HPV (Human Papilloma Virus)

Human papillomavirus (HPV) is a group of common pathogens that can infect the skin and mucous membranes. Mostly, the pathology is diagnosed in patients aged 20 to 30 years, as well as in children under 5 years of age. According to statistics, about 22 percent of the world's population is a carrier of HPV. Many patients are simultaneously affected by several strains.

Currently, more than 190 pathogen genotypes are known. They differ in DNA structure, course and possible complications. 30 pathogens can infect the epithelium of internal and external genital organs. It should be noted that many strains of HPV are characterized by significant carcinogenic activity. Therefore, the virus often causes life-threatening complications: malignant tumors of the vagina, vulva, anal canal, penis.

Causes of HPV

The only source of infectionhuman papillomavirusis in contact with the causative agent of the disease. However, certain factors significantly increase your chances of becoming infected. Exactly:

1. Refusal to use barrier contraception. Only male or female condoms, 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 into sexual intercourse. Sexual intercourse during adolescence often leads to HPV infection because of the irresponsible attitude towards the prevention of pathogen transmission.
4. Failure to comply with hygiene rules. Inadequate self-care leads to the growth of pathogenic microflora on the skin and mucous membranes, which negatively affects the sensitivity to viruses.
5. Bad habits. The body's immune defenses are significantly affected by addictions: alcohol abuse, smoking, and taking psychoactive substances.
6. Weak immunity. The cause of this condition can be a lack of vitamins and minerals, past illnesses, and psycho-emotional burden.
7. Long-term drug treatment. Hormonal drugs taken over a long period of time have significant effects.
8. Traumatic injury. Injuries to the mucous membrane and skin become the "gateway" for infection.
9. Chronic stress. They also affect the patient's immune system and hormonal background.
10. Gynecological intervention. Risk factors for HPV include miscarriage or abortion.
11. Pregnancy. Often the disease first appears during pregnancy. Pregnancy is associated with increased stress on the body, which increases susceptibility to pathogenic flora.

Risks include certain diseases, such as uterine dysplasia. Regular preventive visits to gynecologists and urologists help to significantly reduce the risk.

symptoms

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

1. Papules. These are single or multiple formations that stand out on the skin or resemble freckles. They appear on the skin and mucous membranes of the urogenital area.
2. Itchy skin. Patients often complain of itching in the genital area or other skin areas.
3. Paresthesia. This is a sensitivity disorder in the affected area. Often the opposite manifestation occurs - dyspareunia. In this case, any touch brings pain.
4. Urinary dysfunction. There is a burning sensation, itching, and pain when emptying the bladder. If the urethra is affected, the production of urine may be significantly difficult.
5. crackBleeding cracks appear on the skin and mucous membranes, causing severe pain.

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

1. Genital warts. This 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 certain pattern: variegated or loop-shaped.
2. Papular warts. Appears in the keratin area of the genitals. Can be flat or normal.
3. Stains. The nature of spots varies. There is bright red, brown with a red tint, pink-red, white with gray.
4. Bowen's disease. These are papules or spots characterized by a shiny or velvety surface. The shade varies from red to almost black.
5. Giant condyloma. It is a small formation that gradually increases in size and merges into one.
6. Respiratory papillomatosis. In this case, the formation is localized in the oral cavity, respiratory tract and lungs.

Also, HPV in women in the late stages can manifest as uterine cancer. In 2008, it was discovered that this virus is the cause of malignant tumors. Cervical cancer does not occur as an independent disease. Pathology is accompanied by severe bleeding, pain in the abdomen and lower back, discomfort during intimacy, etc.

Delivery route

Doctors and scientists still argue about the transmission of the human papilloma virus. Some experts believe that one contact without using barrier contraceptives with an asymptomatic carrier is sufficient for the probability of transmission of the pathogen to a healthy partner to reach 70 percent. Other doctors say that such a risk is relevant only when in contact with papilloma carriers. Statistics report that with a constant distance, the transmission of the virus to a healthy person occurs in a period of up to 6 months.

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

1. Sexual transmission. The main method of infection is sexual contact. When using a condom, the risk is reduced to 10 percent. However, pathogens can also penetrate during other intimate manipulations, for example, during kissing.
2. From mother to baby. A newborn baby can be infected with HPV from the mother while passing through the reproductive tract. A common result of this condition is a case of laryngeal papillomosis and anogenital warts.
3. Relationship path and household. The virus is also spread through normal household contact. Often this happens in public areas. The risk of infection is particularly high in bathrooms, saunas, gyms, and swimming pools. Public toilets.
4. Autoinfection. This is the transfer of the virus from the affected area to the healthy one, which occurs during shaving and hair removal.

Pathogenesis

Pathogenesis is significantly influenced by the primary ability of HPV. This 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 human papillomavirus is as follows:

1. Infection. The source of the virus agent can be another person or a commonly used object. The risk of transmission is significantly increased by microtraumas on the skin and mucous membranes: cuts, wounds, cracks, acne.
2. Incubation period. Pathologies that develop as a result of HPV penetration into the body usually have a latent beginning. There is no exact length of incubation period for this disease. The stage takes 1-3 months or reaches 2-3 years.
3. Chronic presence Although there are no clinical manifestations, the disease is constantly developing. A person becomes a source of viral agents for others.
4. Visual manifestations on the skin. The result of infection is the appearance of benign or malignant formations at the site of viral entry.

In the initial stage, the pathogen affects the basal epithelial layer, especially localization on the mucous membranes of the genital organs, oral cavity, and conjunctiva. Viral agents are able to replicate exclusively in the basal epidermis without penetration into the bloodstream. Because of this feature, the body's immune system cannot fully fight the pathology, but acts very limited.

The main cause of oncological pathology 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 suppressing tumor changes, controlling the life cycle and protecting against replication in the presence of DNA damage are affected.

Classification

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

1. skin. This type of human papillomavirus causes growths on the skin of infected people.
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 pathogens, doctors focus more on the carcinogenicity of strains. Exactly:

1. HPV types that are not capable of causing malignant tumors. These include strains 1-5, 10, 28 and 49.
2. A type of pathogen with reduced oncogenic activity. They can cause cancer, but in very rare cases. Among the strains are 6. 7, 32, 40-44 and others.
3. Characterized by moderate oncogenicity. The percentage of affected cells that degenerate into cancer cells is quite high. The group includes strains 52-58, 30, 26 and others.
4. Dangerous form of human papillomavirus. It is this strain that mostly triggers the formation of malignant tumors. This includes 16, 18, 64, 73 and others.

Diagnosis of human papillomavirus

Various diagnostic techniques help identify papillomas in men and women. Therefore, to establish a diagnosis in patients with a latent form, only molecular biological studies are effective. The most common and well-known method is PCR. It aims to determine the genetic nature of the material taken from the patient. PCR helps 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 freckles can also be detected during a routine visual inspection. Colposcopy refers to the examination of the opening of the vagina using a special binocular device. The examination may be accompanied by the collection of biological material for research.
2. Advanced colposcopy. During the examination, additional tests are used. A test using 3% acetic acid, which causes unaltered vasoconstriction, is indicative. In addition, an adrenaline test and a Chrobak test (if cancer is suspected) may be recommended.
3. Cytological examination. To carry out diagnostic procedures, you need material from the epithelium or skin cells. Samples are used to determine viral DNA, as well as to exclude 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 in the first half of the menstrual cycle, but not earlier than on the fifth day. As a last resort, you can donate biological material later, if there are more than 5 days left before your period. Before the procedure, you can not wash the vagina. It is worth excluding sexual intercourse two days before collection. The same rules apply to intravaginal ultrasound and colposcopy.

When diagnosing men with HPV, material is collected from the urethra. At least two hours should have passed since your last pee. It is important to avoid intimacy 48 hours before the test. Otherwise, the study may show false results.

Complications

Pathological complications include excessive growth of warts and papillomas. In rare cases, a purulent-septic process occurs against the background of damage to the formation. Common consequences of infection with oncogenic strains are the following conditions:

1. Anal cancer. 80 percent of cases of malignant tumor detection are associated with HPV infection. Also, negative factors that affect the onset of anal cancer include anal sex, smoking, and hereditary predisposition. The disease may not manifest for a long time. Common symptoms of this condition are rectal bleeding, itching, and foreign body sensation.
2. Vaginal cancer. 70 percent of patients with this diagnosis have human papillomavirus. This condition is usually found in women over 40 years of age. Representatives of the fair sex over the age of 70 are more susceptible to pathology. In the first stage, symptoms can be confused with menstruation. In addition, pain in the pelvic area, constipation, and cramps in the vagina appear.
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 feeling of a foreign body in the larynx. In the final stage, general weakness, nausea, and loss of performance appear.
4. Penile cancer. 50 percent of cases are caused by viral agents. This is a rare malignant tumor, involving tumor processes localized in the male genital organs. Pathology is typical for men over 60 years old.

HPV treatment

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

1. Infection warning. Unfortunately, even the frequent use of contraceptives and a careful approach to hygiene do not protect a person from infection. Of course, this reduces the chances significantly. However, most cases of pathogen transmission are recorded in people during adolescence, at the age of 15-16 years. At the age of 25, the first symptoms appeared. For a significant effect, prevention must be done 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. Papilloma is removed in a cosmetic or medical office. Cancerous tumors require complex multi-level treatment depending on the stage.

Of course, there is good news. So people with a normally functioning immune system can overcome HPV on their own within two years. Patients infected during adolescence become free of the viral agent by the age of 30. Unfortunately, those who have recovered do not acquire lifelong immunity.

Prediction

Most strains are characterized by low or moderate oncogenicity. Only certain types of viruses are associated with an increased risk of cancer. These statistics allow 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 possible outcomes:

1. There is a virus, but it has not yet changed the cellular structure. In this situation, the patient will be classified as a risk group. If the carcinogenic type is identified, then regular monitoring by a gynecologist or urologist is required. In addition, you need to undergo regular tests.
2. Changes in CIN-1 cells are detected at an early stage. Often this condition also does not require medical intervention. Usually, follow-up examinations are carried out once a year to ensure that the pathology does not develop.
3. Marked changes in CIN-1 have been recorded. To exclude dangerous conditions, a biopsy is required. The study will determine whether the formation is oncological.

Prevention

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

1. Visit the doctor on time. Women are recommended to schedule a visit to a gynecologist 1-2 times a year. Men should visit a urologist on the same schedule. If you have risk factors (frequent changes of sexual partners, refusal of contraception), you should visit the doctor more often.
2. Reduce visits to public places - swimming pools, saunas, baths. If this is not possible, then it is important to use your own towel, do not take someone else's razor and do not sit on the surface with your naked body.
3. Use contraception. Only effective deterrent methods. The use of oral contraceptives does not affect the strain.
4. To reject bad habits. Quitting smoking and moderate alcohol consumption will have a moderate effect on the body's condition.
5. Increase the body's immune defenses. Proper nutrition, regular physical activity, adherence to a daily routine, and exercise have a positive effect.
6. Avoid stress. Psycho-emotional excesses can negatively affect the immune system, so it is better to exclude them.

It is important to get tested regularly. If there is a situation when infection may occur, then it is better to take a test for HPV. There are also people who are at risk. So:

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

HPV in pregnant women

Human papilloma in women, as a rule, does not pose any particular risk for childbirth. Anogenital warts deserve special attention. They are localized not only on the outer labia, but also in the vagina. In some cases, it is also accompanied by a bacterial component. Anogenital warts significantly increase the risk of infection of the baby during delivery. It's full of:

1. Recurrent juvenile laryngeal papillomatosis. The same situation is triggered by four types of HPV. Usually the pathology is the result of anogenital warts or genital HPV.
2. Increased risk of cancer in adulthood. Viral infection at such an early age has a significant impact on future susceptibility to cancer.

Let's talk in more detail about laryngeal papillomatosis. At this time, it is not fully known at what point the transmission of the viral agent occurred. Infection can occur through the placental barrier or directly at the time the child is born. The first symptom of pathology is a hoarse voice. In severe cases, the baby's voice is completely lost and breathing difficulties appear.

This disease can develop rapidly. Soon after, the patient developed a persistent cough and shortness of breath. Against the background of HPV, children may experience asphyxia caused by blockage of the airways. Most often, this happens when there is a papilloma on a thin leg.

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

A pregnant mother infected with HPV with a high level of oncogenicity should inform the midwife of the antenatal clinic about this. In this case, the doctor will take all measures to ensure that the virus does not affect the child's health.