Very often, HPV practically does not manifest itself in any way. The main symptoms of the human papilloma virus are, of course, warts, which can appear in the most unexpected places: on the genitals, palms, arms, neck and other parts of the body. Read more about the hidden manifestations of this virus and the methods of its treatment in the following article.
What is human papillomavirus
Human papillomavirus (HPV) is the common name for more than 70 different viruses that can cause disease in various human organs: some of the HPV viruses cause skin diseases, others cause genital warts (genital warts) and dother diseases of the genital organs. Each of the HPV group viruses has its own sequence number and differs from other viruses in its unique DNA composition.
At present, the role of certain types of human papillomaviruses in the development of malignant tumors of various organs has been proven: for example, cancer of the cervix, cancer of the penis, cancer of the throat, etc. Different types of human papillomaviruses are divided into groups, depending on their ability to cause malignant neoplasms. Thus, it is customary to distinguish viruses with high, medium and low oncogenicity (oncogenicity is the ability of a virus to cause cancer). Viruses with high oncogenicity include HPV 16 and 18, tk. they are found more frequently in cervical cancer.
How HPV enters the body
The most common mode of transmission of the human papillomavirus (HPV) is through sexual contact. This infection is therefore classified in the group of sexually transmitted diseases (STDs). In addition, infection with the human papillomavirus (HPV) is possible through contact of damaged skin or mucous membranes with secretions of a sick person (eg, underwear, towels, etc. ) Transmission of the virushuman papilloma from mother to child during childbirth is possible.
Review
Human papillomavirus (HPV) is the most common viral infection of the genital tract. Most sexually active women and men become infected at some point in their lives, and some can become reinfected.
The peak period for contracting the infection in women and men begins immediately after they become sexually active. HPV is sexually transmitted, but penetrative sex is not necessary to transmit the virus. Skin-to-genital contact is a well-established route of transmission.
Many types of HPV do not cause problems. HPV infections usually clear up on their own without any intervention a few months after they are acquired, and about 90% clear up within 2 years. A small proportion of infections with certain types of HPV may persist and develop into cancer.
Cervical cancer is by far the most common HPV-associated disease. Almost all cases of cervical cancer can be due to HPV infections.
Despite limited data on anogenital cancers other than cervical cancer, a growing body of evidence links HPV to cancers of the anus, vulva, vagina, and penis. Although these cancers are less common than cervical cancer, their association with HPV makes them potentially preventable using the same primary prevention strategies as for cervical cancer.
Types of HPV that do not cause cancer (especially types 6 and 11) can cause genital warts and respiratory papillomatosis (a disease in which tumors develop in the airways from the nose and mouth to the lungs). And although these conditions very rarely lead to death, they can often lead to disease. Genital warts are widespread and highly contagious.
How HPV is transmitted and manifests
In modern medical science, more than 150 types of viruses have been identified. Depending on its type, it affects the work of all organs and systems of the human body. For example, infected people notice various neoplasms on the skin and mucous membranes in the form of genital warts and wart-like growths.
The primary route of transmission is physical contact with the carrier, including sex without a condom. But it is also quite common to become infected by household means. Usually, after entering the body, the infection does not manifest itself in any way, so people do not even know that they are carriers.
How does a papillomavirus infection manifest?
The most common manifestations of human papillomavirus infection are:
- Sharp warts. The development of genital warts and papillomas is most often caused by low oncogenic risk HPVs. Condylomas are single and focal, usually occur in places injured during sexual intercourse. The size of the elements is from 1 millimeter to several centimeters, they resemble a "cockscomb" or "cauliflower" and are located on a narrow base (leg). Most often, women find warts to the touch when washing, which is felt as an irregularity. With a large number or large size of genital warts, they can be injured and bleed, interfere with normal sex life and childbirth, and cause psychological discomfort. Itching rarely accompanies the manifestations of human papillomavirus infection.
- Papillomas (warts). Unlike papillomas of a tumoral nature, viral papillomas appear, disappear and reappear, since their severity depends on the state of the body's defenses at the moment. Viral papillomas do not differ from normal skin color and can grow anywhere.
- Flat condyloma of the cervix. Flat condyloma is a manifestation of a long-standing chronic viral infection that caused changes in the cells of the epithelium of the cervix. It can be combined with genital warts on the external genitals. Changes in the cervix, characteristic of HPV, always alert the doctor, because women who have had this virus for a long time are 65 times more likely to have cervical cancer than those who do not have it. not. However, the presence of a high-risk virus in the body does not mean that a woman will definitely get cancer. It is necessary to have additional factors for the cells to degenerate into malignant cells. Detecting high-risk virus types gives the patient a significant head start in fighting the disease; here the formula "warned is warned" is the most appropriate. Thus, the average age of women with the first signs of malignant transformation of the cervix is 30 years, and the average age of patients with cervical cancer is 50 years.
Signs of HPV in Women
In women, infection with the human papillomavirus can provoke the appearance of genital warts - genital warts, which in many cases are found only during a gynecological examination.
They grow about three months after infection. Most often they form on the labia minora, in the vagina, on the cervix, cervical canal, on the skin around the anus.
Externally, these are small formations located on a wide "leg" and with uneven edges. At the same time, the types of HPV that cause genital warts are not the types that cause cancer.
Symptoms of the disease in women also include cervical intraepithelial neoplasia - a precancerous condition of the uterine mucosa, which causes a violation of cell maturation. Currently, doctors are aware of three stages of this disease, two of which are not particularly dangerous, and the third is the first stage of cervical cancer. Similar symptoms are caused by viruses of types 16 and 18. In addition, cancer is caused by 31, 33, 35 and 39 types.
Symptoms of HPV in women and men can include the presence of small growths not only on the genitals, but also in other places - under the mammary glands, in the armpits, on the neck and on the eyelids.
For men, the disease is less dangerous than for women. And if some carcinogenic types of the virus that provoke the development of growths on the skin in a man rarely cause tumors in the stronger sex, then a woman, having acquired them from a man, runs the risk of developing cervical cancerof the uterus.
The course of pregnancy
During pregnancy, visible warts often reappear, tend to increase significantly, become loose, large formations can cause difficulties during childbirth. There is evidence that a primary HPV infection during pregnancy can lead to a threat of termination of pregnancy, but whether such an infection causes malformations in the fetus is debatable.
The frequency of transmission of HPV from the mother to the fetus, according to different researchers, varies quite significantly - from 4 to 80%. How the virus is transmitted is not yet known precisely. It is most likely to pass through the cervical canal and the fetal membranes upwards or by contact when the child passes through the mother's birth canal.
Recently, the development of papillomatosis of the larynx, trachea and bronchi and anogenital warts in infants has been associated with HPV infection during childbirth. The disease is quite rare, moreover, cases of this disease in children born by cesarean section are described, so the presence of HPV and its manifestations in a pregnant woman is not an indication for cesarean section.
An indication for surgery can only be the presence of a giant condyloma, which makes it difficult to deliver through the natural birth canal. But such condyloma occurs only in women with severe immunodeficiency, such as AIDS.
After childbirth, HPV detected during pregnancy is most often not detected, and clinical manifestations in the form of massive growths significantly decrease or disappear. It should be noted that HPV first detected during pregnancy, as a rule, is not detected after childbirth.
Risk factors for cervical cancer
- first sexual intercourse at an early age;
- multiple sexual partners;
- tobacco use;
- immunosuppression (for example, people with HIV are at increased risk of HPV infection and are infected with a wider range of HPV types).
Diagnostic
The main method of diagnosing PVI is a routine clinical examination. To confirm this diagnosis, colposcopy is used (examination of the mucous membrane of the cervix and vagina using a special magnifying device) and cytological examination (for this, a scraping is taken from the cervical canaland the surface of the cervix).
Cytological examination does not reveal the virus itself, but changes in the cells of the epithelium of the cervix characteristic of this infection. A histological examination makes it possible to clarify the cytological diagnosis: in this case, it is not a scraping of the surface cells which is taken, as for cytology, but a piece of tissue, and not only the structure of the cells is studied. , but also the correct arrangement of their layers. During pregnancy, a biopsy is usually not performed.
To determine the types of viruses and their oncogenic risk, the polymerase chain reaction (PCR) is used, which determines the DNA fragments of the pathogen. It allows you to accurately determine the presence of the HPV virus in the cervix. This is important for the prognosis of the development of diseases of the cervix.
HPV treatment
Since it is currently impossible to achieve a complete cure from human papillomavirus infection (moreover, spontaneous and spontaneous recovery is often observed), the manifestations of HPV are treated, and not the presence of the virus in the body. At the same time, the effectiveness of various methods of treatment is 50-70%, and in a quarter of cases the disease recurs already a few months after the end of treatment.
Given the possibility of self-resolution of genital warts, it is sometimes advisable not to proceed with any treatment. The question of the suitability of treatment for each pregnant patient is decided individually.
In this case, factors that reduce immunity should be avoided (hypothermia, severe emotional stress, chronic overstrain, beriberi). There are studies showing the preventive effect of retinoids (beta-carotene and vitamin A), vitamin C and micronutrients such as folate on HPV infections.
The most commonly used treatments for genital warts are:
Destructive methods
Destructive methods are local treatment aimed at eliminating genital warts. There are physical (cryodestruction, laser therapy, diathermocoagulation, electrosurgical excision) and chemical (trichloroacetic acid) destructive methods, as well as surgical removal of genital warts.
In pregnant women, methods of physical destruction and preparations of trichloroacetic acid can be used. It is desirable that treatment with destructive methods be carried out only at the beginning of pregnancy, taking special precautions. At the same time, it is necessary to take into account the risk of possible side effects during treatment (haemorrhages and secondary infections due to impaired blood circulation, toxic complications) and the possibility of the reappearance of genital warts after their removal.
Cytotoxic drugs
Cytotoxic drugs are STRICTLY CONTRAINDICATED during pregnancy. For women of childbearing potential, reliable contraception or abstention from sexual activity is recommended for the duration of treatment.
Immunological methods
Interferons are most commonly used to treat HPV infection. It is a family of proteins produced by cells of the immune system in response to viral stimulation. Immunoglobulin preparations are used in conjunction with the topical application of drugs. These drugs are actively used in late pregnancy. However, in 60% of cases, even long-term treatment with interferon does not lead to clinical improvement and does not prevent fetal HPV infection.
Specific antiviral drugs
specific antiviral drugs. These drugs are not used in pregnant women infected with the papillomavirus, due to insufficiently studied effects on the fetus. By the way, the well-known antiviral drug has no effect on HPV.
Summary
- Itching can be caused by PVI, but to confirm this cause, all other possible causes of contact-transmitted itch should be ruled out. It is not an STD, and the infection does not necessarily come from a sexual partner and not necessarily from sex life. A condom, virginity, a regular sexual partner, abstinence - do not mean the impossibility of contracting PVI.
- HPV is widespread, its detection in the body is more of a pattern than an oddity.
- PVI is diagnosed "by eye", according to clinical manifestations, and not by PCR.
- If PVI is detected, colposcopy is necessary, if necessary, biopsy and treatment. If you can give up OK from the external genitalia and not treat, then the cervix should be examined and treated without fail. PVI is the most common cause of cervical cancer.
- If HPV is detected, an examination of the partner is necessary, since penile cancer is the same consequence of PVI as cervical cancer. The examination is also an eye, not the PCR.
- The manifestations of PVI - OK or flat condyloma - and not the presence of the virus in the body are treated.
- The first stage of treatment is conservative. The basis of therapy is antiviral drugs, incl. - locally. Immunomodulators are an auxiliary and optional component of treatment.
- Itching can be caused by PVI, but all other possible causes of itching should be ruled out to confirm this cause.
- PVI recurs with a decrease in immunity. This does not indicate the ineffectiveness of the previous treatment. No treatment can completely eliminate the virus from the body and does not guarantee the complete elimination of OK.
- PVI can be transmitted during childbirth from mother to child, causing papillomatosis of the larynx. This is easily treatable. Condylomatosis is not an indication for caesarean section.
The human papillomavirus (HPV) can stay in the body of a woman for years and not manifest itself in any way, while constantly endangering the risk of developing cancerous and precancerous diseases of her "mistress".