HPV (human papilloma virus)

Human papilloma virus (HPV) is a group of common pathogens that can infect the skin and mucous membranes. Most often, the pathology is diagnosed in patients aged 20 to 30 years, as well as in children under 5 years old. According to statistics, approximately 22 percent of the world's inhabitants are carriers of HPV. Many patients are affected by several strains at the same time.

More than 190 genotypes of the pathogen are currently known. They differ in DNA structure, course and potential complications. 30 pathogens can infect the epithelium of the internal and external genital organs. It is worth noting that many strains of HPV are characterized by pronounced carcinogenic activity. Thus, the virus often causes life-threatening complications: malignant tumors of the vagina, vulva, anal tract, penis.

Causes of HPV

The only cause of infectionhuman papilloma virusis contact with the causative agent of the disease. However, certain factors greatly increase your chances of becoming infected. Exactly:

1. Refusing to use barrier contraception. Only a male or female condom, as well as special latex wipes, can protect against infection.
2. Frequent change of sexual partners. If you do not pay enough attention to your own safety, the risk of infection increases significantly.
3. Early initiation of sexual relations. Sexual relations in adolescence often lead to HPV infection due to an irresponsible attitude to prevent the transmission of the pathogen.
4. Non-compliance with hygiene rules. Insufficient self-care leads to the growth of pathogenic microflora on the skin and mucous membranes, which negatively affects susceptibility to the virus.
5. Bad habits. The body's immune defense is significantly affected by addictions: alcohol abuse, smoking and intake of psychoactive substances.
6. Weakened immunity. The causes of the condition can be a lack of vitamins and minerals, past illnesses and psycho-emotional overload.
7. Long-term drug treatment. Hormonal preparations taken for a long time have a particularly pronounced effect.
8. Traumatic injuries. Injuries to the mucous membranes and skin become the "gateway" for infection.
9. Chronic stress. They also affect the patient's immune system and hormonal background.
10. Gynecological interventions. Risk factors for HPV include miscarriages or abortions.
11. PregnancyThe disease often appears for the first time during pregnancy. Pregnancy is associated with increased stress on the body, which increases sensitivity to pathogenic flora.

Risks include certain diseases, such as uterine dysplasia. Regular preventive visits to a gynecologist and urologist help to significantly reduce the risks.

Symptoms

Of the total number of carriers of the pathogen, clinical manifestations of the papilloma virus are detected in only 5-10% of patients. The first symptoms may appear either a few months after the infection or after a few years. However, in this state, a person poses a threat to others. It can infect other people through contact. Symptoms can be divided into subjective, which indirectly indicate pathology, and objective characteristic manifestations of HPV. Subjective symptoms include:

1. papules. These are single or multiple formations that protrude above the skin or resemble spots. They appear on the skin and mucous membranes of the urogenital area.
2. Itchy skin. The patient often complains of itching in the genital area or other areas of the skin.
3. Paresthesia. This is a violation of sensitivity in the affected area. The opposite manifestation - dyspareunia - often occurs. In this case, every contact brings pain.
4. Urinary dysfunction. There is a burning sensation, itching and pain when emptying the bladder. If the urethra is affected, passing urine can be significantly difficult.
5. Cracks. Bleeding cracks appear on the skin and mucous membranes, which cause severe pain.

Such clinical manifestations may indicate various diseases of the genitourinary system. Objective symptoms of HPV allow an accurate diagnosis. Such signs include:

1. Genital warts. It is an elevation above the surface of the skin, characterized by an elongated finger-like shape. Localized in the genital area. They differ in a specific pattern: variegated or loop-shaped.
2. Papular warts. They appear on keratinized areas of the genitals. It can be flat or straight.
3. Stains. The nature of the spots is different. There are bright reds, browns with red hues, rose-reds, whites with gray.
4. Bowen's disease. These are papules or spots that are characterized by a shiny or velvety surface. The shade varies from red to almost black.
5. Giant condylomas. This is a small formation that gradually increases in size and merges into one.
6. Respiratory papillomatosis. In this case, the formations are localized in the oral cavity, respiratory tract and lungs.

Also, HPV in women in later stages can manifest as uterine cancer. In 2008, it was found that this very virus is the cause of a malignant tumor. Cervical cancer does not occur as an independent disease. The pathology is accompanied by heavy bleeding, pain in the abdomen and lower back, discomfort during intimacy, etc.

Routes of transmission

Doctors and scientists still argue about the contagiousness of the human papillomavirus. A number of experts believe that a single contact without the use of barrier contraception with an asymptomatic carrier is sufficient to reach a 70% probability of transmission of the pathogen to a healthy partner. Other doctors say that such risks are relevant only in contact with carriers of papillomas. Statistics show that with regular proximity, the virus can be transmitted to a healthy person for a period of up to 6 months.

Infection can occur in different ways. How the papilloma virus is transmitted:

1. Sexual transmission. The main way of infection is sexual contact. Using a condom reduces the risk to 10 percent. However, the pathogen can also penetrate during other intimate manipulations, for example during a kiss.
2. From mother to baby. The newborn can become infected with HPV from the mother during passage through the reproductive tract. Typical results of this situation are cases of laryngeal papilloma and anogenital warts.
3. Contact and household road. The virus is also transmitted through ordinary household contacts. Most often this happens in the common areas. The risk of infection is particularly high in baths, saunas, gyms and swimming pools. Public toilets.
4. Autoinfection. This is the transfer of a virus from an affected area to a healthy one, which occurs during shaving and epilation.

Pathogenesis

Pathogenesis is significantly influenced by the key ability of HPV. It is the only virus that does not penetrate the blood and therefore does not cause an inflammatory process. In a simplified form, the pathogenesis of the human papilloma virus is as follows:

1. Infection. The source of viral agents can be another person or objects in common use. The risks of transmission increase significantly with microtraumas on the skin and mucous membranes: wounds, cuts, cracks, acne.
2. Incubation period. Pathologies that develop as a result of HPV entering the body usually have a latent onset. There is no exact duration of the incubation period of this disease. The stage takes 1-3 months or reaches 2-3 years.
3. Chronic presence Despite the absence of clinical manifestations, the disease continuously progresses. A person becomes a source of viral agents for others.
4. Visual manifestations on the skin. The result of the infection is the appearance of a benign or malignant tumor at the site of virus penetration.

In the initial stage, the pathogen affects the basal epithelial layer, locating mainly on the mucous membranes of the genital organs, the oral cavity and the conjunctiva. The viral agent is able to replicate exclusively in the basal epidermis without entering the bloodstream. Due to this feature, the body's immune system cannot fight the pathology to the greatest extent, but acts extremely limited.

The main cause of oncological pathologies against the background of HPV is the increased release of specific proteins that affect the process of cell division. First of all, the proteins responsible for blocking tumor changes, controlling the life cycle and protecting against replication in the presence of DNA damage are affected.

Classification

Because of the variety of strains, HPV types also differ greatly from each other. So many experts use several pathogen classifications at once. So, depending on the clinical picture, all cases of HPV can be divided into asymptomatic and with characteristic manifestations. There is a subclinical course in which periods of exacerbation are recorded. According to the location, the following are distinguished:

1. skin. This type of human papillomavirus causes a growth on the skin of the infected person.
2. Anogenital. In this case, papillomas can be found mainly on the mucous membranes of the genital organs and in the anal area.

Often the main cause of discomfort for the patient is the external signs of HPV. When evaluating a pathogen, doctors focus more on the carcinogenicity of the strain. Exactly:

1. HPV types that are not capable of causing malignant tumors. These include strains 1-5, 10, 28 and 49.
2. Types of pathogens with reduced oncogenic activity. They can cause cancer, but in extremely rare cases. Among such strains are 6. 7, 32, 40-44, etc.
3. It is characterized by moderate oncogenicity. The proportion of affected cells degenerating into cancer cells is quite high. The group includes strains 52-58, 30, 26, etc.
4. Dangerous forms of human papilloma virus. It is these strains that primarily provoke malignant tumor formations. This includes 16, 18, 64, 73 and others.

Diagnosis of human papillomavirus

Various diagnostic techniques help identify papillomas in men and women. Thus, to establish a diagnosis in a patient with a latent form, only molecular biological studies are effective. The most common and well-known method is PCR. It is aimed at determining the genetic properties of the material taken from the patient. PCR helps to identify not only the fact of infection, but also the specific strain of HPV. Subclinical and clinical forms can be diagnosed by methods such as:

1. A simple colposcopy. Papillomas, warts and spots can also be detected during a routine visual examination. Colposcopy is an examination of the vaginal opening using a special binocular device. The examination may be accompanied by taking biological material for research.
2. Extended colposcopy. Additional tests are used during the examination. A test with 3% acetic acid, which provokes a narrowing of unchanged blood vessels, is indicative. In addition, an adrenaline test and a Chrobak test (if cancer is suspected) may be recommended.
3. Cytological examination. To perform a diagnostic procedure, you will need material from epithelium or skin cells. The sample is used to determine the DNA of the virus, as well as to rule out cancerous tumors. Usually, cytology detects only the most oncogenic types of viruses.

It is better to plan the collection of biomaterial for papilloma virus in women during the first half of the menstrual cycle, but not earlier than the fifth day. As a last resort, you can donate biological material later if there are more than 5 days left until menstruation. Before the procedure, you should not smell the vagina. It is worth excluding sexual contact two days before the gathering. A similar rule applies to intravaginal ultrasound and colposcopy.

When diagnosing men with HPV, material is taken from the urethra. It must have been at least two hours since you last urinated. It is important to avoid intimacy for 48 hours before the test. Otherwise, the test may show incorrect results.

Complications

Complications of pathology include excessive growth of warts and papillomas. In rare cases, purulent-septic processes occur against the background of damage to the formation. Typical consequences of infection with oncogenic strains are the following conditions:

1. Anal cancer. 80 percent of cases of detection of this malignant tumor are associated with HPV infection. Also, negative factors affecting the occurrence of cancer of the anus include anal sex, smoking and hereditary predisposition. The disease may not manifest itself for a long time. Typical symptoms of the condition are rectal bleeding, itching and a foreign body sensation.
2. Vaginal cancer. 70 percent of patients with this diagnosis suffer from human papillomavirus. The condition usually occurs in women over the age of 40. Females over the age of 70 are more susceptible to pathology. In the first stages, the symptoms can be confused with menstruation. In addition, there is pain in the pelvic area, constipation and tightness in the vagina.
3. Cancer of the oral cavity and pharynx. One third of diagnoses are the result of HPV infection. The patient complains of pain when swallowing and eating food. In a calm state, there is a sensation of a foreign body in the larynx. In the later stages, general weakness, nausea and loss of working capacity appear.
4. Penile cancer. 50 percent of cases are caused by viral agents. It is a rare malignant tumor involving a tumor process located in the male genital organs. The pathology is characteristic of men over 60 years of age.

HPV treatment

There is currently no effective treatment for HPV. Therapeutic tactics for papilloma virus can be built in two ways:

1. Infection warnings. Unfortunately, even the regular use of contraception and a careful approach to hygiene do not protect a person from infection. Of course, this greatly reduces the chances. However, most cases of transmission of the pathogen are registered in persons of adolescent age, 15-16 years old. By the age of 25, the first symptoms already appear. For a pronounced effect, prevention should be carried out from an early age.
2. Treatment of diseases caused by human papillomavirus. If the strain causes a malignant or benign formation, then therapy for the identified pathology is required. Papillomas are removed in cosmetic or medical offices. Cancerous tumors require complex multi-stage treatment depending on the stage.

Of course, there is good news. So people who have a normally functioning immune system are able to clear HPV on their own within two years. Patients infected during adolescence are cleared of the viral agent by the age of 30. Unfortunately, those who have had the disease do not acquire lifelong immunity.

Forecast

A significant part of the strains are characterized by low or moderate oncogenicity. Only certain types of viruses are associated with an increased risk of developing cancer. This statistic allows us to give many patients a positive prognosis regarding HPV. Early detection of malignant tumors significantly increases the chances of recovery.

The discovery of a virus that can cause cell damage has three potential outcomes:

1. There is a virus, but it has not yet changed the cell structure. In this situation, the patient will be classified as a risk group. If a cancerous type is found, regular monitoring by a gynecologist or urologist is necessary. In addition, you should periodically undergo tests.
2. Changes in CIN-1 cells are detected at an early stage. Most often, this condition also does not require medical intervention. A control examination is usually carried out once a year to ensure that the pathology does not progress.
3. Pronounced changes in CIN-1 were recorded. To rule out dangerous conditions, a biopsy is necessary. The examination will determine whether the formation is of an oncological nature.

Prevention

You can prevent HPV infection by following basic prevention rules. Important:

1. See the doctors promptly. Women are recommended to visit a gynecologist 1-2 times a year. Men should visit a urologist on a similar schedule. If you have risk factors (frequent change of sexual partners, refusal of contraception), you should visit a doctor more often.
2. Minimize visits to public places - swimming pools, saunas, baths. If this is not possible, then it is important to use your own towel, not to take other people's razors and not to sit on the surface naked.
3. Use contraception. Only barrier methods are effective. The use of oral contraceptives does not affect the strains.
4. To give up bad habits. Quitting smoking and moderate alcohol consumption will have a moderate impact on the body's condition.
5. Increasing the immune defense of the body. Proper nutrition, regular physical activity, compliance with the daily routine and movement have a beneficial effect.
6. Avoid stress. Psychoemotional overload can negatively affect the immune system, so it is better to exclude them.

It is important to examine yourself periodically. If there were situations where an infection could occur, then it is better to do an HPV test. There are also people at risk. Thus:

• patients aged 21-30 should have a PAP test at least once every five years (preferably with liquid cytology);
• persons aged 30 to 65 should undergo a Pap test for HPV every three years with mandatory PCR for oncogenic forms (16 and 18).

HPV in pregnant women

Human papilloma in women, as a rule, does not pose a particular risk for the birth of a child. Anogenital warts deserve special attention. They are located not only on the external labia, but also in the vagina. In some cases, they are also accompanied by a bacterial component. Anogenital warts significantly increase the baby's risk of infection during delivery. This is filled with:

1. Recurrent juvenile papillomatosis of the larynx. A similar situation is provoked by four strains of HPV. Usually, the pathology is a consequence of anogenital warts or HPV of the genital type.
2. Increased risk of developing cancer in adulthood. Infection with the virus at such an early age significantly affects the susceptibility to cancer in the future.

Let's dwell in more detail on the papillomatosis of the larynx. At the moment, it is not completely known at what point the transmission of the viral agent takes place. Infection can occur through the placental barrier or directly during the birth of the child. The first symptoms of the pathology are a hoarse voice. In difficult cases, the baby's voice completely disappears and breathing difficulties appear.

The disease is capable of rapid progression. A little later, the patient developed a cough and persistent shortness of breath. Against the background of HPV, the child can get asphyxia caused by blockage of the airways. Most often this happens when there are papillomas on thin legs.

A special medical device called a laryngoscope is used to diagnose the disease. It can be replaced with a bronchoscope. The devices allow us to identify the main sign of pathology - growth of the larynx (condylomas). Surgical treatment is usually recommended for the child. Condylomas are removed by destruction (freezing) or excision. However, the aggressive nature of the disease often leads to relapse.

An expectant mother infected with HPV with a high degree of oncogenicity should inform the obstetrician-gynecologist of the antenatal clinic about this. In this case, doctors will take all measures to ensure that the virus does not affect the health of the child.