HPV very often 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, hands, neck and other parts of the body. Read more about the hidden manifestations of this virus and methods of its treatment in the following article.
What is human papillomavirus?
Human papilloma virus (HPV) is the common name for more than 70 different viruses that can cause diseases of various human organs: some of the HPV viruses cause skin diseases, others cause genital warts (genital warts) and other diseases of the genital organs. Each of the HPV group viruses has its own sequence number and differs from other viruses by its unique DNA composition.
Currently, the role of some types of human papillomaviruses in the development of malignant tumors of various organs has been proven: for example, cervical cancer, penile cancer, throat cancer, etc. The different types of human papillomaviruses are divided into groups depending on their ability to cause malignant neoplasms. So it is common to distinguish between 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 more common in cervical cancer.
How HPV enters the body
The most common way of transmission of the human papilloma virus (HPV) is sexual contact, so this infection is classified as a group of sexually transmitted diseases (STDs). In addition, infection with human papilloma virus (HPV) is possible when damaged skin or mucous membranes come into contact with secretions of a sick person (for example, underwear, towels, etc. ). Human papilloma virus can be transmitted from mother to child during childbirth.
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 may become infected again.
The peak period for infection in both women and men begins immediately after initiation of sexual activity. HPV is sexually transmitted, but penetrative sex is not required to transmit the virus. Skin-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 within a few months of acquiring them, and about 90% clear up within 2 years. A small proportion of infections with certain types of HPV can persist and develop into cancer.
Cervical cancer is the most common HPV-related disease. Almost all cases of cervical cancer can be attributed to HPV infections.
Despite limited data on anogenital cancers other than cervical cancer, increasing 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.
HPV types that do not cause cancer (especially types 6 and 11) can cause genital warts and respiratory papillomatosis (a disease in which tumors grow in the airways leading from the nose and mouth to the lungs). And although these conditions very rarely lead to death, they can often lead to illness. Genital warts are widespread and highly contagious.
How HPV is transmitted and manifested
More than 150 types of virus have been identified in modern medicine. 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 formations.
The main route of transmission is physical contact with the carrier, including intercourse without a condom. But it is also quite common to be 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 papillomavirus infection manifest itself?
The most common manifestations of human papillomavirus infection are:
- Pointed warts. The development of genital warts and papillomas is more often caused by HPV with a low oncogenic risk. Condylomas are single and focal, usually appear in places that are injured during sexual intercourse. The size of the elements is from 1 millimeter to several centimeters, in shape they resemble a "cock's comb" or "cauliflower" and are located on a narrow base (foot). Most often, women find warts to the touch during washing, which is felt as a bump. With a large number or size of genital warts, they can be injured and bleed, interfere with normal sexual life and childbirth, cause psychological discomfort. Itching rarely accompanies symptoms of human papillomavirus infection.
- Papillomas (warts). Unlike papillomas of a tumor nature, viral papillomas appear, disappear and reappear, as their severity depends on the state of the body's defenses at the moment. Viral papillomas do not differ in color from normal skin and can grow anywhere.
- Flat condylomas of the cervix. Flat condylomas are a manifestation of a chronic, prolonged viral infection that causes changes in the cells of the epithelium of the cervix. It can be combined with genital warts on the external genitalia. Changes in the cervix, characteristic of HPV, always alert the doctor, because women who have this virus for a long time are 65 times more likely to get cervical cancer than those who do not have it. But the presence of a high-risk virus in the body does not mean that a woman will definitely get cancer. Additional factors are required for cells to become malignant. The fact of detecting high-risk types of viruses gives the patient a significant advantage in the fight against the disease; here the formula "forewarned is armed" is most appropriate. Thus, the average age of women with the first signs of malignant transformation in 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 cause the appearance of genital warts - genital warts, which in many cases are detected only during a gynecological examination.
They grow about three months after infection. Most often, they are formed on the labia minora, in the vagina, on the cervix, cervical canal, on the skin around the anus.
Externally, they are small formations that are located on a wide "foot" and have uneven edges. At the same time, the HPV types that cause genital warts are not the ones that cause cancer.
Symptoms of the disease in women also include cervical intraepithelial neoplasia - a precancerous condition of the uterine lining that provokes a violation of cell maturation. Currently, doctors know 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. Also, cancer is provoked by types 31, 33, 35 and 39.
Symptoms of HPV in both 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 armpit, on the neck and on the eyelids.
For men, the disease is less dangerous than for women. And if some carcinogenic types of viruses that cause the development of growths on the skin in a man rarely provoke tumors in the stronger sex, then a woman, having contracted them from a man, risks developing cervical cancer.
The course of pregnancy
During pregnancy, visible warts often recur, tend to increase significantly, loosen, large formations can cause difficulties during childbirth. There is evidence that primary HPV infection during pregnancy can lead to threatened termination, but whether such infection causes fetal malformations is a controversial issue.
The frequency of transmission of HPV from the mother to the fetus, according to various researchers, varies significantly - from 4 to 80%. It is not yet known exactly how the virus is transmitted. Most likely through the cervical canal and fetal membranes on the ascending route or through contact when the child passes through the birth canal of the mother.
Recently, the development of laryngeal, tracheal, and bronchial papillomatosis and anogenital warts in infants has been associated with HPV infection at birth. The disease is quite rare, in addition, cases of this disease have been described in children born by cesarean section, 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 give birth through the natural birth canal. But such condylomas are found only in women with severe immune deficiency, for example, AIDS.
After birth, 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 detected for the first time during pregnancy, as a rule, is not detected after birth.
Risk factors for cervical cancer
- first intercourse at an early age;
- multiple sexual partners;
- tobacco use;
- immunosuppression (eg, HIV-infected people are at increased risk of HPV infection and are infected with a wider range of HPV types).
Diagnosis
The main method for 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 canal and from the surface of the cervix).
Cytological examination does not reveal the virus itself, but the changes in the cells of the epithelium of the cervix, characteristic of this infection. Histological examination helps to clarify the cytological diagnosis: in this case, a scraping of surface cells is not taken, as in cytology, but a piece of tissue, examining not only the structure of the cells, but also the correct arrangement of their layers. A biopsy is usually not performed during pregnancy.
Polymerase chain reaction (PCR) is used to determine the types of viruses and their oncogenic risk, 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 of human papillomavirus infection (along with this, spontaneous, spontaneous recovery is often observed), the manifestations of HPV are treated, not the presence of the virus in the body. At the same time, the effectiveness of various treatment methods is 50-70%, and in a quarter of cases the disease reappears several months after the end of treatment.
Given the possibility of self-resolution of genital warts, it is sometimes advisable not to undergo any treatment. The question of the expediency of treatment for each pregnant patient is decided individually.
In this case, it is necessary to avoid factors that reduce immunity (hypothermia, strong emotional stress, chronic overload, beriberi). There are studies showing the preventive effect of retinoids (beta-carotene and vitamin A), vitamin C and micronutrients such as folic acid in HPV infections.
The most commonly used treatments for genital warts are:
Destructive methods
Destructive methods are local treatment aimed at removing 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, physical destructive methods and preparations with trichloroacetic acid can be used. Treatment with destructive methods is desirable to be carried out only in the early stages of pregnancy, taking special care. At the same time, it is necessary to take into account the risk of possible side effects during treatment (bleeding and secondary infection due to impaired blood circulation, toxic complications) and the possibility of recurrence of genital warts after their removal.
Cytotoxic drugs
Cytostatics are STRICTLY CONTRAINDICATED during pregnancy. In women of childbearing age, reliable contraception or abstinence from sexual activity during treatment is recommended.
Immunological methods
Interferons are most commonly used to treat HPV infection. They are a family of proteins that are produced by cells of the immune system in response to viral stimulation. Immunoglobulin preparations are used together with topical medication. These drugs are actively used at the end of pregnancy. However, in 60% of cases, even long-term interferon therapy 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 with papillomavirus infection, due to the insufficiently studied effect on the fetus. By the way, the well-known antiviral drug has no effect on HPV.
Summary
- Pruritus may be caused by PVI, but to confirm this cause, all other possible causes of pruritus transmitted by contact must be ruled out. It is not a sexually transmitted disease, and the infection may not necessarily be from a sexual partner, and not necessarily from sexual life at all. Condom, virginity, regular sexual partner, abstinence - do not mean 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, not by PCR.
- When PVI is detected, colposcopy is required, if necessary, biopsy and treatment. If you can refuse the OK of the external genital organs and do not treat, then the cervix must be examined and treated without fail. PVI is the most common cause of cervical cancer.
- If HPV is detected, partner screening is required, as penile cancer is the same consequence of PVI as cervical cancer. The test is also an eye, not a PCR.
- The manifestations of PVI - OK or flat condylomas - are subject to treatment, not the presence of the virus in the body.
- The first stage of treatment is conservative. The basis of therapy is antiviral drugs, incl. - local. Immunomodulators are an auxiliary and optional component of treatment.
- Pruritus may be caused by PVI, but all other possible causes of pruritus must be ruled out to confirm this cause.
- PVI is repeated with a decrease in immunity. This does not indicate the ineffectiveness of the previous treatment. No treatment can completely remove the virus from the body and does not guarantee complete elimination of OC.
- PVI can be transmitted during childbirth from the mother to the child, causing papillomatosis of the larynx. This is easily treatable. Condylomatosis is not an indication for cesarean section.
The human papilloma virus (HPV) can be in a woman's body for years and not manifest itself in any way, while constantly threatening the risk of developing cancerous and precancerous diseases of its "owner".