should be thorough and multi-stage, while it is desirable to deviate from routine examination methods. In some cases, the diagnosis of diseases caused by papillomavirus is not difficult. In some situations, the detection of a virus is an accidental find.
The methods of examination and diagnosis of papillomavirus are divided into the following:
1. Visual inspection of the foci of the alleged lesion.
2. Colposcopy and the use of a magnifying glass.
3. Cytological examination.
4. Molecular biological methods.
5. Histological methods.
The complex of examination for PVI should include mandatory tests for the diagnosis of syphilis, HIV and hepatitis. Microscopy of smears from the urethra, vagina and cervical canal, PCR and bacteriological methods of studying other sexually transmitted infections are also needed.
Diagnosis of PVI does not cause any particular difficulties - papillomas are detected during standard examinations by a dermatologist or gynecologist. In order to make sure of their viral nature, PCR is used - a special method of research that allows you to identify viral particles in smears from the mucous membrane of the vagina or cervix, scrapings. If the corresponding symptoms of the papilloma virus are found, a targeted biopsy is performed. Diagnostics requires the earliest possible detection of the presence of human papillomavirus in the anogenital area with testing of HPV serotypes with oncogenic marecr, as this can lead to cancer.
PVI treatment
Diagnosis of HPV requires early detection of the presence of papillomavirus in the anogenital area with testing of human papillomavirus serotypes with oncogenic marecr, as this can lead to cancer.
Removal of papillomas (genital warts, warts) does not relieve the patient from their secondary appearance. HPV is a viral disease and a person remains a carrier of the virus for several years. Therefore, in terms of preventing the disease, it is necessary to heal the entire body as a whole.
It should be noted that when a virus is detected in human blood, treatment is not always prescribed. If HPV is present in the body, but examination shows that there are no symptoms, then treatment is usually not carried out, except for a course of immune-strengthening therapy, if necessary.
The cause of papilloma is a viral infection, therefore, successful treatment of the human papillomavirus is possible only with competent antiviral and immunomodulatory therapy. There are several methods to eliminate papillomas and condylomas.
In clinics for the treatment of warts and papillomas, the most common methods of removal are laser, treatment of viral papillomas with nitrogen (cryodestruction) and radio wave treatment. All of them allow you to remove papillomas and genital warts. Patients are usually encouraged to undergo laser or radio scalpel treatment. Both of these methods ensure the sterility of the procedure and allow you to achieve the highest quality aesthetic result, which consists in the absence of scars and scars after removal of papillomas. The laser also has additional qualities. The laser beam is unsurpassedly accurate, in the process of exposure to disinfect the wound and stimulate the internal resources of the skin for smooth healing. The laser is an ideal method even in "gynecology" for treating papilloma in the external genital area, as well as for treating papillomavirus infection in men, since the special qualities of the laser beam ensure quick healing.
After treatment, the removed neoplasm can be sent to the laboratory for histological examination.
Still, it is necessary to remember that getting rid of skin papillomas does not mean a complete cure for the human papillomavirus. Medicine does not yet know how to completely eliminate HPV from the human body, therefore, under favorable conditions, papillomas may reappear. In order to avoid this, it is necessary to lead a healthy lifestyle, supporting the immune system. And modern technologies can help with this.
After the elimination of papilloma, immunomodulatory therapy is carried out, which consolidates the result. It provides a multiple decrease in the activity of the virus and the prevention of the emergence of new growths on the skin.
Medicines often used for HPV are interferon agents: substances that are produced by the human body to protect against viral infections. Also, for the treatment of PVI, an innovative tool is used - ozone therapy. Ozone droppers strengthen the immune system and freeze the activity of the virus. So papillomavirus infection is cured for 5-10 years. To all its advantages, ozone therapy is an excellent regenerator and excellent stress reliever.
When treating papillomavirus with a high carcinogenic risk, additional consultation with an oncologist is required. Treatment of HPV 31, 33, 16, 18, 56 types is accompanied by a mandatory cytological examination, and without fail includes the removal of genital warts and antiviral treatment.
All patients should be prescribed medications that are designed to ensure smooth healing of the skin. Only in this case, the treatment of papillomatosis of the skin can be recognized as successful.
Thus, the treatment of papillomavirus infection of the anogenital zone includes the following measures:
1. Destructive interventions aimed at the destruction of exophytic neoplasms and altered epithelial layer.
2. Use of immunomodulating and immunostimulating drugs.
3. The use of antiviral drugs (acting on the processes of replication, transcription and transformation of DNA).
4. The use of cytotoxic drugs.
5. Photodynamic therapy (not used in general practice).
6. Therapeutic vaccination (the method is in clinical trials).
7. Symptomatic and complementary therapy (treatment of concomitant diseases).
In the presence of exophytic genital warts, both in men and women, in cases where the clinical picture is typical, it is necessary to carry out a combination treatment. In this case, in any case, the removal of the formations is shown. Before removal, for several days, various drugs are prescribed (interferons, immunomodulators, inducers of endogenous interferon, antineoplastic agents), however, there is no convincing data on the pronounced therapeutic effect of using these treatment regimens. This treatment regimen is called combination therapy.
Removal should be carried out using radio wave coagulation or laser coagulation. The use of local chemical preparations for the destruction of formations often does not lead to the desired effect, but only on the contrary creates certain difficulties in subsequent treatment, which leads to the need for repeated exposure. In turn, chemical destruction leads to the development of a large area of scar tissue. This is due to the fact that it is impossible to control the entire removal process. It is worth saying that the removal of formations by any method should be carried out simultaneously.
With subkinic forms of papillomavirus, treatment is carried out according to all the principles of treatment of exophytic formations, provided that the doctor fully estimates the volume of tissue damage. Otherwise, it is more expedient to conduct dynamic observation. In addition, in such cases, the use of local immune therapy is justified.
Latent PVI does not require specific treatment. This is especially true for young women and men. A significant proportion of these patients self-purify from papillomavirus within 1-2 years. Medical treatment is ineffective, expensive, and unjustified. However, in 10-15% of cases, negative dynamics is noted, which leads to the development of clinical forms of the disease. Most often this occurs in the presence of unfavorable factors, such as the presence of other concomitant infectious and inflammatory processes of the anogenital zone or re-infection. It is also possible that the development of manifest forms of PVI is facilitated by disorders of the immune system, as well as various chronic diseases, especially from the endocrine system (diabetes mellitus).
The prognosis is usually positive. In some cases, after removal of the papilloma, relapses and malignancy are likely. If genital warts are detected, treatment with chemicals (podophyllin, podophyllotoxin) or surgical removal is performed. It is not uncommon for condylomas to disappear without treatment. Genital warts are small, flesh-colored growths that can occur on the genitals, around the anus, and sometimes in the mouth.
Risk factors for PVI
Among the risk factors in the first place are the characteristics of sexual behavior. This is an earlier onset of sexual activity, frequent change of sexual partners, a large number of sexual partners, neglect of condom use. In addition, there is irrefutable evidence that PVI is almost always found in association with other sexually transmitted diseases: chlamydia, trichomoniasis, genital herpes, myco- and ureaplasmosis.
Most often papillomavirus infection occurs in young people 18-30 years old. At the same time, the phenomenon of elimination (self-destruction of the human body from the virus) is known in young people under the age of 25. Elimination can reach 70%, and its duration is about 8 months, provided the re-infections cease. In this case, the elimination of the clinical manifestations of HPV infection can also take place. The maximum of malignant processes of the cervix occurs at the age of 45-50 years.
Among the features of the manifestations of human papillomavirus infection is that the clinical forms of the disease tend to recur. The same patient can have several types of papillomavirus at the same time. Human papillomavirus infection in pregnant women is of particular importance.
Prevention of human papillomavirus infection
Prevention of papillomavirus has a great impact on reducing the risk of cervical cancer in women and penile cancer in men. Currently, PVI prevention is divided into the following options:
1. Primary prevention. It consists in the timely identification of various risk factors for infection and the spread of infection, the development of prevention methods. This also includes the methodology for the development of preventive vaccines against papillomavirus.
2. Secondary prevention. This section includes the development and implementation of screening diagnostic programs, which makes it possible to detect the disease as early as possible.
3. Tertiary prevention of papillomavirus. Aimed at reducing the frequency of possible relapses of already infected patients.
The most important aspect of PVI prevention is health education among adolescents who are just beginning to have sex. In the first place is an explanation of the main aspects of this disease, its complications and dangers.
Among the most effective and simple methods of preventing infection with the human papillomavirus HPV is the use of barrier methods of contraception during sexual intercourse with new partners, as well as a preliminary comprehensive examination of sexual partners before starting a regular sex life. In case of detection of human papillomavirus infection, it is necessary to recommend examination of all sexual partners for the last 6-12 months.
An extremely important link in primary prevention is vaccination against papillomavirus, and the maximum effect is obtained with the introduction of the vaccine before the onset of regular sexual activity. The Gardasil vaccine is registered and used in Russia.
Secondary prevention of PVI includes screening programs. The main task of this link is to identify potentially dangerous diseases of the cervix that can lead to cancer. The best research methods are the Pap test, which is simultaneously performed with the detection of HPV by PCR diagnostics or HPV Digene test, as well as colposcopic examination.
Human papillomavirus and pregnancy
During pregnancy, women infected with papillomavirus have a greater percentage of the development of clinical forms of the disease, and exophytic warts reach large sizes. At the same time, they often disappear spontaneously after childbirth. This is due to a change in the hormonal background, which leads to increased tissue vascularization, a violation of the ratio of indicators of vaginal microbiocenosis and, possibly, an effect on the functional activity of the immune system.
Before planning a pregnancy, it is imperative to conduct a study in order to exclude PVI. The examination plan should include HPV PCR diagnostics or Digene Test. Colposcopy and cytological examination are mandatory in all cases of PVI. If during pregnancy the presence of cervical dysplasia of all degrees is revealed, then it is immediately worthwhile to carry out anti-inflammatory and antiviral therapy, at the end of which the Pap test should be performed again.
Latent HPV infection is not a contraindication for planning pregnancy. But in cases where there are various clinical forms of the disease, treatment is indicated before pregnancy.
PVI treatment in pregnant women should be carried out in the 1st trimester. In the presence of eexophytic warts, their removal is indicated, since in the later stages of pregnancy it is possible to expect their rapid growth. This is fraught with various complications during the further course of pregnancy and childbirth. In addition, during the passage of the birth canal, infection of the child is possible with the subsequent development of papillomatosis of the larynx.
And although it is recommended to remove genital warts using chemical destruction methods, preference is given to removing genital warts by radio wave coagulation. Before removal, it is necessary to sanitize the vagina. The appointment of immunostimulants and immunomodulators is not unambiguously approved. Topical preparations are usually used.
After removal of genital warts until the moment of delivery, constant monitoring by a doctor and repeated manipulations in case of relapse are shown. At the same time, the treatment of concomitant inflammatory diseases of the pelvic organs, the normalization of the vaginal microflora is carried out.
In cases where active manifestations of PVI, including CIN 1 and 2, are detected during pregnancy, termination of pregnancy is most often not performed. After treatment, colposcopy and cytological examination are performed again. If CIN 2-3 is detected at short stages of pregnancy, it is optimal to provide termination of pregnancy and appropriate treatment. However, the tactics may be different, the decision is made specifically in each case, based on the duration of pregnancy, the patient's age, clinical picture data and examination. In this case, consultation with an oncologist is mandatory. It is possible to carry out microconization of the cervix during pregnancy, followed by delivery by cesarean section.
In the presence of cervical cancer during pregnancy, provided that the depth of tumor invasion does not exceed 3 mm, conization of the cervix is performed (shallow). The removed part of the cervix is subjected to histological examination. The tactics are determined after receiving the histology data in conjunction with the oncologist. Radical surgeries are performed 4-6 weeks after delivery. It should be said that there is no absolutely unified tactics for the treatment of such diseases, and the decision is made individually.
Malignant diseases develop in patients for various reasons. One of the main adverse factors leading to cancerous processes is HPV infection. Strains of high carcinogenic risk are the most dangerous.
HPV type 68: what is it?
This type is considered one of the most dangerous, as it is often found when diagnosing cancer of the genital organs in patients. You can become infected with HPV 68 through unprotected sex, the use of other people's objects.
The pathogen is a threat to both men and women. HPV type 68 DNA quickly penetrates the genetic material of cells and provokes the multiplication of atypical structures. When infected with strain 68, the following pathologies can develop:
- phallus oncology;
- cancer of the urinary tract;
- dysplasia or cancer of the cervical canal;
- malignant degeneration of vulvar tissues.
Features of HPV 73 types
This strain of the pathogen is also considered oncogenic, but it rarely leads to the formation of malignant tumors. According to statistics, from the moment of infection with HPV 73 until the first signs of its vital activity appear, it can take about 20 years.
Clinically, this type of pathogen manifests itself in the form of flat papillomas located on the surface of the cervix. The formations do not differ in color from healthy epithelium, therefore, even an experienced gynecologist is not easy to notice them during an objective examination. If there is a suspicion of infection with genotype 73 HPV, colposcopy is recommended.
Papillomavirus treatment 68, 73
Therapeutic tactics involves an integrated approach. Together with drug treatment, destructive methods are prescribed. The latter can be physical (electrocoagulation, cryodestruction, laser exposure, radiotherapy) or chemical - treatment of growths with concentrated substances.
Drug treatment of HPV 33 and 68, 73 strains involves the appointment of antiviral agents - Genferon, Acyclovir, Panavir. They are combined with immunostimulating drugs - Amiksin, Lavomax, Groprinosin. Such a complex allows you to suppress the virus and prevent its reproduction.
Even after such treatment, there is a likelihood of re-infection with the papilloma virus 68, 73, therefore, preventive measures should be followed after complete recovery. Only vaccination will help to avoid infection, which is recommended at the age of 9 to 26 years. For this purpose, the drugs Gardasil, Cervarix are used. Under their influence, antibodies to the pathogen are produced, which remain in the body forever, which makes it possible to avoid infection with the papillomavirus.
Human papillomavirus (or HPV) is a family of viruses that cause warts, papillomas, dysplasia, or cancer of the cervix and genital organs in humans. This is the most common viral infection of the genital area.
Common family: Papillomaviridae. Latin name: Human Papillomavirus.
Abbreviation: HPV (as written in analyzes).
For doctors and students: the whole history of changes in the classifications of papillomaviruses on the website of the International Committee on Virus Taxonomy - link.
What is this virus?
- For 50 years, more than 100 types of human papillomavirus have been discovered. Pathogenic for humans - 80 types.
- According to WHO, 70% of the world's population is infected with HPV by the age of 50.
- In children, papilloma viruses cause warts.
- In women, HPV types 16 and 18 are more likely than other types to lead to cervical cancer. Every year, 500,000 new cases of cervical cancer are diagnosed worldwide.
- HPV is overwhelmingly the cause of genital cancer in women and men.
- It will not be possible to completely and permanently cure HPV. It is possible to suppress its development only for a while and prevent the appearance of formations.
- The most effective prevention against cervical and genital cancer worldwide is considered to be a vaccine against types 6, 11, 16 and 18 of papillomaviruses.
This is what HPV looks like under an electron microscope.
How does the infection take place?
The source of the virus is the skin cells of a sick person. Not blood! Not saliva! Only skin cells or mucous membranes.
If a patient has a papilloma, even of a small size, it is this that is the direct source of the virus!
In this case, the patient may not yet have a warts or condyloma during examination. Changes may still be microscopic, not visible to the eye (subclinical stage of the disease). But such a person can already transmit the virus to another person.
Infection usually occurs during childhood. Through microdamage to the child's skin (scratches, abrasions), the papillomavirus penetrates the skin and causes the appearance of warts. About what types of warts are, we read here: link.
In adults, certain types of the virus (discussed below) cause the development of anogenital warts, or genital warts (genital warts). The transmission mechanism of these types is predominantly sexual.
But theoretically, a contact-household transmission route is also possible - through general hygiene items, the rim of the toilet bowl, taking a bath, visiting a bathhouse, pool, etc.
Through microtrauma of the genitals, the virus is transmitted from one sexual partner to another. In this case, the patient also may not have any changes visible to the eye. But there can be microscopic changes on the genital mucosa. And these altered cells are the sources of the virus.
Then the virus enters the skin or mucous membrane and is met by various cells of the human immune system. In most cases, the immune cells destroy the virus. Read more about the work of the immune system.
But if the immune system is weakened, the virus manages to penetrate the cells of the basal layer of the epithelium of the skin or mucous membranes, HPV DNA is embedded in the chromosomes of cells and changes the work of these cells. The cells begin to divide excessively and grow in a limited area, outwardly turning into warts and papillomas.
The incubation period can be short - 3 months, or it can last for years. That is, there is a virus in the body, it can be present in only a few epithelial cells. But the immune system is strong enough to prevent it from developing into a full-fledged formation visible to the eye.
This is how the papilloma virus develops in the skin.
Remember
The HPV types that cause warts enter the body during childhood.
HPV types that cause genital warts enter the body mainly through sexual intercourse.
In rare cases, the development of human papillomavirus infection in the human body can lead to malignancy (that is, degeneration into cancer). Therefore, all types of papillomaviruses are classified according to the degree of oncogenicity (that is, according to the degree of possible development of cancer).
HPV types oncogenic and non-oncogenic
(according to research McConcl DJ, 1991; Lorincz A. T., 1992; Bosch E X. et al., 2002; Kozlova V. I., Puhner A. F., 2003; Syrjanen S., 2003; Shakhova N. M. et al., 2006;).
- Non-oncogenic HPV types that never cause cancer: 1, 2, 3, 4, 5, 10, 28, 49
- Low-oncogenic HPV types (very rarely cause cancer): 6, 11, 13, 32, 34, 40, 41, 42, 43, 44, 51, 72
- Types of average oncogenic risk (percentage of cancerous degeneration is average): 26, 30, 35, 52, 53, 56, 58, 65
- Highly oncogenic HPV types (the risk of cancerous degeneration is high): 16, 18, 31, 33, 39, 45, 50, 59, 61, 62, 64, 68, 70, 73. This is especially important in women.
By the way, sometimes the classification changes. For example, HPV type 58 in women is no longer highly oncogenic. He began to be classified as a type with medium oncogenicity.
Occurrence in diseases
- In 73-90% of cases with cervical cancer, they find: 16, 18 and 45 HPV type
- In 77-93% of cases with cervical cancer, they find: 16, 18, 45, 31 and 59 HPV type
- In 80-94% of cases with cervical cancer, they find: 16, 18, 45, 31, 33 and 59 HPV type
- Precancerous conditions in urology and gynecology are often combined with 61, 62, 68, 70, 73 HPV types.
Most often found in analyzes
- human papillomavirus 16 (spelled HPV 16) - 50%
- human papillomavirus 18 (HPV 18) - 10%
HPV 16 and 18 types
Symptoms and clinic
Symptoms and manifestations of HPV infection are warts, papillomas, dysplasia, and cervical cancer. Different types of viruses - different manifestations in patients.
1. Warts
They are caused by the following types of HPV - 1, 2, 3, 4, 5, 10, 28, 49.
- juvenile (or flat) warts - caused by types 3 and 5 of the virus. These are small flat bumps on the skin, occur mainly in children. This type of warts is described in detail.
- spines (or plantar warts) are caused by types 1 and 2 of the virus (you can read more about them).
- vulgar warts on the fingers - caused by type 2 viruses (detailed article about them).
2. Genital warts
Localization: on the genitals, in the anus, in the mouth and on the lips (types - 6, 11, 13, 16, 18, 31, 35). Read more about these warts -.
The main mechanism of transmission of this disease in adults is sexual. Very rarely, there can be a contact transmission path - through shared toilet items, through a dirty toilet rim, using a shared bathroom, in a bath, etc.
If a child is born to a mother suffering from genital warts, he also becomes infected and subsequently he may also develop genital warts or papillomatosis of the larynx and respiratory tract (discussed above). However, the incidence of these symptoms in infants is extremely low. Children have a fairly high level of immunity, which protects them from such manifestations of infection.
3. Papillomatosis of the larynx
Small flat warts (somewhat similar to flat warts) appear around the genitals. It develops more often in men who constantly change sexual partners. Called by types - 16, 18, 31, 33, 42, 48, 51, 54.
5. Dysplasia and cervical cancer
More formidable clinical manifestations of HPV infection in women are cervical intraepithelial neoplasia (CIN, or dysplasia) of the cervix and cervical cancer (see photo). This is the most common type of malignant course of this infection. A more detailed article on CIN and dysplasia -.
In the photo - cervical cancer
Remember
Erosion of the cervix and HPV are NOT the same thing. A detailed article on what is cervical erosion and how it differs from dysplasia and HPV -.
Modern medicine with 100% confidence declares that cervical cancer is caused exclusively by papillomaviruses of types 16, 18, 31, 33, 35, 39, 40, 42, 43, 55, 57, 59, 61, 62, 66, 67.
The diagram shows the development of HPV infection over the years
6. Penile skin cancer (Bowen's disease)
It is caused by the types of the virus - 16 and 18.
Today, some foreign scientists believe that the human papillomavirus is the cause of cancer of any localization. Since cancer is a malignant tumor of the epithelium of the skin or mucous membrane, therefore, the HPV virus, which causes dysplastic phenomena in the epithelium, causes cancer. And with cervical cancer it's 100% proven.
There is evidence for breast and laryngeal cancer, although not yet formulated into a global recommendation. And, according to some cancer researchers, the day is not far off when cancer of other localization (for example, intestines) is also recognized as the result of the human papillomavirus in the human body.
Remember
Any viral infection that is constantly in the human body (and HPV refers to just such), is activated only with a decrease in immunity.
Diagnostics
1. PCR analysis
The main method for diagnosing papillomavirus is the PCR reaction. With the help of special reagents, the presence of HPV DNA in the material from the patient is determined. The most common types of analysis for HPV are 16, 18 types of the virus, as well as a number of other highly oncogenic types.
Material for analysis is taken from the mucous membrane of the vagina and cervix of a woman. In men - from the mucous membrane of the penis.
Below in the photo is an example of PCR analysis and its decoding.
PCR can detect the presence of the virus even in a latent (i.e. dormant) state. Therefore, it is important to determine the viral load, or the concentration of the virus.
The PCR reaction can also give a false result, both a false positive and a false negative result, especially if the conditions for its conduct are violated (even the push of the table on which the study is carried out can lead to such a false result).
So, according to modern researchers in the West, up to 20% of all PCR results for papillomavirus were false. And this fact did not depend on the complexity of the equipment and on the quality of the reagents.
2. Digene test
New research that is gaining popularity in the medical environment. This test is used to determine the presence of clinically relevant virus concentrations. Thanks to this test, it is possible to identify - a high degree of oncogenicity in viruses in the patient's body, or low.
The Digene test is used in conjunction with a cytological examination of the cervix, and they are also evaluated in a comprehensive manner.
3. Examination by a gynecologist and / or urologist
4. PAP test
Other names - cytological examination, or "Pap smear".
A smear taken during a gynecological examination is examined. This study is often referred to as "fluid cytology" or simply "cytology".
In this case, a laboratory assistant under a microscope determines the presence or absence of pathologically altered cells, which should not normally be present, but they appear only with the development of the disease. The presence of such altered cells may indicate the presence of CIN (or cervical dysplasia) in a woman.
5. Histological examination
A microscopic piece of tissue is examined, also taken during a gynecological or urological examination. Another name for this study is "biopsy". Under a microscope, the doctor assesses the degree of change in the tissue taken for examination.
How to decipher an HPV test?
An example of a PCR analysis for HPV
Interpreting Analysis
The unit of measurement is the number of genome equivalents (in simple terms, the number of viruses) per 100,000 human epithelial cells (that is, 10 to the 5th power).
Abbreviated: Lg
Gradations:
- 3 - 5 Lg. This is a clinically significant indicator. The risk of developing the disease is medium. It is necessary to be examined by a doctor.
- > 5 Lg. High viral load. It is imperative to undergo a full examination to exclude cervical dysplasia.
What is a reference value
This means the average statistical indicators for this study for a given age group. That is, in a simple way, reference values are the norm.
HPV reference values are negative. That is, in the norm, HPV DNA should not be in the analyzes.
What is KVM?
KVM is a control of taking material. Normally, the doctor should take a scraping so that the sample contains at least 10,000 (or 10 to the 4th degree, or 4Lg) epithelial cells.
If the CME value is less than 4Lg, this means there are few cells for analysis. The analysis is not recommended, as it will be uninformative, and the doctor is advised to repeat the sampling of the material.
Treatment
Remember
- In the treatment of human papillomavirus, you need to know: the virus may not be completely removed from the body. The main goal of treatment is to remove the manifestations of the virus and reduce its concentration in the body, so that the human immunity itself suppresses the virus.
- First, the doctor must make the correct diagnosis, and this is already half of the treatment !!!
- Self-medication has low effectiveness and can lead to a progression of the process. Self-medication is especially dangerous for diseases of the genital area.
- All types of treatment require a healthy lifestyle that boosts immunity.
3 directions of treatment are required
- removal of manifestations - warts, genital warts, dysplasia (erosion) or cervical cancer
- taking antiviral drugs (rarely used in the treatment of warts)
- strengthening the immune system (rarely used in the treatment of warts)
1) Removal
Removal of papillomas with a laser
Radio wave removal of papilloma
A radio wave vaporizes the formation as well as a laser. ...
Removal of papilloma with a scalpel
Removal of papillomas with an electric knife
In fact - this is the same scalpel, only electric. Currently, it is practically not used in cosmetology.
Removal with liquid nitrogen
A detailed article about this method -
Cauterizers
Pharmacy local necrotizing drugs (acids, alkalis) are used:
- Supercleaner
- Solkoderm ()
- Duofilm ()
- Kollomak ()
- Verrukacid, or Feresol ()
- Condilin ()
- and a number of others.
2) Antiviral drugs
- Isoprinosine (or groprinosin): 2 tablets - 3 times a day; 14-28 days (a more detailed article about this drug -).
- Allokin-alpha: 1 ampoule, the powder is dissolved in 1 ml of 0.9% sodium chloride, injected subcutaneously once every two days, the course is 6 injections (more details about allokin are described).
- Epigen intim spray: spray the affected area 4 times a day throughout the entire treatment period (more detailed instructions).
- Panavir: available in different forms - gel, spray, suppositories, injection solution - it all depends on the prevalence and localization of the process (detailed material about Panavir).
3) Drugs that increase immunity
Polyoxidonium, Roncoleukin, Immunal and others:
- Immunal: 1 tablet - 4 times a day, course from 2 to 8 weeks.
- Reaferon: dilute the powder of 1 bottle (1 million units) with water (half a teaspoon), drink 30 minutes before meals - 2 times a day, for 10 days.
- Polyoxidonium: 1 suppository (12 mg) inside the vagina or into the rectum at night every other day - 10 times.
HPV and pregnancy
Attention
The human papillomavirus does not affect reproductive function, that is, the virus does not prevent a woman from having a child.
If papillomavirus infection is detected during pregnancy:
- the first is to find a good gynecologist and be observed by him until the very birth,
- the most important thing is what are the manifestations of the infection in a woman, the tactics of the doctor will depend on this,
- the virus does not affect the fetus in any way!
- warts and papillomas can be removed after childbirth,
- a minimum of drugs (only if necessary) during pregnancy,
- during childbirth, the baby can become infected by passing through the birth canal,
- in the presence of expressed changes in the cervix of a pregnant woman may suggest a cesarean section,
- in the absence of manifestations - childbirth in a natural way.
In general, a caesarean section for HPV infection is rarely performed. And the manifestations of infection in children subsequently are also extremely rare or insignificant.
Prophylaxis
Prevention is the best cure. Remember this phrase, especially when it comes to the genital area.
Nature has come up with a wonderful mechanism of cure and prevention for a person, which then helps him not to get sick again. It's the immune system.
If a person has already had warts or papillomas once, then subsequently he develops immunity to this type of virus. Therefore, juvenile warts, spines and vulgar warts very rarely appear in adults.
It is on this principle that the method of vaccination of a person against various infectious diseases, including papillomavirus, is built.
That is why it is SO IMPORTANT to maintain your immunity at a high level. Read a detailed article on how to strengthen the immune system.
Specific prevention of PVI infection
- Vaccine "Gardasil" manufactured in the USA. This vaccination against types 6, 11, 16, 18 - prevents the development of symptoms of infection such as genital warts, neoplasia (dysplasia, or erosion) and cervical cancer, penile skin cancer in men. In many developed countries, HPV vaccination is carried out very actively, starting from 11-12 years of age (link), until the time of sexual intercourse, when infection already occurs. Suitable for both girls and boys.
- Vaccine "Gardasil 9". This vaccine is nine-valent, that is, it acts against 9 types of the virus: 6, 11, 16, 18, 31, 33, 45, 52 and 58. The effectiveness of preventing cervical cancer is from 98% to 100%.
- Vaccine "Cervarix". This vaccine forms immunity against 2 types of virus: 16 and 18.
Non-specific prophylaxis
- Personal hygiene measures in public places
- A healthy lifestyle that supports high immunity
- The correct mode of work and rest
- Moderate physical education
- Taking vitamins, fruits, juices
- Only one sexual partner (ideally)
- Condom use during sexual intercourse
And in conclusion - a few videos on the topic of material, recommended for viewing.
Attention: if the doctor did not answer your question, then the answer is already on the pages of the site. Use the search on the site.
Updated: 08 October 2019I can't say that I often discuss health issues with my friends. But it so happened that recently girls began to actively complain to me (maybe age has come, or is this recognition? Authority?), And now several times - about the human papillomavirus. "How tired I am of being treated for him!" - with a sad look declared one enchantress. And she continued her speech, the key points in which were the words “plague” and “tin”, and also the “social factor”: “In general, why is all this not advertised in our country? Why doesn't anyone know about the problem? This the virus leads to cancer of the cervix, and HPV, after all, in general, every second... And many do not even know that they need to take tests for it. " Another friend was interested in the vaccine: "Mom heard somewhere that with its help you can quickly recover, and does not give me rest, - Nastya, well, say something!" Okay, I'll try.
We were helped by:
Evgeniya Markova
Obstetrician-gynecologist of the Medicina clinic; c. m. n.
Nona Hovsepyan
Gynecologist, consultant of the Independent Laboratory "INVITRO"
What is HPV
HPV is a group of viruses with more than 150 genotypes. Fortunately, not all of them are deadly. The worst - numbers 16 and 18 (highly oncogenic) - are associated with more than 70% of cases of cervical cancer (CC). The 6th and 11th are also not gifts, but they are considered low oncogenic.
Any type of HPV can be passed from mother to baby during childbirth. Still, the main "channel" is intimate contact with an actively infected partner. The virus is considered almost the most common sexually transmitted infection in the world. According to our expert, obstetrician-gynecologist Evgenia Markova, in almost 100% of cases, at the first contact, a girl becomes infected with HPV(if the partner is a carrier).
The only thing that can save is barrier contraception, but it is not omnipotent either: the virus can also be transmitted from the skin of the genitals. True, then he can disappear without a trace. Here everything, as usual, depends on your immunity: if it is good, the body is healthy and young, you will not even know that you were on the verge of a foul. In other cases, persistence occurs (the virus remains in you), in which HPV is either inactive (this is called "carriage"), or causes complications and clinical manifestations.
Living with HPV
This does not have to be "tin". If HPV of a non-oncogenic or low-oncogenic type is detected and there are no clinical manifestations, no treatment is required - you just need to regularly visit a gynecologist. The virus does not mutate from one type to another - not bad. The strategy is the same with oncogenic variants. Yes,
in 95% of cases in which women are diagnosed with cervical cancer, they have been diagnosed with HPV... But! Most of those infected with the "high risk" virus do not end up with a life-threatening illness.
If you are dealing with an oncogenic thing, there are two options.
- The first - in the absence of clinical manifestations and normal analyzes: just be observed 2 times a year by a gynecologist, no special treatment is required.
- In the second, the doctor will act according to the circumstances. Clinical manifestations are endocervicitis (inflammation of the cervix), genital warts and papillomas, erosion of the cervix, her dysplasia (this is already precancerous) and other things. Then you can be prescribed local anti-inflammatory or antiviral therapy, as well as radio wave surgery, laser vaporization - excision of areas affected by HPV.
By the way, as for papillomas and genital warts - let's say you have them - this is not a reason to sound the alarm. “The appearance of such formations on the skin causes HPV of low-oncogenic type - 6th and 11th, - Evgenia Markova soothes. - And in the presence of papillomas, HPV, by the way, is not always found in the analyzes. But their absence on the body, alas, is not a guarantee that the virus has bypassed the patient. " Small and single warts and papillomas can go away by themselves. Multiple and large - require surgical intervention. “Especially if a girl is planning a pregnancy, warts run the risk of growing later to large sizes,” warns gynecologist Nona Hovsepyan.
Dangerous!
The incidence rate of cervical cancer in our country is 13.7 per
100,000 people. And there is a tendency for its growth - in particular, among young women under 29 years old. With persistence of the 16th or 18th type of the virus, the chances of developing precancer and cervical cancer are quite high. And they increase if the carrier of the virus smokes, with concomitant urogenital infection (herpes, chlamydia, etc.), promiscuous sex life and frequent partner changes, decreased immunity (the presence of various chronic diseases), with early HPV infection (under the age of 17) ...
How to get tested for HPV
If you've read this paragraph, we may be dealing with panic. And what should be done now? Visit a doctor at least once a year. " HPV can be detected in a cervical swab(study by PCR). In order to detect clinical signs of the virus, cytological screening is recommended for all patients once a year: oncocytological smear from the cervix (PAP test) plus colposcopy - examination of the cervix using a microscope, ”says Evgenia Markova.
Nona Hovsepyan adds that the modern PAP test is liquid cytology (if it is available to you, use it - this is the best option). “Unfortunately, there are also clinics where such studies are not carried out. Or they only offer women over forty years old, - laments Nona. "But the disease is getting younger, so I would strongly recommend these tests to everyone."
HPV vaccine
The main thing that is important to know about it is that the vaccine does not have a therapeutic effect, this measure is preventive. So if the virus is already in you, the vaccine will not help. It can be done between the ages of 9 and 26, if you are not infected with HPV.... “In practice, gynecologists recommend vaccination from 12-13 years of age in girls who are not sexually active,” adds Evgenia Markova. Vaccination will help develop antibodies against those same viruses of the 16th, 18th, 6th and 11th types.
Statistics say that the effectiveness of vaccines (there are two of them on the market - "Gardasil" and "Cervarix") is as much as 95-100%. True, the effect will last 6-7 years, hardly more. Why, then, is there such a stir around them? “When vaccines first appeared, some private clinics seized the opportunity to offer them as a treatment. Of course, there is no harm from the procedures, but there is no effect even in the presence of HPV, ”explains Nona Hovsepyan.
What's more, there was talk some time ago about introducing a vaccine into the national immunization schedule. Alas, this did not happen. So far, you can only get vaccinated privately, if you wish, you can buy a vaccine with a doctor's prescription and administer it in a polyclinic or a private hospital. Every year there are more and more applicants - which is good, because with the help of vaccination, up to 80% of cases of cervical cancer can be prevented.
HPV in men
Without further ado, here's the statistics cited by Evgenia Markova, just in case: “73% of anal cancer is associated with HPV type 16, 18 (both in women and men), oropharyngeal cancer - in 36% with HPV type 16, oral cancer - in 24% with HPV type 16 too. Genital warts and papillomas of the larynx and respiratory tract in 99% are associated with HPV type 6, 11. In 47% of cases, the main cause of the development of cancer of the glans penis is HPV type 16 and 18 ”.
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