HPV very often practically does not manifest itself in any way. The main symptoms of human papillomavirus are, of course, 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 its treatment methods in the following article.
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 diseasesof the genitals. Each of the HPV group viruses has its own sequence number and differs from other viruses in its unique DNA composition.
Currently, the role of several types of human papillomaviruses in the development of malignant tumors of various organs has been proven: for example, cervical cancer, penile cancer, throat cancer, etc. Different types of human papillomaviruses are divided into groups, depending on their ability to cause malignant neoplasms. So, it is customary to distinguish between viruses with high, medium 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 found more often in cervical cancer.
How HPV enters the body
The most common way of transmission of human papillomavirus (HPV) is sexual contact, so this infection is classified as a group of sexually transmitted diseases (STD). In addition, human papillomavirus (HPV) infection is possible through contact of damaged skin or mucous membranes with the secretions of a sick person (for example, underwear, towels, etc. ) Transmission of human papillomavirus from mother to child during childbirthit is possible. .
Review
Human papillomavirus (HPV) is the most common viral infection of the genital tract. Most sexually active women and men become infected at some point in their lives, and some may be reinfected.
The peak period for acquiring the infection for both women and men begins soon after they become sexually active. HPV is sexually transmitted, but penetrative sex is not required to transmit the virus. Skin-genital contact is a well-established route of transmission.
Many types of HPV do not cause problems. HPV infections usually clear up on their own without any intervention within a few months of getting them, and about 90% clear up within 2 years. A small number of infections with certain types of HPV can persist and develop into cancer.
Cervical cancer is the most common disease associated with HPV. Almost all cases of cervical cancer can be due to HPV infections.
Despite limited data on anogenital cancers other than cervical cancer, a growing body of evidence links HPV to cancer of the anus, vulva, vagina, and penis. While these cancers are less common than cervical cancer, their association with HPV makes them potentially preventable using the same primary prevention strategies as for cervical cancer.
Non-cancer types of HPV (especially types 6 and 11) can cause genital warts and respiratory papillomatosis (a disease in which tumors grow in the airways leading from the nose and mouth to the lungs). And although these conditions very rarely lead to death, they can often lead to illness. Genital warts are widespread and highly contagious.
How HPV is transmitted and manifested
In modern medical science, more than 150 types of the virus have been identified. Depending on its type, it affects the work of all organs and systems of the human body. For example, the infected notice various neoplasms 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. But it's also quite common to get infected with household items. 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 is papillomavirus infection manifested?
The most common manifestations of human papillomavirus infection are:
- Pointy warts. The development of genital warts and papillomas is most often caused by HPV with a low oncogenic risk. Condylomas are single and focal, usually occur in places that are injured during sexual intercourse. The size of the elements is from 1 millimeter to several centimeters, they resemble a "cock's comb" or "cauliflower" in shape and are located on a narrow base (foot). Most often, women find warts to the touch while washing, which feels like an unevenness. With a large number or size of genital warts, they can hurt and bleed, interfere with normal sexual life and childbirth, and cause psychological discomfort. Itching rarely accompanies the manifestations of human papillomavirus infection.
- Papilloma (warts). Unlike papillomas of a tumor nature, viral papillomas appear, disappear and reappear, because their severity depends on the state of the body's defenses at the moment. 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 caused changes in the epithelial cells of the cervix. It can be combined with genital warts on the external genitalia. Changes in the cervix, characteristic of HPV, always alert the doctor, because women who have this virus for a long time are 65 times more likely to be affected by 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 for cells to degenerate into malignancy. The fact of detecting high-risk virus types gives the patient an important head start in the fight against the disease; here the formula "forewarned is forewarned" is more appropriate. Thus, 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 cause the appearance of genital warts - genital warts, which in many cases are found only during a gynecological examination.
They grow about three months after infection. Most often they are formed in the labia minora, in the vagina, on the cervix, the cervical canal, on the skin around the anus.
Outwardly, they are small formations that are located on a wide "foot" and have uneven edges. At the same time, the types of HPV that cause genital warts are not the ones that cause cancer.
Symptoms of the disease in women also include cervical intraepithelial neoplasia - a precancerous condition of the uterine mucosa, which provokes a violation of cell maturation. At the moment, doctors recognize 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 viruses of type 16 and 18. Also, cancer is provoked by types 31, 33, 35 and 39.
Symptoms of HPV in both women and men can include the presence of 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 cancerous types of the virus that cause the development of skin rashes in a man rarely provoke tumors in the stronger sex, then a woman, having contracted them from a man, risks developing cervical cancer.
Pregnancy progress
During pregnancy, visible warts often recur, tend to grow significantly, become loose, large formations can cause difficulties during childbirth. There is evidence that primary HPV infection during pregnancy can lead to a threat of termination, but whether such infection causes malformations in the fetus is a controversial point.
The frequency of HPV transmission from mother to fetus, according to various researchers, varies quite significantly - from 4 to 80%. It is not yet known exactly how the virus is transmitted. It is very likely that through the cervical canal and the membranes of the fetus in an adhesive or contact manner when the baby passes through the birth canal of the mother.
Recently, the development of papillomatosis of the larynx, trachea and bronchi and anogenital warts in infants has been associated with HPV infection during birth. The disease is quite rare, in addition, cases of this disease are described in children born by cesarean section, so the presence of HPV and its manifestations in a pregnant woman is not an indication for cesarean section.
An indication for surgery can only be the presence of a giant condyloma, which makes it difficult to give birth through the natural birth canal. But such condylomas occur only in women with severe immunodeficiency, such as AIDS.
After birth, HPV detected during pregnancy is most often not detected, and clinical manifestations in the form of massive growths are significantly reduced or disappear. It should be noted that HPV detected for the first time during pregnancy, as a rule, is not detected after birth.
Risk factors for cervical cancer
- First sexual intercourse at a young age;
- multiple sexual partners;
- tobacco use;
- immunosuppression (for example, HIV-infected people are at increased risk of HPV infection and are infected with a wider range of HPV types).
Diagnosing
The main method for diagnosing PVI is a routine clinical examination. To confirm this diagnosis, colposcopy (examination of the cervical and vaginal mucosa using a special magnifying device) and cytological examination (for this, a scraping is taken from the cervical canal and the surface of the cervix) are used. .
Cytological examination does not detect the virus itself, but changes in the epithelial cells of the cervix that are characteristic of this infection. Histological examination helps to clarify the cytological diagnosis: in this case, a scraping of surface cells is not taken, as for cytology, but a part of the tissue, and not only the structure of the cells, but also the exact arrangement of their layers is studied. During pregnancy, a biopsy is usually not performed.
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. This allows you to accurately determine the presence of the HPV virus on the cervix. This is important for the prognosis of the development of cervical diseases.
Treatment of HPV
Since it is currently impossible to achieve a complete cure for human papillomavirus infection (along with this, spontaneous, spontaneous recovery is often observed), the manifestations of HPV are treated, and not the presence of the virus in the body. At the same time, the effectiveness of various treatment methods is 50-70%, and in a quarter of cases the disease reappears already a few months after the end of the treatment.
Given the possibility of self-resolution of genital warts, it is sometimes advisable not to carry out any treatment. The question of suitability of treatment for each pregnant patient is decided individually.
In this case, it is necessary to avoid factors that reduce immunity (hypothermia, severe emotional stress, chronic overwork, beriberi). There are studies showing the preventive effect of retinoids (beta-carotene and vitamin A), vitamin C and micronutrients such as folate on HPV infections.
The most commonly used treatments for genital warts are:
Destructive methods
Destructive methods are local treatment 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.
In pregnant women, destructive physical methods and preparations of trichloroacetic acid can be used. Treatment with destructive methods is desirable to be carried out only in the early stages of pregnancy, with special care. At the same time, it is necessary to consider the risk of possible side effects during treatment (bleeding and secondary infection due to altered blood circulation, toxic complications) and the possibility of genital warts reappearing after their removal.
Cytotoxic drugs
Cytotoxic drugs are STRICTLY CONTRAINDICATED during pregnancy. For women of reproductive age, reliable contraception or abstinence from sexual activity for the duration of treatment is recommended.
Immunological methods
Interferons are most commonly used to treat HPV infection. They are a family of proteins that are produced by cells of the immune system in response to viral stimulation. Preparations of immunoglobulins are used in connection 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 lead to clinical improvement and does not prevent fetal HPV infection.
Specific antiviral medications
specific antiviral drugs. These drugs are not used in pregnant women with papillomavirus infection, due to insufficiently studied effects on the fetus. By the way, the well-known antiviral drug has no effect on HPV.
summary
- Pruritus may be caused by PVI, but to confirm this cause, all other possible causes of contact-transmitted pruritus must be excluded. This is not an STD and the infection may not necessarily come from a sexual partner and not necessarily from sex life. Condom, virginity, regular sexual partner, abstinence - do not mean the impossibility of contracting PVI.
- HPV is widespread, its detection in the body is more of a pattern than a surprise.
- PVI is diagnosed "by eye", according to clinical manifestations, and not by PCR.
- If PVI is detected, a colposcopy is needed, if necessary, a biopsy and treatment. If you can give up the OK of the external genitalia and not treat, then the cervix should be examined and treated without fail. PVI is the most common cause of cervical cancer.
- If HPV is detected, screening of the partner is necessary, as penile cancer is the same consequence of PVI as cervical cancer. The examination is also an eye, not PCR.
- Manifestations of PVI - OK or flat condyloma - and not the presence of the virus in the body are subject to treatment.
- The first step of treatment is conservative. The basis of therapy are antiviral drugs, incl. - at the local level. Immunomodulators are an auxiliary and optional component of treatment.
- Pruritus may be caused by PVI, but all other possible causes of pruritus must be ruled out to confirm this cause.
- PVI is repeated 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 the complete elimination of OK.
- PVI can be transmitted during childbirth from mother to child, causing laryngeal papillomatosis. This is easily treatable. Condylomatosis is not an indication for caesarean section.
Human papillomavirus (HPV) can be in a woman's body for years and not appear in any way, while constantly risking the risk of the appearance of cancerous and precancerous diseases of her "lady".