HPV very often practically does not manifest itself in any way. Of course, the main symptoms of human papillomavirus are warts, which can appear in the most unexpected places: on the genitals, palms, arms, neck and other parts of the body. Read more about the hidden manifestations of this virus and methods of its treatment in the article below.
What is human papillomavirus
Human papillomavirus (HPV) is the common name for more than 70 different viruses that can cause diseases in various human organs: some of the HPV viruses cause skin diseases, others cause genital warts (genital warts) and other diseases of the sex organs. Each of the viruses in the HPV group has its own sequence number and differs from other viruses in its unique DNA composition.
Currently, the role of certain types of human papillomaviruses in the development of malignant tumors of various organs has been proven: for example, cervical cancer, penile cancer, larynx cancer, etc. Different types of human papillomaviruses are divided into groups depending on their ability to cause malignant neoplasms. Therefore, it is common to distinguish between viruses with high, intermediate 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 commonly found in cervical cancer.
How HPV gets into the body
The most common route of human papillomavirus (HPV) transmission is sexual contact, so this infection is classified as a group of sexually transmitted diseases (STDs). In addition, infection with human papilloma viruses (HPV) is possible through contact of damaged skin or mucous membranes with secretions from a sick person (e. g. underwear, towels, etc. ).
Verification
The human papillomavirus (HPV) is the most common viral infection of the genital tract. Most sexually active women and men will become infected at some point in their lives, and some can become infected again.
The peak phase of contagion begins in both women and men immediately after the start of sexual activity. HPV is sexually transmitted, but penetrative sex is not required to transmit the virus. Skin-to-genital contact is an established transmission route.
Many HPV types do not cause problems. HPV infections usually resolve on their own without intervention within a few months of acquisition, and about 90% resolve within 2 years. A small proportion of infections with certain HPV types can persist and develop into cancer.
Cervical cancer is by far the most common HPV-associated disease. Almost all cases of cervical cancer can be due to HPV infection.
Despite limited data on anogenital cancers other than cervical cancer, a growing body of 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 cervical cancer.
HPV types that don't cause cancer (particularly types 6 and 11) can cause genital warts and respiratory papillomatosis (a disease in which tumors grow in the airways that lead from the nose and mouth to the lungs). And although these conditions very rarely lead to death, they can often lead to disease. Genital warts are common and highly contagious.
How HPV is transmitted and manifested
More than 150 species of the virus have been identified in modern medical science. Depending on the species, it affects the work of all organs and systems of the human body. For example, infected people notice various new growths on the skin and mucous membranes in the form of genital warts and wart-like growths.
The main route of transmission is physical contact with the carrier, including sexual intercourse without a condom. However, it is also quite common to become infected through household funds. 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 a 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 low oncogenic risk HPV. Condylomas are solitary and focal and usually appear at sites injured during intercourse. The size of the elements is from 1 millimeter to several centimeters, in shape they resemble a "cockscomb" or "cauliflower" and are located on a narrow base (leg). Most often, when washing, women find warts that feel like bumps. With a large number or size of genital warts, they can bruise and bleed, interfere with normal sex life and childbirth, and cause psychological distress. Itching rarely accompanies manifestations of human papillomavirus infection.
- papillomas (warts). Unlike tumor papillomas, viral papillomas appear, disappear and reappear, since their severity depends on the current state of the body's defenses. Viral papillomas do not differ in color from normal skin and can grow anywhere.
- Flat condyloma of the cervix. Flat condyloma is a manifestation of a chronic, long-standing viral infection that causes changes in the cells of the cervical epithelium. It can be combined with genital warts on the external genitals. Changes in the cervix, characteristic of HPV, always warn the doctor, because women who have had this virus for a long time are 65 times more likely to develop cervical cancer than those who do not have it. However, the presence of a high-risk virus in the body does not mean that a woman will definitely get cancer. Additional factors are necessary so that the cells can degenerate into malignant ones. Detection of high-risk virus types gives the patient a significant edge in the fight against the disease; here the formula "forewarned is forearmed" is most appropriate. For example, 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, human papillomavirus infection can lead to 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 form on the labia minora, in the vagina, on the cervix, in the cervical canal and on the skin around the anus.
Outwardly, they are small formations located on a wide "leg" and have uneven edges. At the same time, the HPV types that cause genital warts are not the ones that cause cancer.
The symptoms of the disease in women also include cervical intraepithelial neoplasia - a precancerous disease of the lining of the uterus, provoking a violation of cell maturation. At the moment, 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 types 16 and 18 viruses. Also, cancer is provoked by 31, 33, 35 and 39 types.
Symptoms of HPV in women and men can include 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 types of cancer-causing viruses, which cause the development of growths on the skin in a man, rarely provoke tumors in the stronger sex, then for a woman who contracted a man there is a risk of developing cervical cancer.
The course of pregnancy
During pregnancy, visible warts often reappear, tend to increase significantly, become loose, large formations can cause difficulties in childbirth. There is evidence that primary infection with HPV during pregnancy can lead to a risk of termination of pregnancy, but whether such infection causes birth defects in the fetus is debatable.
According to various researchers, the frequency of transmission of HPV from mother to fetus varies quite widely - from 4 to 80%. It is not yet known exactly how the virus is transmitted. Most likely ascending through the cervical canal and fetal membranes, or by contact as the child passes through the mother's birth canal.
Recently, the development of laryngeal, tracheal and bronchial papillomatosis and anogenital warts in infants has been associated with HPV infection during delivery. The disease is quite rare, moreover, cases of this disease are described in children born by cesarean section, so the presence of HPV and its manifestations in a pregnant woman are not an indication for cesarean section.
An indication for surgery can only be the presence of a giant condyloma, which makes birth through the natural birth canal difficult. But such condylomas appear only in women with severe immunodeficiency, such as AIDS.
After childbirth, HPV detected during pregnancy most often goes unrecognized, and clinical manifestations in the form of massive growths significantly decrease or disappear. It should be noted that HPV, which is first detected during pregnancy, is usually no longer detected after birth.
Risk factors for cervical cancer
- first sexual intercourse at a young age;
- multiple sexual partners;
- tobacco use;
- Immunosuppression (eg, HIV-infected individuals have an increased risk of HPV infection and are infected with a wider range of HPV types).
diagnosis
The main method of diagnosing PVI is a routine clinical examination. To confirm this diagnosis, colposcopy (examination of the mucous membrane of the cervix and vagina with a special magnifying device) and cytological examination (for this a smear is taken from the cervical canal and from the surface of the cervix) are used.
Cytological examination does not show the virus itself, but changes in the cells of the cervical epithelium that are characteristic of this infection. A histological examination helps to clarify the cytological diagnosis: here, unlike in cytology, a scraping of surface cells is removed, but a piece of tissue is taken and not only the structure of the cells is examined, but also the correct arrangement of their layers. A biopsy is not usually performed during pregnancy.
To determine the types of viruses and their oncogenic risk, the polymerase chain reaction (PCR) is used, 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 predicting the development of diseases of the cervix.
HPV treatment
Since it is currently impossible to achieve a complete cure from human papillomavirus infection (with this, spontaneous spontaneous recovery is often observed), it is the manifestations of HPV that are treated, and not the presence of the virus in the body. At the same time, the effectiveness of various methods of treatment is 50-70%, and in a quarter of cases the disease recurs already a few months after stopping treatment.
Given the possibility of self-healing of genital warts, it is sometimes advisable not to undergo treatment. The question of the adequacy of treatment is decided individually for each pregnant patient.
In this case, it is necessary to avoid factors that reduce immunity (hypothermia, severe emotional stress, chronic overwork, beriberi). There are studies that show the preventive effects of retinoids (beta-carotene and vitamin A), vitamin C and micronutrients such as folic acid on HPV infections.
The most commonly used treatments for genital warts are:
destructive methods
Destructive methods are local treatments 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.
Physically destructive methods and trichloroacetic acid preparations can be used in pregnant women. Treatment with destructive methods should be carried out with special care only in the early stages of pregnancy. 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 circulatory disorders, toxic complications) and the possibility of recurrence of genital warts after their removal.
Cytotoxic Drugs
Cytotoxic drugs are STRICTLY CONTRAINDICATED during pregnancy. For women of childbearing potential, effective contraception or abstinence from sexual activity is recommended for the duration of treatment.
Immunological methods
Interferons are most commonly used to treat HPV infection. They are a family of proteins produced by immune system cells in response to viral stimulation. Immunoglobulin preparations are used in conjunction with the topical application of drugs. These drugs are actively used in late pregnancy. However, in 60% of cases, even long-term interferon therapy does not result in 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 poorly studied effects on the fetus. By the way, the well-known antiviral drug has no effect on HPV.
summary
- Pruritus can be caused by PVI, but to confirm this cause all other possible causes of contact-borne pruritus must be ruled out. This is not a sexually transmitted disease, and the infection does not necessarily have to come from a sexual partner or from sex life. A condom, virginity, a regular sexual partner, abstinence - do not mean the impossibility of contracting PVI.
- HPV is widespread, and its presence in the body is more of a pattern than an oddity.
- PVI is diagnosed "by eye" according to the clinical manifestations and not by PCR.
- If PVI is detected, colposcopy is required, and if necessary, biopsy and treatment. If you do without OK of the external genital organs and cannot treat them, then the cervix definitely needs to be examined and treated. PVI is the most common cause of cervical cancer.
- If HPV is detected, the partner needs to be tested because penile cancer is the same consequence of PVI as cervical cancer. The examination is also an eye, not a PCR.
- The manifestations of PVI - OK or flat condyloma - and not the presence of the virus in the body are subject to treatment.
- The first step in treatment is conservative. The basis of therapy are antiviral drugs, incl. - local. Immunomodulators are an additional and optional component of treatment.
- Itching can be caused by PVI, but all other possible causes of itching must be ruled out to confirm this cause.
- PVI recurs 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 OK.
- PVI can be transmitted from mother to child during childbirth and can cause laryngeal papillomatosis. This is easily treatable. Condylomatosis is not an indication for a cesarean section.
The human papillomavirus (HPV) can be in a woman's body for years and not manifest itself in any way, while constantly threatening the risk of developing cancer and precancerous diseases of its "mistress".