Diseases caused by the human papilloma virus have been known for a very 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 only attracted scientific attention in the last 30 to 40 years. The human papillomavirus (HPV) group was identified as a separate species in 1971. Since then, scientists have classified HPV types and established their relationship to many pathologies, but research continues. At the same time, doctors are looking for more effective ways to combat this insidious virus.
What is HPV
Human papillomavirus is a large group of viruses that contain DNA and exhibit affinity for the epithelial cells that form the skin and mucous membranes. Today, around 170 types of viruses have been discovered and around 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, research has been conducted that has proven that human papillomavirus infection plays a role in the development of adenocarcinoma and squamous cell cancer of the cervix (the second type of tumor ismuch more common). In 99% of cases, oncology patients are diagnosed with HPV infection and cells specifically modified by the virus.
The papilloma virus invades epithelial cells. After entering the genome, replication (reproduction of the virus's DNA) begins. In this case, the cells divide in an atypical way and their structure changes, which can be seen if we do a cytological analysis.
The papilloma virus manifests itself by specific changes in the epithelium:
- on the skin of the body (common 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 relatively rarely recorded.
All types of viruses are divided into three groups:
- with a 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. Their detection in a pregnant woman requires attention, since there is a risk of developing laryngeal papillomatosis in a newborn upon contact with the mother's mucous membranes during childbirth. Therefore, when planning a pregnancy, both women and men should 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 diagnosis.
Infection methods
The most common route of infection is sexual. Almost 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 during testing. Only occasionally does HPV cause minor clinical manifestations and, in extremely rare cases, cancer that develops several years after infection (10-15).
Other routes of infection:
- Contact– by touch. This is how you can become infected with warts;
- Domestic.The virus remains viable in the external environment for some time. Infection is possible in bathhouses, swimming pools and other public places. The pathogen enters through microdamages 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 baby has genital warts.
- Self-infection.Human papillomavirus (HPV) infection can spread throughout the body from one place to another, for example by shaving or scratching warts.
Stages of infection development
After infection, the latent stage begins - latent or carrier 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, since it does not reproduce its copies and does not change the epithelial tissue. However, its DNA can be detected by 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 stage (subclinical), 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 upon examination, isolated condyloma or small papillomas may be visible.
The third stage is clinical (manifest). The symptoms are pronounced and the disease requires treatment. Most 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 period, the cells become malignant and the carcinoma begins to grow.
Reasons for activation of papillomavirus
Infection with PVI occurs very easily, but the human immune system copes well with it and the virus often disappears on its own. A persistent infection that periodically gets worse and does not leave the body is a sign of a diminished 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 illnesses that weaken the body;
- Endocrine pathologies (diabetes mellitus, thyroid disease) and hormonal fluctuations (pregnancy, menopause);
- Constant stress, prolonged psycho-emotional stress;
- Poor diet, strict diets, lack of vitamins, minerals and complete proteins;
- Severe nutritional obesity and sedentary lifestyle;
- Taking medications that suppress the immune system, exposure to radiation, chemotherapy;
- Primary and secondary immunodeficiencies, HIV;
- Onset of sexual activity before age 16 and indiscriminate intimate contact;
- Concomitant infection with other sexually transmitted infections;
- Gynecological interventions leading to mechanical damage to the mucous membranes of the cervical canal (abortion, curettage, placement of a spiral, etc. ).
The incubation period of PVI is very 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 once and be constantly reinfected, for example by a sexual partner.
HPV diagnosis
The first step in diagnosis is always an examination by a doctor and taking a 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 at a subclinical stage, small warts may not be visually visible. Therefore, a test is carried out with acetic acid - after treatment with it, new shoots turn white and stand out against the background of the surface.
The same thing happens with the mucous membrane of the cervix (examined by colposcopy) - the identification of white areas on it indicates that the epithelium in this place is changed. 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 monitoring are necessary after six months, as the disease may progress. On the other hand, the virus can go into a latent state, then 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 fabric previously treated with vinegar are colored with a solution of iodine in glycerin. Normal cells absorb this solution and turn uniformly brown. In atypical cells, the processes of glycogen accumulation are disrupted and do not absorb the solution. Mosaic coloring appears, its characteristic features suggest a diagnosis.
Cytology smear
It is otherwise called PAP test, named after its inventor, the Greek doctor Papanikolaou. For the test, a scraping is done on 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: the results of cytology, PCR analysis, tests for other infections, the 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 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 as that taken for the cytological analysis. The polymerase chain reaction is carried out in a special apparatus, where a predetermined genetic sequence is copied several 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 venereal diseases. If positive PCR results are obtained, further diagnostics are necessary.
Since the DNA test is very precise, its use often leads to overdiagnosis. After all, detected DNA from a virus does not mean 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 carried out to find out the concentration of the pathogen in the tissues, that is, the viral load (indicated in the results by the letters lg). At the same time, genotyping is carried out to determine the exact type of pathogen. If oncogenic strains are detected, control tests are prescribed after 3 to 6 months.
Digene test
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 combined with a cytology smear 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 a woman when positive screening results are obtained: cytological analysis showed cell class 3-4-5. 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 showing signs of malignancy. Thus, histology makes it possible to determine the degree of neoplasia and identify cancer at an early stage, when it can be successfully treated.
In some cases, tissues taken from neoplasms of the skin and mucous membranes are subjected to histological analysis in case of doubt about their nature and good quality.
Treatment of PVI
In the latent stage of PVI, no treatment is required. The detected infection only becomes a reason for observation over time. It should be noted that it is impossible to kill the virus in the body with drugs, because it replicates inside cells.
An infected person is advised to:
- avoid factors that reduce immunity, take vitamins;
- recover from concomitant sexually transmitted infections, if any, not develop chronic diseases;
- lead a healthy lifestyle, give up bad habits;
- live a sex life with a permanent and trusted partner.
Treatment of human papillomavirus begins with the stage of subclinical manifestations. At this point he is conservative. Immunomodulatory treatment is generally prescribed. For this purpose, preparations of human interferon or its inducers are used.
Nonspecific immunomodulators are also effective against HPV. Antiviral drugs are used.
Doctors often prescribe local medications at the same time - ointments, gels and creams.
Important!
Immunomodulatory treatment is prescribed only by a doctor based on the results of an immunogram; uncontrolled use of medications can lead to the opposite result: dysfunction of the immune system.
At 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 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 when cervical cancer is diagnosed. In this case, the woman is treated and observed by an oncologist.
Because PVI is often associated with other sexually transmitted infections, antibacterial, anti-inflammatory, and other medications may be prescribed.
Common 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 complete cure is impossible, doctors give favorable prognoses. Usually, after individually developed treatment, taking into account the oncogenicity of the virus and concomitant diseases, the infection disappears.
Relapses do occur, but are relatively rare if treatment is not discontinued. Some people experience one relapse, sometimes several, but shorter, weaker relapses. Constant exacerbations are typical only for people with a prolonged decrease in immunity due to HIV infection or severe chronic diseases.
Prevention of PVI
Prevention measures are divided into general and specific. General recommendations to avoid infection:
- use barrier methods of contraception;
- having sex with a regular partner;
- do not start sexual activity before the age of 18, because in adolescents the immune system is not yet fully formed;
- Avoid artificial termination of pregnancy.
Until now, there is only one specific method of prevention: vaccination. It is now possible to be vaccinated 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 old.
Patient feedback
- "I had condyloma, I didn’t know about it, " said the gynecologist after the examination. I immediately asked if we were going to remove it, I agreed. Then she prescribed me and my husband to take an antiviral medication. Expensive, but we decided: follow treatment to the end. I also did baths with chamomile, thread 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. A doctor told me: just cauterize, otherwise there will be cancer later. Another said there was no need to treat anything before age 30, especially before giving birth. She 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 years, as the second doctor told me, the body no longer recovers on its own.