HPV (Human Papillomavirus)

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

Currently, more than 190 genotypes of the pathogen are known. They differ in DNA structure, progression and possible 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. The virus often causes life-threatening complications: malignant tumors of the vagina, vulva, anal tract, and penis.

Causes of HPV

The only cause of infectionHuman papilloma virusesis contact with the causative agent of the disease. However, certain factors significantly increase the risk of infection. Exactly:

1. Refusal to use barrier contraceptives. Only a male or female condom and special latex cloths can protect against infection.
2. Frequent change of sexual partners. If you don't pay enough attention to your own safety, the risk of infection increases significantly.
3. Early entry into sexual relationships. Sexual relationships in adolescence often lead to HPV infection due to an irresponsible attitude to preventing the transmission of the pathogen.
4. Non-compliance with hygiene regulations. Insufficient self-care leads to the growth of pathogenic microflora on the skin and mucous membranes, which negatively affects sensitivity to the virus.
5. Bad habits. The body's immune defense is significantly impaired by addictions: alcohol abuse, smoking and the use of psychoactive substances.
6. Weakened immunity. The causes of the disease can be vitamin and mineral deficiency, previous illnesses and psycho-emotional overload.
7. Long-term drug treatment. Hormonal medications that are taken over a longer period of time have a particularly pronounced effect.
8. Traumatic injuries. Injuries to the mucous membranes and skin become a "gateway" for infections.
9. Chronic stress. They also affect the patient's immune system and hormone levels.
10. Gynecological procedures. Risk factors for HPV include spontaneous miscarriage or abortion.
11. Pregnancy. The disease often first occurs 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 a gynecologist and urologist help to significantly reduce risks.

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 a few years. However, a person in this condition poses a danger to others. It can infect other people through contact. Symptoms can be divided into subjective, indirectly indicating pathology, and objective, characteristic manifestations of HPV. Subjective symptoms include:

1. papules. These are single or multiple formations that protrude above the skin or are spot-like. They occur on the skin and mucous membranes of the urogenital area.
2. Itching on the skin. The patient often complains of itching in the genital area or other skin areas.
3. Paresthesia. This is a sensory disorder in the affected area. Often the opposite manifestation occurs – dyspareunia. In this case, any contact causes pain.
4. Urinary dysfunction. When emptying the bladder there is burning, itching and pain. If the urethra is affected, excreting urine can be significantly more difficult.
5. cracks. Bleeding cracks appear on the skin and mucous membranes, causing severe pain.

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

1. Genital warts. This is a bump above the surface of the skin characterized by an elongated, finger-like shape. Localized in the genital area. They differ in a certain pattern: colorful or looped.
2. Papular warts. Appear on keratinized areas of the genitals. Can be flat or regular.
3. Stains. The type of stains varies. There are bright reds, browns with red undertones, rose-colored tones and whites with gray tones.
4. Bowen disease. These are papules or spots that are characterized by a shiny or velvety surface. The color varies from red to almost black.
5. Giant condyloma. It is a small formation that gradually increases in size and merges into a single entity.
6. Respiratory papillomatosis. In this case, the formations are localized in the oral cavity, respiratory tract and lungs.

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

Transmission routes

Doctors and scientists still argue about the contagiousness of the human papilloma virus. A number of experts assume that even a single contact with an asymptomatic carrier without barrier contraception is enough to increase the probability of transmitting the pathogen to a healthy partner to 70 percent. Other doctors say that such risks are relevant only when in contact with papilloma carriers. Statistics show that with regular proximity, the transmission of the virus to a healthy person occurs within a period of up to 6 months.

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

1. Sexual transmission. The main method of infection is sexual contact. Using a condom reduces the risk to 10 percent. However, the pathogen can also penetrate during other intimate manipulations, such as kissing.
2. From mother to baby. A newborn can become infected with HPV from the mother as it passes through the reproductive tract. Typical consequences of this situation are cases of laryngeal papilosis and anogenital warts.
3. Contact and household route. The virus is also transmitted through ordinary household contacts. This most often happens in public areas. The risk of infection is particularly high in baths, saunas, fitness studios and swimming pools. Public toilets.
4. Autoinfection. This is the transmission of a virus from an affected area to a healthy area that occurs during shaving and hair removal.

Pathogenesis

The pathogenesis is significantly influenced by the key 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 the human papillomavirus is as follows:

1. Infection. The source of viral pathogens can be another person or common objects. The risks of transmission are significantly increased by 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 begin latently. There is no exact duration of the incubation period of this disease. The phase lasts 1-3 months or reaches 2-3 years.
3. Chronic presence Despite the absence of clinical manifestations, the disease is constantly progressing. A person becomes a source of viral pathogens for others.
4. Visual manifestations on the skin. The result of infection is the appearance of a benign or malignant formation at the site of entry of the virus.

In the initial stage, the pathogen affects the basal epithelial layer and localizes mainly on the mucous membranes of the genital organs, the oral cavity and the conjunctiva. The viral pathogen can only multiply within the basal epidermis without penetrating the bloodstream. Due to this property, the body's immune system cannot completely fight the pathology, but has an extremely limited effect.

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

classification

Due to the diversity of strains, the HPV types also differ significantly from each other. Therefore, many experts use several classifications of the pathogen at once. Depending on the clinical picture, all HPV cases can be divided into asymptomatic cases and cases with characteristic manifestations. There is a subclinical course in which periods of exacerbation are recorded. A distinction is made based on location:

1. Skin. This type of human papillomavirus causes formation on the skin of the infected person.
2. Anogenital. Papillomas are found primarily on the mucous membranes of the genital organs and in the anal area.

Often the main cause of the patient's complaints are the external signs of HPV. When evaluating a pathogen, doctors focus more on the carcinogenicity of the strain. Exactly:

1. HPV types that cannot cause malignant tumors. These include strains 1-5, 10, 28 and 49.
2. Types of pathogens with reduced oncogenic activity. They can cause cancer, although in extremely rare cases. These strains include 6, 7, 32, 40-44 and others.
3. Characterized by moderate oncogenicity. The proportion of affected cells that degenerate into cancer cells is quite high. The group includes strains 52-58, 30, 26 and others.
4. Dangerous forms of the human papillomavirus. It is these strains that predominantly cause malignant tumor formations. These include 16, 18, 64, 73 and others.

Diagnosis of human papillomavirus

Various diagnostic techniques help identify papillomas in men and women. Therefore, to make a diagnosis in a patient with a latent form, only molecular biological studies are effective. The most common and well-known method is PCR. The aim is to determine the genetic characteristics 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 the following methods:

1. Simple colposcopy. Papillomas, warts and pimples can also be detected during a routine visual examination. Colposcopy is the examination of the vaginal opening using a special binocular device. The investigation may be accompanied by the collection of biological material for research purposes.
2. Advanced colposcopy. Additional tests are used during the examination. A test with 3% acetic acid, which causes narrowing of unchanged blood vessels, is indicative. Additionally, an adrenaline test and a Chrobak test (if cancer is suspected) may be recommended.
3. Cytological examination. To carry out a diagnostic procedure, you need material from epithelial or skin cells. The sample is used to determine the DNA of the virus and to rule out cancerous tumors. Typically, cytology detects only the most oncogenic virus types.

It is better to plan the collection of biomaterial for papillomavirus in women in 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 the period. Before the procedure, you should not rinse the vagina. It is worth avoiding sexual intercourse two days before the collection. A similar rule applies to intravaginal ultrasound and colposcopy.

When diagnosing HPV infections in men, material is collected from the urethra. At least two hours should have passed since you last urinated. It is important to avoid intimacy for 48 hours before the test. Otherwise the study could produce false 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 an infection with oncogenic strains are the following diseases:

1. Anal cancer. 80 percent of cases in which this malignant tumor is discovered are related to an HPV infection. The negative factors that influence the development of anal cancer also include anal sex, smoking and hereditary predisposition. The disease may not manifest itself for a long time. Typical symptoms of the disease include bleeding from the rectum, itching and a foreign body sensation.
2. Vaginal cancer. 70 percent of patients with this diagnosis suffer from human papillomavirus. The disease usually occurs in women over 40. Representatives of the fair sex over 70 years old are more susceptible to pathologies. In the early stages, symptoms may be confused with menstruation. In addition, pain in the pelvic area, constipation and a feeling of tightness in the vagina occur.
3. Cancer of the oral cavity and throat. A third of diagnoses are the result of an HPV infection. The patient complains of pain when swallowing and eating. When you are at rest, there is a feeling of a foreign body in the larynx. In the later stages, general weakness, nausea and loss of performance occur.
4. Penile cancer. 50 percent of cases are caused by viral pathogens. This is a rare malignant tumor, which is a tumor process localized in the male genital organ. The pathology is typical for men over 60 years old.

HPV treatment

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

1. Infection alerts. Unfortunately, regular use of contraceptives and careful hygiene do not protect against infection. Of course, this significantly reduces the chances. However, most cases of transmission of the pathogen are recorded in people of adolescence, aged 15-16. The first symptoms appear at the age of 25. For a pronounced effect, prevention must take place at a young age.
2. Treatment of diseases caused by the human papilloma virus. If the strain causes a malignant or benign formation, therapy of the identified pathology is required. Papillomas are removed in cosmetic or doctor's offices. Depending on the stage, cancerous tumors require complex multi-stage treatment.

Of course there is good news. People with a normally functioning immune system are able to fight HPV on their own within two years. Patients who were infected in their youth are free of the viral pathogen by the age of 30. Unfortunately, those who recover do not gain lifelong immunity.

forecast

A significant proportion of 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. The early detection of malignant tumors significantly increases the chances of recovery.

The discovery of a virus that can cause cell damage has three possible consequences:

1. There is a virus, but it has not yet changed the cell structure. In this situation, the patient is classified as a risk group. If a cancer-causing type is detected, regular monitoring by a gynecologist or urologist is required. In addition, you should undergo regular tests.
2. Changes in CIN-1 cells were detected at early stages. This condition usually does not require medical intervention. Typically, a follow-up examination is carried out once a year to ensure that the pathology does not progress.
3. Significant changes in CIN-1 were noted. To rule out dangerous conditions, a biopsy is required. The study will determine whether the formation is of an oncological nature.

prevention

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

1. Visit doctors on time. Women are recommended to schedule a visit to the gynecologist 1-2 times a year. Men should see a urologist on a similar schedule. If you have risk factors (frequent changes in sexual partners, refusal to use contraception), you should see a doctor more often.
2. Minimize visits to public places – swimming pools, saunas, baths. If this is not possible, it is important to use your own towel, not to take other people's razors and not to sit on the surface with your naked body.
3. Use contraceptives. Only barrier methods are effective. The use of oral contraceptives does not affect the strains.
4. Give up bad habits. Quitting smoking and moderate alcohol consumption have a moderate effect on the condition of the body.
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 overload can negatively affect the immune system, so it is better to exclude it.

It is important to get tested regularly. If there were situations in which infection may have occurred, it is better to do an HPV test. There are also people at risk. So:

• Patients aged 21 to 30 years must have a PAP test (preferably by liquid cytology) at least every five years;
• People aged 30 to 65 must undergo a Pap test for HPV with mandatory PCR for oncogenic forms (16 and 18) every three years.

HPV in pregnant women

Human papilloma in women usually does not pose any particular risks to bearing a child. Anogenital warts deserve special attention. They are located not only on the outer 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 birth. This is fraught with:

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

Let's dwell on laryngeal papillomatosis in more detail. It is currently not fully known when the viral pathogen is transmitted. The infection can occur through the placental barrier or directly when the child is born. The first symptoms of pathology are hoarseness. In difficult cases, the baby's voice disappears completely and difficulty breathing occurs.

The disease can progress quickly. A little later, the patient develops a cough and constant shortness of breath. Against the background of HPV, a child may experience suffocation caused by obstruction of the respiratory tract. This most often happens when there are papillomas on thin legs.

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

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