Diseases caused by the human papillomavirus have been known for a long time. First of all, these are all types of warts that one in six people on the planet suffer from. However, the pathogen itself has attracted the attention of scientists only in the last 30-40 years. The group of human papillomaviruses (Human papillomavirus - HPV) was identified as a separate species in 1971. Since then, scientists have classified HPV types and established their relationship to many diseases, but research is still ongoing. At the same time, doctors are looking for more effective ways to fight this insidious virus.
What is HPV
Human papillomavirus is a large group of viruses that contain DNA and show an affinity for the epithelial cells that form the skin and mucous membranes. Today, about 170 types of viruses have been discovered, and about 60 have been well studied.
Some papillomaviruses are dangerous due to their oncogenic activity, that is, they increase the risk of the formation of malignant tumors. Since the 1980s, there has been research showing that human papillomavirus infection plays a role in the development of adenocarcinoma and cervical squamous cell cancer (the latter type of cancer is much more common). In 99% of cases, cancer patients are diagnosed with HPV infection and cells specifically modified by the virus.
The papilloma virus invades epithelial cells. After its penetration into the genome, replication (reproduction of the virus's DNA) begins. In this case, the cells divide atypically and their structure changes, which can be seen if a cytological analysis is done.
The papilloma virus manifests itself in specific changes in the epithelium:
- on the skin of the body (vulgar and flat warts, papillomas);
- on the epidermis and mucous membranes of the genital organs (genital warts, bowenoid papulosis, cervical neoplasia, cancer);
- on the mucous membranes of other organs (oral cavity, larynx, bladder, rectum, bronchi, etc. ).
Changes in the first group are caused by non-oncogenic viruses. They are unpleasant, but not dangerous. The third group of manifestations is considered atypical and is recorded relatively rarely.
All types of viruses are divided into three groups:
- with low oncogenic risk (3, 6, 11, 13, 32, 40, 41, 43, 44, 51, 61);
- with moderate risk (30, 35, 45, 52, 56);
- at high risk (16, 18, 31, 33, 39, 59, 64).
Common types 6 and 11 cause multiple anogenital warts and mild cervical neoplasia. Detecting them in a pregnant woman requires attention, since there is a risk of developing laryngeal papillomatosis in a newborn in contact with the mother's mucous membranes during childbirth. Therefore, when planning a pregnancy, women and men need to undergo an HPV test.
Detection of viruses of the third group in the analysis results requires special attention, since the risk of tissue degeneration is high and the patient requires advanced diagnostics.
Methods of infection
The most common route of infection is sexual. Nearly all sexually active adults are diagnosed with HPV. However, most often the infection is transient: the body copes with it, and after a year and a half the virus is not detected in tests. Only occasionally does HPV cause minor clinical manifestations and, in extremely rare cases, cancer, which develops many years after infection (10-15).
Other routes of infection:
- Contact– through touch. Here's how you can get infected from warts;
- Domestic.The virus remains viable in the external environment for some time. Infection is possible in a bathhouse, a swimming pool and other public places. The pathogen penetrates through microdamage in the skin.
- Vertical.The virus can be transmitted from mother to child during childbirth. In this case, the newborn occasionally develops papillomatosis of the larynx and upper respiratory tract. In some cases, the child is affected by genital warts.
- Autoinfection.Human papillomavirus infection (PVI) can spread throughout the body from one place to another, such as by shaving or scratching warts.
Stages of development of the infection
After infection, the latent phase begins: latent or carrier of PVI. At the same time, the virus is inactive, does not manifest itself clinically and is not detected during cytological and histological examination, since it does not reproduce its copies and does not change the epithelial tissue. However, its DNA can be detected using PCR analysis.
Important!
It is not at all necessary for the latent stage to turn into a disease. Perhaps the person himself will remain only a carrier and will not have clinical manifestations.
In the second (subclinical) phase, tissue changes have already begun, but they may still be minimal and not bother the person. However, during cytological analysis, atypical cells are detected, and single warts or small papillomas may be visible on examination.
The third phase is clinical (manifest). The symptoms are pronounced and the disease requires treatment. More often, PVI occurs latently or subclinically, and obvious signs appear under the influence of provoking factors.
The fourth stage (mutagenesis) is a sad consequence of PVI. During this time, the cells become malignant and the carcinoma begins to grow.
Reasons for the activation of papillomavirus
PVI infection occurs very easily, but the human immune system copes with it well and the virus often disappears on its own. A persistent infection that periodically worsens and does not leave the body is a sign of a decreased immune response.
The following factors contribute to this:
- Age. Healthy adults are less likely to suffer from PVI. Most often – children, adolescents and the elderly;
- Long-term chronic diseases that weaken the body;
- Endocrine disorders (diabetes mellitus, thyroid diseases) and hormonal fluctuations (pregnancy, menopause);
- Constant stress, prolonged psycho-emotional stress;
- Poor nutrition, rigid diets, lack of vitamins, minerals and complete proteins;
- Severe nutritional obesity and sedentary lifestyle;
- Taking drugs that suppress the immune system, exposure to radiation, chemotherapy;
- Primary and secondary immunodeficiencies, HIV;
- Initiation of sexual activity before the age of 16 and indiscriminate intimate contact;
- Concomitant infection with other sexually transmitted infections;
- Gynecological procedures leading to mechanical damage to the mucous membranes of the cervical canal (abortion, curettage, installation of a spiral, etc. ).
The incubation period of PVI is highly variable. The pathogen can remain in a latent and 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 the same time and be constantly re-infected, for example, from a sexual partner.
HPV diagnosis
The first stage of diagnosis is always an examination by a doctor and taking a medical history. Women are examined by a gynecologist, men by a urologist or dermatovenerologist. When exophytic genital warts are detected, the diagnosis is obvious, since these neoplasms are characteristic only of PVI.
Acetic acid test
If the disease is in a subclinical stage, small warts may not be visually visible. Therefore, a test with acetic acid is carried out: after treatment with it, new growths become white and stand out against the background of the surface.
The same thing happens with the mucosa of the cervix (examined by colposcopy): the identification of white areas on it indicates that the epithelium in this place has changed. It is from this surface that a cytological smear is taken or a biopsy performed.
If the acetic acid test is positive, observation and follow-up is required after six months, as the disease may progress. On the other hand, the virus can enter a latent state, after which the manifestations will disappear.
Schiller test
It is performed as part of an extended colposcopy after an acetic acid test. In this case, areas of tissue previously treated with vinegar are stained with a solution of iodine in glycerin. Normal cells absorb this solution and become uniformly brown. In atypical cells, glycogen accumulation processes are disrupted and do not absorb solution. Mosaic coloring occurs, its features suggest a diagnosis.
Cytological smear
It is otherwise called PAP test after the name of its inventor, the Greek doctor Papanikolaou. For the test, a scraping is taken from the lining of the cervix (urethra in men) to obtain epithelial cells for analysis. The biomaterial is applied to a glass slide, fixed with alcohol, stained and examined under a microscope.
The interpretation of the results is carried out by a doctor, since other data are also taken into account: cytology results, PCR analysis, tests for other infections, presence of inflammation in the vagina, etc. A class 1-2 result is considered negative, i. e. no morphological changes caused by the virus have been detected.
For grade 3, additional examination methods are prescribed, but grades 4 and 5 are a possible sign of grade III neoplasm or cancer.
PCR analysis
A very sensitive test that detects the presence of viral DNA in epithelial cells. The study can be carried out with the same biomaterial taken for the cytological analysis. The polymerase chain reaction is carried out in a special device, where a predetermined genetic sequence is copied several times.
The PCR method is used to detect hidden sexually transmitted infections, including HPV, so it is used as part of a screening exam. Genital warts often occur against the background of other venereal diseases. If positive PCR results are obtained, thorough diagnostics are required.
Because DNA testing is so accurate, its use often leads to overdiagnosis. After all, the detected DNA of a virus 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 tissues, that is, the viral load (indicated in the results with the letters lg). At the same time, genotyping is performed to determine the exact type of pathogen. If oncogenic strains are detected, control tests are prescribed after 3-6 months.
Digene tests
This method is screening (primary, carried out for initial diagnosis). It also detects viral DNA in tissues. In this case, the oncogenicity of viruses and their number are determined collectively. The Digene test in combination with a cytology smear is the standard adopted today in many developed countries for identifying clinically significant HPV infection and cancer risk.
Histological examination
This is an advanced diagnostic method. It is prescribed to women when positive screening results are obtained: the cytological analysis highlighted a class of 3-4-5 cells. A piece of tissue obtained following a biopsy is examined under a microscope.
The study allows us to identify cells specifically modified by the virus: koilocytes and dyskeratocytes, as well as cells with signs of malignancy. Therefore, histology allows you to determine the degree of neoplasm and identify cancer in the early stages, when it can be successfully treated.
In some cases, tissues taken from skin and mucosal tumors are subjected to histological analysis if there are doubts about their nature and good quality.
Treatment of PVI
In the latent phase of PVI, no treatment is required. The detected infection only becomes a reason for observation over time. It is worth noting that it is impossible to kill the virus in the body with drugs, as it replicates inside cells.
An infected person is advised to:
- avoid factors that reduce immunity, take vitamins;
- recover from concomitant sexually transmitted infections, if detected, do not develop chronic diseases;
- lead a healthy lifestyle, abandon bad habits;
- live a sexual life with a permanent and trusted 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, human interferon preparations or its inducers are used.
Nonspecific immunomodulators are also effective against HPV. Antiviral drugs are used.
Doctors often simultaneously prescribe local drugs: ointments, gels and creams.
Important!
Immunomodulatory treatment is prescribed only by a doctor based on the results of an immunogram; uncontrolled use of drugs can lead to the opposite result: a malfunction of the immune system.
In the third stage, the treatment regimen includes radical methods. You can get rid of genital warts, papillomas and warts using the following methods:
- chemical removal with cauterizing drugs;
- radio knife;
- electrocoagulation;
- laser destruction;
- cryodestruction.
The same methods are used in the treatment of benign pathologies of the cervix.
Surgical removal of tissue is indicated for diagnosed cervical cancer. In this case, the woman is treated and observed by an oncologist.
Because PVI is often combined with other sexually transmitted infections, antibacterial, anti-inflammatory, and other medications may be prescribed.
Vulgar warts can be removed at home using mummifying agents sold in pharmacies.
Treatment prognosis
Contrary to the belief that the virus remains in the body forever and that a complete cure is impossible, doctors give a favorable prognosis. Usually, after a course of therapy, developed individually, taking into account the oncogenicity of the virus and concomitant diseases, the infection regresses.
Relapses do occur, but are relatively rare if treatment is not stopped. Some people experience a relapse, sometimes several times, but shorter and weaker. Constant exacerbations are typical only for people with a prolonged decrease in immunity due to HIV infection or serious chronic diseases.
Prevention of PVI
Prevention measures are divided into general and specific. General recommendations to avoid infection:
- use barrier contraceptive methods;
- have sex with a regular partner;
- do not start sexual activity before the age of 18, since in adolescents the immune system is not yet fully formed;
- Avoid artificial termination of pregnancy.
So far there is only one specific method of prevention: vaccination. Today it is possible to vaccinate against virus types 6, 11, 16 and 18. Vaccination occurs in three phases; it is better to start vaccination in adolescence - from 9-10 years old.
Patient reviews
- "I had warts, I didn't know about them, " the gynecologist said after the exam. I immediately asked if we would cancel it, I agreed. Then he prescribed me and my husband to take an antiviral drug. Expensive, but we decided: to undergo treatment until the end. I also took baths with chamomile, string and calendula. Now everything has been clean for two years. "
- "Doctors have different attitudes towards treatment. I was diagnosed with dysplasia grade 1 and HPV type 18. One doctor told me: just cauterize, otherwise there will be cancer later. Another said that it is not need to treat nothing before the age of 30, especially before giving birth. He prescribed only pills and suppositories. A year later the virus was still being analyzed, 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 never recovers on its own. "