Diseases caused by human papillomavirus have been known for a long time. First of all, these are all kinds of warts, from which every sixth person on the planet suffers. However, the pathogen itself has attracted the attention of scientists only in the last 30-40 years. The human papillomavirus group (Human papillomavirus - HPV) was identified as a separate species in 1971. Since then, scientists have classified HPV types and established their relationship with many pathologies, but research is still ongoing. At the same time, doctors are looking for more effective ways to fight this dangerous virus.
What is HPV?
Human papillomaviruses are a large group of viruses that contain DNA and exhibit affinity for the epithelial cells that make up the skin and mucous membranes. Today, about 170 types of viruses have been discovered, and about 60 have been well studied.
Some papillomaviruses are dangerous because of their oncogenic activity, that is, they increase the risk of malignant tumor formation. Since the 1980s, research has been conducted that has proven 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, patients with oncology are diagnosed with HPV infection and cells specifically modified by the virus.
Papilloma virus attacks epithelial cells. After its penetration into the genome, replication (reproduction of viral DNA) begins. In this case, the cells divide in an atypical way, and the structure changes, which can be seen if you do a cytological analysis.
The papilloma virus manifests itself in specific changes in the epithelium:
- on the skin of the body (rough and flat warts, papillomas);
- on the epidermis and mucous membrane of the genital organs (genital warts, bowenoid papulosis, cervical neoplasia, cancer);
- on the mucous membranes of other organs (oral cavity, larynx, bladder, rectum, bronchus, 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 recorded relatively rarely.
All types of viruses are divided into three groups:
- with low oncogenic risk (3, 6, 11, 13, 32, 40, 41, 43, 44, 51, 61);
- with moderate risk (30, 35, 45, 52, 56);
- 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 pregnant women requires attention, because there is a risk of developing laryngeal papillomatosis in newborns when in contact with the mother's mucous membrane during childbirth. Therefore, when planning pregnancy, women and men must undergo an HPV test.
The detection of viruses from the third group in the analysis results requires special attention, because the risk of tissue degeneration is high, and the patient needs advanced diagnostics.
Method of infection
The most common route of infection is sexual. Almost all sexually active adults are diagnosed with HPV. However, often the infection is temporary - the body overcomes it, and after a year and a half the virus is not detected in tests. Only occasionally does HPV cause minor clinical manifestations and, in very rare cases, cancer, which develops years after infection (10-15).
Other routes of infection:
- Contacts– through touch. This is how you can get warts;
- Domestically.The virus remains viable in the external environment for some time. Infection can occur in bathhouses, swimming pools and other public places. Pathogens penetrate through micro-damages in the skin.
- Vertical.This virus can be transmitted from mother to child during childbirth. In this case, newborns sometimes develop papillomatosis of the larynx and upper respiratory tract. In some cases, babies get genital warts.
- Autoinfection.Human papillomavirus infection (PVI) can spread throughout the body from one place to another, for example, by shaving or scratching a wart.
The stage of infection
After infection, the latent stage begins - latent or carriage of PVI. At the same time, the virus is inactive, it does not manifest itself clinically and is not detected during cytological and histological examination, because it does not reproduce its copies and does not change the epithelial tissue. However, its DNA can be detected using PCR analysis.
Important!
It is not necessary that the latent stage will develop into a disease. Perhaps the person himself will remain a carrier, and he will not have clinical manifestations.
In the second (subclinical) stage, tissue changes have already begun, but they may still be minimal and not bother the person. However, when taking a cytological analysis, atypical cells are detected, and after examination, a single condyloma or small papilloma may be visible.
The third stage is clinical (manifest). The symptoms are stated and the disease requires treatment. More often, PVI occurs latently or subclinically, and clear signs appear under the influence of provoking factors.
The fourth stage (mutagenesis) is a sad consequence of PVI. During this period, cells become malignant and carcinoma begins to develop.
Causes of papillomavirus activation
PVI infection occurs very easily, but the human immune system copes with it well, and often the virus disappears on its own. Persistent infections that worsen periodically and do not leave the body are a sign of a decreased immune response.
The following factors contribute to this:
- Age. Healthy adults are less likely to develop PVI. More often - children, teenagers and the elderly;
- Long-term chronic diseases that weaken the body;
- Endocrine pathology (diabetes mellitus, thyroid disease) and hormonal fluctuations (pregnancy, menopause);
- Constant stress, prolonged psycho-emotional stress;
- Poor nutrition, strict diet, lack of vitamins, minerals and complete proteins;
- Severe dietary obesity and an inactive lifestyle;
- Taking drugs that suppress the immune system, exposure to radiation, chemotherapy;
- Primary and secondary immunodeficiency, HIV;
- Initiation of sexual activity before the age of 16 and indiscriminate intimate relationships;
- Simultaneous infection with other sexually transmitted infections;
- Gynecological procedures that lead to mechanical damage to the mucous membrane of the cervical canal (abortion, curettage, spiral installation, etc. ).
The incubation period for PVI is highly variable. Pathogens can remain in a latent, inactive state for a long time (from 3 weeks to several years), so it is impossible to accurately determine the time and circumstances of infection. A person can be infected with several types of viruses at once and constantly re-infected, for example, from a sexual partner.
HPV diagnosis
The first stage of diagnosis is always an examination by a doctor and the 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 this neoplasm is only characteristic of PVI.
Acetic acid test
If the disease is at a subclinical stage, small condylomas may not be visually visible. Therefore, the test is carried out with acetic acid - after treatment with it, the new growth becomes white and stands out against the background of the surface.
The same thing happens with the mucous membrane of the cervix (checked by colposcopy) - the identification of a white area on it indicates that the epithelium in this place is changing. 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, then the manifestation will disappear.
Schiller's test
It is carried out as part of an extended colposcopy after a test with acetic acid. In this case, the area of the fabric that was previously treated with vinegar is stained with a solution of iodine in glycerin. Normal cells absorb this solution and turn a uniform brown color. In atypical cells, the process of glycogen accumulation is disrupted and they do not absorb the solution. Mosaic staining occurs, its characteristic features suggest the diagnosis.
Cytological smear
It is otherwise called the PAP test after the name of its creator, the Greek doctor Papanikolaou. For the test, a scraping is taken from the mucous membrane of the cervix (urethra in men) to obtain epithelial cells for analysis. Biomaterials are applied to glass slides, fixed with alcohol, stained and examined under a microscope.
The interpretation of the results is carried out by the doctor, because other data are also taken into account: cytology results, PCR analysis, tests for other infections, the presence of inflammation in the vagina, etc. Class 1-2 results are considered negative, i. e. no morphological changes caused by the virus are detected.
For grade 3, additional examination methods are prescribed, but grades 4 and 5 are signs of possible grade III neoplasia or cancer.
PCR analysis
A highly sensitive test that detects 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 copied many times.
The PCR method is used to detect hidden sexually transmitted infections, including HPV, therefore it is used as part of a screening examination. Genital warts often occur against the background of other sexually transmitted diseases. If a positive PCR result is obtained, in-depth diagnostics are required.
Because DNA testing is so precise, its use often leads to overdiagnosis. After all, the detected viral DNA does not mean that a person is sick. It may be a new infection that will go away on its own.
Therefore, the PCR test is expanded - a quantitative analysis is performed to find out the concentration of the pathogen in the tissue, that is, the viral load (marked in the results with the letter lg). At the same time, genotyping is carried out to determine the exact type of pathogen. If an oncogenic strain is found, a control test is set after 3-6 months.
Digene Test
This method is screening (primary, carried out for early diagnosis). It also detects viral DNA in tissue. In this case, the oncogenicity of the virus and its number are determined collectively. The Digene test in combination with cytological smears is the standard adopted today in many developed countries to identify clinically significant HPV infection and cancer risk.
Histological examination
This is an advanced diagnostic method. It is prescribed to women when a positive screening result is obtained: cytological analysis shows class 3-4-5 cells. A piece of tissue obtained from a biopsy is examined under a microscope.
The study allowed us to identify cells specifically modified by the virus - koilocytes and dyskeratocytes, as well as cells with signs of malignancy. Therefore, histology makes it possible to determine the degree of neoplasia and identify cancer at an early stage, when it can be treated successfully.
In some cases, tissues taken from neoplasms of the skin and mucous membranes are submitted for histological analysis if there is doubt about the nature and good quality.
PVI treatment
In the latent stage of PVI, no treatment is required. The detected infection is only a reason for observation from time to time. Keep in mind that it is impossible to kill the virus in the body with drugs, because it replicates inside the cells.
An infected person is advised to:
- avoid factors that reduce immunity, take vitamins;
- recover from concomitant sexually transmitted infections, if any are detected, do not develop chronic diseases;
- live a healthy lifestyle, abandon bad habits;
- live a sexual life with a trusted permanent partner.
Treatment of human papillomavirus begins with the stage of subclinical manifestations. At this stage it is conservative. Immunomodulatory therapy is usually prescribed. For this purpose, preparations of human interferon or its parent are used.
Non-specific immunomodulators are also effective against HPV. Antiviral drugs are used.
Doctors often prescribe local medicines at the same time - ointments, gels and creams.
Important!
Immunomodulator treatment is only prescribed by a doctor based on the results of an immunogram; uncontrolled use of drugs can lead to the opposite result - damage to 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 cauterization drugs;
- radio knife;
- electrocoagulation;
- laser destruction;
- cryo destruction.
The same method is 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 was 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 mummy agents sold in pharmacies.
Treatment prognosis
Contrary to the belief that the virus remains in the body forever and complete recovery is impossible, doctors give a favorable prognosis. Usually, after a course of therapy, which is developed individually, taking into account the oncogenicity of the virus and concomitant diseases, the infection subsides.
Relapses do occur, but are relatively rare if treatment is not stopped. Some people have one relapse, sometimes several, but shorter and weaker. Persistent exacerbations are typical only for people with prolonged immunosuppression due to HIV infection or serious chronic diseases.
Prevention of PVI
Preventive measures are divided into general and specific. General recommendations to prevent infection:
- use a barrier method of contraception;
- having sex with a common partner;
- do not start sexual activity before the age of 18, because in teenagers the immune system is not fully formed;
- Avoid artificial termination of pregnancy.
There is only one specific method of prevention so far - vaccination. Today it is possible to get a vaccine against types 6, 11, 16 and 18 of the virus. Vaccination takes place in three stages; it is best to start vaccination in adolescence - from 9-10 years.
Reviews from patients
- "I have condylomas, I don't know about them, " said the gynecologist after the examination. I immediately asked if we would delete it, I agreed. Then he prescribed me and my husband to take antiviral drugs. Expensive, but we decided: to undergo treatment until the end. I also do baths with chamomile, string and calendula. Now everything has been clean for two years. "
- "Doctors have different attitudes towards treatment. I have been diagnosed with grade 1 dysplasia and HPV type 18. One doctor told me - just cauterize, otherwise there will be cancer later. Another said, there is no need to treat anything before the age of 30, especially before childbirth. He only prescribed pills and suppositories. A year later, the virus was still in the analysis, but two years later it was no longer there, and the cervix was normal. But after 30, as the second doctor told me, the body no longer recovers by itself. "