Human papillomavirus

Human papillomavirus is the most common infection on the globe.

According to researchers, more than 90% of people around the world are infected with one type or another of HPV.Currently, there are more than 70 varieties of human papillomavirus.

The virus affects the skin and mucous membranes: various warts, papillomas and condylomas are formed on them.The human papillomavirus lives in human blood and does not manifest itself until a certain time.But as soon as the immune system weakens, growths appear on the skin and/or mucous membranes.This explains the rather long incubation period: from several weeks to tens of years.

What is it?

Human papillomavirus (HPV) causes changes in tissue growth patterns.It causes various skin diseases and mucous membrane lesions.Modern medicine identifies more than a hundred types of the virus.

Papilloma is a tumor, considered benign, that grows on the surface of the skin and looks like a small nipple.The size of papillomas can be from one to two cm. Places of occurrence: oral cavity, nose, pharynx, vocal cords;can form on the bladder and other places.

Depending on the type of virus, diseases also differ: warts are caused by human papillomavirus types 2 and 4, flat warts are caused by viruses of types 3 and 10, and genital warts are caused by types 6 and 11.Some types of virus (16, 18, 31, 33, 35) cause cervical dysplasia or a favorable background for the development of cervical cancer.The human papillomavirus is transmitted through contact and household routes, remaining in the skin and mucous membranes.

Human papillomavirus is divided into two groups -high and low risk.The low-risk group includes types of the virus (primarily 6 and 11) that cause genital warts.The high-risk group includes types 16, 18, 31, 33, 35 of the virus, which cause cervical dysplasia and increase the risk of cervical cancer.

How can you get infected?

The source of infection is a sick person or a virus carrier, that is, HPV is transmitted only from person to person.

There are three known ways of transmitting this infection:

• contact and household (through touch);
• sexual (genital, anal, oral-genital);
• in childbirth from mother to child.

HPV affects the skin and mucous membranes: various warts, papillomas and condylomas form on them.

Risk factors

An interesting fact is that different types of HPV can manifest themselves differently, causing a person to develop benign or malignant tumors.Also, human papilloma is a virus that can affect the skin and mucous membranes, or may not detect itself at all until the immunity of the carrier of the infection decreases.

According to world statistics, the likelihood of developing this disease increases several times in the following categories of citizens:

• women who are pregnant;
• patients who often suffer from various ailments;
• persons with non-traditional orientation;
• male or female representatives who suffered from sexually transmitted diseases;
• people who are overly sexually active;
• persons with immune system disorders;
• sexual partners of people who are found to be carriers of HPV or have an active form of this disease;
• women suffering from various cervical diseases.

All representatives of these categories must undergo examination to detect papillomatosis.It is also recommended to get tested for those people who are adherents of free sexual relations, have many sexual partners or change them frequently.Even one unprotected act can cause infection, so experts advise you to follow preventive measures for this disease.

Human papillomavirus: incubation period

Typically, when infected with the human papillomavirus, the incubation period is long: from half a month to several years.Human papillomavirus infection is characterized by a hidden (latent) course.A person can become infected with several types of papillomaviruses at the same time.Under the influence of various factors, the virus is activated, its increased reproduction, and the disease enters the stage of clinical manifestations.

In most cases (up to 90%), self-healing occurs within 6-12 months, in other cases there is a long-term chronic relapsing course with possible malignancy of the process (depending on the type of virus).

Classification and symptoms of HPV

The clinical symptoms of human papillomavirus are quite variable - for some types they are practically absent, and many are manifested by the growth of papillomas in different parts of the body.

There are several types of such skin growths - they serve as the basis for the classification of HPV.

Simple papillomas

Their growth is provoked by human papillomavirus type 2; the growths themselves are distinguished by their roughness, the presence of a keratinized layer and their size from 1 mm or more.Very often, such growths are not isolated, but represent a localized “merged” zone.Simple (also called vulgar) papillomas can be located on the palms and between the fingers; in children they are detected on the knees.

Flat papillomas

Caused by human papillomavirus types 3 and 10, they are identical in color to the skin and are therefore least noticeable.But in addition to the appearance of neoplasms, flat papillomas are characterized by itching, hyperemia (redness) of the skin and pain.

Plantar papillomas

At the very beginning of their development, plantar papillomas look like a whitish, shiny spot.Then it “rises” slightly above the level of the skin surface.Multiple mosaic neoplasms may appear around the main papilloma.Such neoplasms complicate the patient’s life – it is difficult for him to walk, and it is almost impossible to find comfortable shoes.

Filiform papillomas

This type of neoplasm in question is characteristic of women over 50 years of age; they first appear in the form of small bumps of a yellowish tint.Over time, these bumps grow and they turn into a cluster of numerous “threads.”

Condylomas acuminata

The appearance of the formations resembles cauliflower or cockscomb.Most often, condylomas are located on the foreskin, head of the penis, near the urethra, around the anus, on the labia minora, on the vaginal mucosa, cervix, in the corners of the mouth, at the mouth of the urethra.

Bowen's disease

It looks like a single formation exclusively in the upper layer of the epidermis (usually on the head).A lesion from 5 to 50 mm looks like a growing stratum corneum of the skin, sometimes covered with crusts.Caused by HPV type 16.The formations are prone to degeneration into squamous cell carcinoma.

Formations in the oropharynx

Blooming papillomatosis in the oral cavity also looks like cauliflower: white plaques on the oral mucosa.Occurs in older people.Laryngeal papillomatosis can descend to the trachea, bronchi and lung tissue, and occurs in children and adults.Signs of laryngeal papillomatosis are dysphonia (speech disorder) and aphonia (inability to speak), hoarseness and difficulty breathing.When HPV infects the oropharynx, cancer can occur.

Human papillomavirus in men

Human papillomavirus infection in men can occur without any symptoms.It is also worth noting that in the main risk group, men who often change sexual partners have unprotected sex.

Pathological formations are localized in the following places:

• on the head and shaft of the penis;
• on the skin of the scrotum;
• in the perineal area;
• on the mucous membrane.

A virus of this type in men can take the form of high oncogenicity.This leads to cancer of the genital organs.But, if you start treatment on time, the risk of oncogenic diseases is minimized.Warts that are caused by the HPV virus are removed surgically or using special chemical solutions.At the same time, antiviral drugs are prescribed.Therefore, in the early stages of the development of this type of disease in men, it can be completely eliminated.

Human papillomavirus in women

As already mentioned, women aged 20–45 years are most susceptible to the virus.But here it is worth noting the fact that the main risk group is those who often change sexual partners and have unprotected sex.

This type of infection in women is divided into the following groups:

• high oncogenicity;
• low oncogenicity;
• non-oncogenic type.

The most dangerous infection for women's health is a high type of oncogenic infection.Almost always it leads to an oncological disease - a malignant tumor, cervical cancer.The risk of such pathology development is 90%.The situation is further aggravated by the fact that in the first stages of development the disease does not show symptoms.Occasionally, small warts may appear on the palms and soles.

With a type of infection of high oncogenicity, condylomas are formed.These are formations similar to warts, but with jagged edges.Such formations can appear in the vagina, anus, and perineum.Sometimes condylomas can take the form of bubbles with liquid, which over time burst and emit an unpleasant odor.

High type HPV infection can also cause cancer of the vagina and vulva.In more rare clinical cases, nasopharyngeal cancer is possible.It is worth noting that it is almost impossible to completely cure the highly oncogenic form of HPV.

The danger of human papillomavirus infection

The properties of the papillomatosis virus are such that it settles either in the skin or in the mucous membrane of various organs: reproductive (both male and female), esophagus, bronchi, oral cavity, rectum.It can also be localized in the conjunctiva of the eyes.

Each strain of the virus has its own “favorite” localization.Thus, the most dangerous types 16 and 18, when ingested, are immediately “directed” to the genitals, and low-oncogenic viruses 6 and 11 infect the vulva and perineum area, causing the development of genital warts there.These same strains can cause papillomatosis in the respiratory tract of a child if he is born naturally from a mother with genital warts.

After infection, a disease with pronounced symptoms does not always develop.On the contrary, the disease most often occurs unnoticed and does not lead to serious consequences.

The most dangerous complications of human papillomavirus infection are:

1. Cervical cancer.It occurs in women as a result of infection with human papillomavirus types 16 or 18.It has been proven that this disease does not occur in the absence of papillomavirus.And if earlier they talked about the development of cervical carcinoma from erosion or ectropion, now this has been revised and denied;
2. Rectal carcinoma.It, unlike the first disease, may have other causes;
3. Throat cancer.It is also caused by virus type 16;
4. Lung cancer, which can occur when infected with types 16, 18, 11, 2, 6, 30;
5. Respiratory failure, which develops with the growth of malignant papillomas in the respiratory tract (larynx, trachea);
6. Contact bleeding from condylomas.If they are on the external genitalia, perineum or in the vagina, then they are provoked by sex.In other locations (in the nose, mouth), bleeding can be provoked by mechanically injuring them with other objects.

Every year, according to official sources, just under half a million (470 thousand) new cases of cervical cancer caused by this virus are registered worldwide.233 thousand women die from this disease every year.This places this cancer in 2nd place in frequency among all cancer pathologies in gynecology (first place in breast cancer) and in 5th place among all causes of mortality in women.Most often, women under 40 years of age die from cervical carcinoma.

HPV and pregnancy

The human papillomavirus does not affect reproductive function, that is, the virus does not prevent a woman from having a child.

If a human papillomavirus infection is detected during pregnancy:

• the first thing is to find a good gynecologist and be observed by him until the birth,
• the most important thing is what manifestations of infection a woman has, the doctor’s tactics will depend on this,
• The virus has no effect on the fetus!
• warts and papillomas can be removed after childbirth,
• minimum medications (only as needed) during pregnancy,
• during childbirth, the child can become infected while passing through the birth canal,
• if there are pronounced changes in the pregnant woman’s cervix, they may offer a caesarean section,
• in the absence of manifestations - natural birth.

In general, cesarean section for HPV infection is rarely performed.And subsequent manifestations of infection in children are also extremely rare or insignificant.

Diagnostics

In recent years, medicine has made significant progress in diagnosing PVI.This became possible thanks to the systematization of data on HPV and the diseases associated with it, the study of all existing routes of infection, many mechanisms of the pathogenesis of the infectious process and the state of the immune system, as well as possible morphological changes.

There are several ways to diagnose human papillomavirus infection, and in this case, experts adhere to generally accepted algorithms:

• Sexually active women and men are required to be tested for HPV.
• HIV-infected patients and those with symptoms of sexually transmitted diseases should also be screened.
• People who have proven risk factors for PVI.
• Patients with pointed papillomas in the oral cavity and anogenital area.
• Patients suffering from various pathologies of the cervix.
• Couples planning pregnancy.

Basic diagnostic methods of PVI:

1. Visual inspection of lesions.
2. Using a magnifying glass and colposcope.
3. Cytological research methods.
4. Molecular biological techniques.
5. Histological (pathomorphological) examination.

All patients examined for the presence of PVI are simultaneously tested for syphilis, hepatitis and HIV, smears are taken for bacterioscopic examination of the discharge of the urethra, vagina and cervix, and PCR and bacteriological examination are prescribed for the presence of urogenital infections.

As a rule, detection of papillomavirus does not cause difficulties: the infection is detected during standard examinations by a gynecologist or dermatologist.If appropriate symptoms occur, a targeted biopsy is performed.In the case when a patient is diagnosed with flat condylomas localized in the anogenital region, to prevent the development of malignant diseases, testing of human papillomavirus serotypes with an oncogenic marker is carried out.

How to treat human papillomavirus?

At the moment, methods for radical treatment of human papillomavirus infection in men or women have not been developed.All existing schemes are aimed at inactivating the pathogen and strengthening antiviral immunity;warts, condylomas and dysplasia are removed using minimally invasive methods.Surgical excision, conization and removal of the cervix are rarely practiced and mainly in cases of reasonable suspicion of oncological pathology.

Destructive methods: surgical excision, curettage, electrosurgery, cryodestruction, laser surgery.

• Surgical treatment is performed if malignancy is suspected.It is not used so often, because when a wart is removed, severe bleeding may occur.During this manipulation, the excised wart is sent for a biopsy, and the wound is sutured.
• Curettage is the removal of a wart using a curette, i.e. by curettage.After this, electrocoagulation is performed, and a dry bandage is placed on the wound.
• Electrosurgery is used to remove small warts.But even in this case, relapses are possible.This method can also be used for large warts, but before starting they must be soaked or an electrode must be inserted into the thickness of the wart, so the separation between the cells becomes less strong.
• Cryodestruction is performed with liquid nitrogen.
• Laser surgery currently occupies a leading position in surgical treatment, i.e., in addition to destruction, hemostasis is carried out in parallel.In addition to the fact that the laser vaporizes the wart, it also has a direct toxic effect on HPV, so this treatment method is in first place in the choice of treatment for cervical intraepithelial neoplasia, and is also dominant in the treatment of genital warts in pregnant women (even in the last stages of development).

Cytostatic drugs and chemicals with a cauterizing effect are also used.

Immunotherapy - this method of treatment is used only in combination with other methods, as it does not have any specific effect, but activates only components of the immune system.

Combination treatments include a combination of the above methods.

TOP 10 myths about the human papillomavirus

There are more than enough myths about HPV.We want to talk about the most common of them.So, what do people say about papillomaviruses:

1. There is no reliable data on whether vaccination against HPV helps, so you don’t have to get vaccinated.Answer: Yes, indeed, there are more than 100 papillomaviruses, and there is really no data that the vaccine will protect against all of them.However, vaccination will protect you from the most aggressive strains for 5 years.The vast majority of recipients did not experience any side effects from the vaccine, so, in our opinion, it is better to still get vaccinated.
2. If you have genital warts, this will lead to cervical cancer.Answer: It is not known how many sleepless nights this myth has caused.In fact, things are not entirely so gloomy.Both warts and cervical cancer are caused by the human papillomavirus.But with completely different strains.So troubles on the genitals may have nothing to do with cancer.
3. It is more effective to get a smear test than to get the HPV vaccine.Answer: A smear test is a screening test to see if you have mutated, precancerous cells on your cervix.And vaccination is precisely intended to ensure that antibodies are formed in the body, protecting cells from mutation when the virus enters.So it is definitely better not to skimp on vaccination than to wait until the cells begin to become malignant.
4. Older women do not need to be tested for HPV.Answer: One in four cases of cervical cancer and 41% of all deaths from cervical cancer occur in women aged 65 or older.Regular screening is extremely important because HPV can reappear after years of being silent.It is advisable to perform the analysis every three years for women aged 21 to 29 years, and every 3-5 years between 30 and 65 years.
5. If there are no condylomas, but the smear reveals viruses, then I have cervical cancer.”Answer: don't rush to conclusions.Viruses can stay in the human body for a long time, but this does not mean a precancerous condition.The appearance of these viruses in tests indicates that its number has increased, and this occurs as a result of a decrease in the overall immunity of the body.Therefore, the main thing that you should pay attention to based on this analysis result is the state of immunity, and it is better to carry out treatment aimed at maintaining it.
6. All papillomaviruses cause cancer.Answer: Many types of HPV do not cause problems.HPV infections usually clear up on their own, without any intervention, within a few months of being acquired, and about 90% resolve within 2 years.And only a small proportion of infections with certain types of HPV can persist and develop into cancer.
7. If you always use a condom, you will not catch papillomaviruses.Answer: A condom certainly reduces the likelihood of contracting HPV and sexually transmitted diseases.However, protected sex is not a 100% guarantee, since the papillomavirus is transmitted through any contact of mucous membranes.HPV can also be transmitted by touching, using the same toilet and hygiene items.If papillomas are located on the mucous membrane of the lips, then transmission of papillomavirus through a kiss is possible.All of the above does not eliminate the need to use condoms.
8. HPV can be completely cured.Answer: It is not the virus itself that can be treated, but the diseases that it caused.You can get rid of genital warts, you can remove warts, you can even cure a precancerous condition of the cervix.But the virus itself, unfortunately, remains in the human body.
9. Once you get HPV, it will come back again and again.Truth: Not at all necessary.Yes, the doctor will most likely see the presence of strains on the smears.But if you lead a healthy lifestyle, eat right and, as a result, have good immunity, viruses will not manifest themselves.Not at all!
10. In a relationship, a diagnosis of HPV means that one partner has cheated on the other.Answer: It is this myth that has led many people to tragically incorrect conclusions and caused many couples to break up because they did not take into account one of the most mysterious aspects of genital HPV - the ability of the virus to remain latent.Even if you and your man have been together since school, an HPV diagnosis only means that one of you has contracted a human papillomavirus infection at some point in your life.

Prevention

Prevention of HPV is based on the following three methods:

1. Primary, which helps identify risk factors, prevent the spread of infection, as well as the development of special vaccines;
2. Secondary, which is based on examination of the patient, helping to identify the disease at the very initial stage;
3. Tertiary, which is based on preventing the development of relapses in individuals treated for this infection.

At the state level, a number of preventive measures are also being taken to prevent the spread of HPV.This is the desire to improve the well-being of the population, limiting videos and advertising, which are based on hidden propaganda of promiscuity, and introducing programs to support young families.

At the medical level, preventive measures are based on carrying out sanitary and educational work among the population with familiarization with the routes of transmission of various sexually transmitted infections, their symptoms, treatment methods and, most importantly, methods of barrier contraception against their infection.

Individual preventive measures include the following:

• refusal of promiscuous sexual intercourse;
• mandatory use of a condom during sexual intercourse, although it has been established that HPV can also be transmitted through close skin contact;
• periodically visit a doctor for examination;
• maintaining a healthy lifestyle, active sports;
• promptly treat identified diseases of the reproductive system.

Nowadays, 2 types of vaccines have been invented and introduced into medical practice.These drugs are completely harmless to humans, since the viruses they contain are not alive.It is recommended to prescribe them to both women and men aged 9-17 years; they are also allowed to be administered for preventive purposes to women under the age of 26 years.