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 old. According to statistics, approximately 22 percent of the world's population are carriers of HPV. Many patients are simultaneously affected by several strains.

At the moment, more than 190 genotypes of the pathogen are known. They differ in DNA structure, flow and potential complications. 30 pathogens can infect the epithelium of internal and external genital organs. It is worth noting that many HPV strains are characterized by pronounced carcinogenic activity. Thus, the virus often causes life-threatening complications: malignant tumors of the vagina, vulva, anal tract, penis.

Causes of HPV

The only cause of infectionhuman papillomavirusis contact with the causative agent of the disease. However, some factors significantly increase the chances of getting infected. Exactly:

1. Refusal to use barrier contraception. Only a male or female condom, as well as special latex napkins, can protect against infection.
2. Frequent change of sexual partners. If you pay insufficient attention to your safety, the risk of infection increases significantly.
3. Early initiation into sexual relations. Sexual relations during adolescence often lead to HPV infection due to an irresponsible attitude towards preventing the transmission of the pathogen.
4. Non-compliance with hygiene rules. Insufficient self-care leads to the growth of pathogenic microflora on the skin and mucous membranes, which negatively affects susceptibility to the virus.
5. Bad habits. The immune defense of the body is significantly affected by addictions: alcohol abuse, smoking and taking psychoactive substances.
6. Weakened immunity. The causes of the condition can be a lack of vitamins and minerals, past illnesses and psycho-emotional overload.
7. Long-term drug treatment. Hormonal drugs taken over a long period of time have a particularly pronounced effect.
8. Traumatic injuries. Injuries to the mucous membrane and skin become the "gateway" of infection.
9. Chronic stress. They also affect the patient's immune system and hormonal background.
10. Gynecological interventions. Risk factors for HPV include miscarriages or abortions.
11. Pregnancy. Often the disease appears for the first time 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 the gynecologist and urologist help to significantly reduce the risks.

Symptoms

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

1. Papules. These are single or multiple formations that appear on the skin or resemble spots. They appear on the skin and mucous membrane of the urogenital area.
2. Itching of the skin. The patient often complains of itching in the genital area or other areas of the skin.
3. Paresthesia. This is a disorder of sensitivity in the affected area. The opposite manifestation often occurs - dyspareunia. In this case, every contact brings pain.
4. Urinary dysfunction. There is a burning sensation, itching and pain when emptying the bladder. If the urethra is affected, passing urine can be very difficult.
5. Crack. Bleeding cracks appear on the skin and mucous membrane, causing severe pain.

Such clinical manifestations may indicate various diseases of the genitourinary system. Objective symptoms of HPV allow an accurate diagnosis. Such 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 specific pattern: variegated or loop-shaped.
2. Papular warts. They appear in the keratinized areas of the genitals. It can be flat or regular.
3. The stains. The nature of the spots varies. There are bright red, brown with red shades, pink-red, white with gray.
4. Bowen's disease. These are papules or spots that are 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, formations are localized in the oral cavity, respiratory tract and lungs.

Also, HPV in women in later stages can appear as uterine cancer. In 2008, it was discovered that this particular virus is the cause of a malignant tumor. Cervical cancer does not appear as an independent disease. The pathology is accompanied by heavy bleeding, pain in the abdomen and lower back, discomfort during intimacy, etc.

Transmission routes

Doctors and scientists are still debating the contagion of the human papillomavirus. A number of experts believe that a single contact without the use of barrier contraception 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 risks are important only when they are in contact with papilloma carriers. Statistics report that with regular proximity, transmission of the virus to a healthy person occurs within a period of up to 6 months.

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

1. Sexual transmission. The main method of infection is sexual contact. When you use a condom, the risk is reduced to 10 percent. However, the pathogen can also penetrate during other intimate manipulations, for example, during a kiss.
2. From mother to child. A newborn can become infected with HPV from the mother during passage through the reproductive tract. Typical results of this situation are cases of laryngeal papillomosis and anogenital warts.
3. Contact and home route. The virus is also transmitted through common household contacts. Most often this happens in common areas. The risk of infection is particularly high in baths, saunas, gyms and swimming pools. Public toilets.
4. Autoinfection. This is the transfer of a virus from an affected area to a 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 the human papillomavirus is as follows:

1. Infection. The source of viral agents can be another person or objects in common use. The risks of transmission increase significantly from microtraumas on the skin and mucous membranes: wounds, cuts, cracks, acne.
2. Incubation period. Pathologies that develop as a result of HPV penetration into the body usually have a latent onset. There is no exact duration of the incubation period for this disease. The phase lasts 1-3 months or reaches 2-3 years.
3. Chronic presence Despite the lack of clinical manifestations, the disease is constantly progressing. A person becomes a source of viral agents for others.
4. Visual manifestations on the skin. The result of the 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, mainly being localized in the mucous membrane of the genital organs, oral cavity and conjunctiva. The viral agent is able to reproduce exclusively within the basal epidermis without penetrating the bloodstream. Due to this feature, the body's immune system cannot fight the pathology to the fullest extent, but acts extremely limited.

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

Distribution

Due to the variety of strains, HPV types also differ significantly from each other. So, many experts use several classifications of the pathogen at the same time. So, depending on the clinical picture, all cases of HPV can be divided into asymptomatic and with characteristic manifestations. There is a subclinical course in which periods of deterioration are recorded. According to the location, the following are distinguished:

1. Skin. This type of human papillomavirus causes the formation on the skin of the infected person.
2. Anogenital. In this case, papillomas can be found mainly in the mucous membrane of the genitals and in the anal area.

Often the main cause of concern for the patient is the external signs of HPV. When evaluating a pathogen, doctors focus more on the carcinogenicity of the strain. Exactly:

1. HPV types that are not capable of causing malignant tumors. These include strains 1-5, 10, 28 and 49.
2. Types of pathogens with reduced oncogenic activity. They can cause cancer, but in extremely rare cases. Among such strains are 6. 7, 32, 40-44 and others.
3. It is characterized by moderate oncogenicity. The percentage of affected cells that degenerate into cancerous cells is quite high. The group includes strains 52-58, 30, 26 and others.
4. Dangerous forms of human papillomavirus. It is these strains that mainly provoke malignant tumor formations. This includes 16, 18, 64, 73 and others.

Diagnosis of human papillomavirus

Different diagnostic techniques help to identify papillomas in men and women. Thus, to establish a diagnosis in a patient 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 properties of the material taken from the patient. PCR helps to identify not only the fact of infection, but also the specific type of HPV. Subclinical and clinical forms can be diagnosed by methods such as:

1. Simple colposcopy. Papillomas, warts and spots may also be detected during a routine visual examination. Colposcopy refers to the examination of the vaginal opening using a special binocular device. The examination may be accompanied by the collection of biological material for research.
2. Extended colposcopy. During the examination, additional tests are used. A test with 3% acetic acid, which provokes a narrowing of unchanged blood vessels, is indicative. In addition, an adrenaline test and a Chrobak test (if cancer is suspected) may be recommended.
3. Cytological examination. To perform a diagnostic procedure, you will need material from the epithelium or skin cells. The sample is used to determine the DNA of the virus, as well as to rule out cancerous tumors. Typically, cytology detects only the most oncogenic types of viruses.

It is better to plan the collection of biomaterial for the papilloma virus 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 before menstruation. Before the procedure, you should not wash the vagina. It is worth excluding sexual relations two days before the meeting. A similar rule applies to intravaginal ultrasound and colposcopy.

When diagnosing men with HPV, material is collected from the urethra. It must have been at least two hours since you last urinated. It is important to avoid intimacy 48 hours before the test. Otherwise, the study may show false results.

Complications

Complications of the 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 infection with oncogenic strains are the following conditions:

1. Anal cancer. 80 percent of cases of detection of this malignant tumor are associated with HPV infection. Also, negative factors that affect the occurrence of anal cancer include anal sex, smoking and hereditary predisposition. The disease may not appear for a long time. Typical symptoms of the condition are rectal bleeding, itching and a foreign body sensation.
2. Vaginal cancer. 70 percent of patients with this diagnosis suffer from human papillomavirus. The condition is usually found in women over 40 years of age. Representatives of the fair sex over 70 years old are more susceptible to pathology. In the early stages, symptoms can be confused with menstruation. In addition, pain in the pelvic area, constipation and tightness 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 while swallowing and eating food. In a calm state there is a feeling of a foreign body in the larynx. In the later stages, 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 a localized tumor process in the male genital organ. The pathology is typical for men over 60 years old.

Treatment of HPV

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

1. Infection warnings. Unfortunately, even the regular use of contraception and a careful approach to hygiene do not protect a person from infection. Of course, this significantly reduces the chances. However, most cases of transmission of the pathogen are recorded in persons during adolescence, at the age of 15-16 years. At the age of 25, the first symptoms already appear. For a pronounced effect, prevention should be done from a young age.
2. Treatment of diseases caused by human papillomavirus. If the strain causes a malignant or benign formation, then therapy is required for the identified pathology. Papillomas are removed in cosmetic or medical offices. Cancerous tumors require complex multi-stage treatment depending on the stage.

Of course, there is good news. So people who have a normally functioning immune system are able to fight off HPV on their own within two years. Patients infected during adolescence are freed from the viral agent by the age of 30. Unfortunately, those who are cured do not gain lifelong immunity.

prediction

A significant part of the strains are characterized by low or moderate oncogenicity. Only certain types of the virus are associated with an increased risk of developing cancer. This statistic allows 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 cellular 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 a type of cancer is identified, then regular monitoring by a gynecologist or urologist is required. In addition, you should undergo tests periodically.
2. Changes in CIN-1 cells were detected in the early stages. Mostly this condition also does not require medical intervention. Typically, a follow-up examination is performed once a year to ensure that the pathology does not progress.
3. Marked changes were recorded in CIN-1. To rule out dangerous conditions, a biopsy is required. The study will determine whether the formation is of an oncological nature.

Preventing

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

1. Visit doctors at the right time. Women are recommended to plan a visit to the gynecologist 1-2 times a year. Men should visit a urologist on a similar schedule. If you have risk factors (frequent changes of sexual partners, refusal of contraception), you should visit the doctor more often.
2. Minimize visits to public places - swimming pools, saunas, baths. If this is not possible, then it is important to use your own towel, not to take other people's razors and not to sit on the surface with your body naked.
3. Use contraception. Only preventive methods are effective. The use of oral contraceptives does not affect the strains.
4. To refuse from bad habits. Quitting smoking and moderate alcohol consumption will have a moderate impact on the body's condition.
5. Increasing the immune defense of the body. Proper nutrition, regular physical activity, compliance with the daily routine and exercise have a beneficial effect.
6. Avoid stress. Psycho-emotional overload can negatively affect the immune system, so it is better to exclude them.

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

• patients 21-30 years old should have a PAP test at least once every five years (preferably using liquid cytology);
• persons aged 30 to 65 should undergo a Pap test for HPV every three years with 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 the birth of a child. Anogenital warts deserve special attention. They are located not only on the outer lips, but also in the vagina. In some cases, they are also accompanied by a bacterial component. Anogenital warts significantly increase the risk of infection of the baby during birth. This is packed with:

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

Let's dwell in more detail on papillomatosis of the larynx. At the moment, it is not fully known at what point transmission of the viral agent occurs. Infection can occur through the placental barrier or directly at the time of childbirth. The first symptoms of pathology are hoarseness. In severe cases, the baby's voice disappears completely and breathing difficulties appear.

The disease can progress rapidly. A little later, the patient develops a persistent cough and shortness of breath. Against the background of HPV, a child may experience asphyxia caused by the blockage of the respiratory tract. Most often, this 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 by a bronchoscope. The devices allow us to identify the main sign of pathology - growth of the larynx (condyloma). Surgical treatment is usually recommended for the child. 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 degree of oncogenicity should inform about this the obstetrician from the antenatal clinic. In this case, doctors will take all measures to ensure that the virus does not affect the child's health.