HPV (human papilloma virus)

Human papillomavirus (HPV) is a group of common pathogens that can infect the skin and mucous membranes. Mainly, the pathology is diagnosed in patients aged 20 to 30 years, as well as in children under 5 years of age. According to statistics, approximately 22% of the world's inhabitants carry HPV. Many patients are affected simultaneously by several strains.

Currently, more than 190 genotypes of the pathogen are known. They differ in DNA structure, course and potential 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. Thus, the virus often causes potentially fatal complications: malignant tumors of the vagina, vulva, anal tract, penis.

Causes of HPV

The only cause of infectionhuman papillomavirusis contact with the agent that causes the disease. However, certain factors significantly increase your chances of getting infected. Exactly:

1. Refusal to use barrier contraception. Only a male or female condom, as well as special latex wet wipes, can protect against infections.
2. Frequent change of sexual partners. If you pay insufficient attention to your own safety, the risk of infection increases significantly.
3. Early initiation of sexual relations. Sexual intercourse during adolescence often leads to HPV infection due to an irresponsible attitude towards preventing transmission of the pathogen.
4. Failure to comply with hygiene rules. 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 affected by addictions: alcohol abuse, smoking and consumption of psychoactive substances.
6. Weakened immunity. The causes of the disease can be vitamin and mineral deficiencies, previous illnesses and psycho-emotional overload.
7. Long-term drug treatment. Hormonal medicines taken over a long period of time have a particularly pronounced effect.
8. Traumatic injuries. Injuries to mucous membranes and skin become the "gateway" for infections.
9. Chronic stress. They also affect the patient's immune system and hormonal history.
10. Gynecological interventions. Risk factors for HPV include miscarriages or miscarriages.
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 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 to 10 percent of patients. The first symptoms may appear a few months after infection or a few years later. However, in this state, a person poses a threat to other people. You 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 protrude above the skin or resemble spots. They appear on the skin and mucous membranes of the urogenital area.
2. Itchy skin. The patient often complains of itching in the genital region or other areas of the skin.
3. Paresthesia. This is a sensitivity disorder in the affected area. The opposite manifestation often occurs - dyspareunia. In this case, any contact brings pain.
4. Urinary dysfunction. There is a burning sensation, itching and pain when emptying the bladder. If the urethra is affected, urine production may be significantly difficult.
5. Cracks. Hemorrhagic fissures appear on the skin and mucous membranes, causing intense pain.

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

1. Genital warts. This is an elevation above the surface of the skin, characterized by an elongated finger-like shape. Located in the genital area. They differ in a specific pattern: variegated or loop-shaped.
2. Papular warts. They appear in keratinized areas of the genitals. It can be flat or regular.
3. Stains. The nature of the stains varies. There are bright reds, browns with red tones, pinkish reds, whites with gray.
4. Bowen's disease. They are papules or spots characterized by a shiny or velvety surface. The hue 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, the formations are localized in the oral cavity, respiratory tract and lungs.

In addition, HPV in women at later stages can manifest as uterine cancer. In 2008, this specific virus was discovered to be the cause of a malignant tumor. Cervical cancer does not occur 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 still argue about the contagiousness of the human papillomavirus. A number of experts believe that a single contact without the use of barrier contraception with an asymptomatic carrier is enough for the probability of transmitting the pathogen to a healthy partner to reach 70%. Other doctors claim that such risks are only relevant when in contact with papilloma carriers. Statistics report that with regular proximity, transmission of the virus to a healthy person occurs over a period of up to 6 months.

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

1. Sexual transmission. The main method of infection is sexual contact. When using a condom, the risk is reduced to 10%. However, the pathogen can also penetrate during other intimate manipulations, for example, during a kiss.
2. From mother to baby. A newborn can be infected by the mother's HPV as it passes through the reproductive tract. Typical results of this situation are cases of laryngeal papillomosis and anogenital warts.
3. Contact and home history. The virus is also transmitted through common household contacts. Most of the time this happens in common areas. The risk of infection is especially high in baths, saunas, gyms and swimming pools. Public bathrooms.
4. Autoinfection. It is the transfer of a virus from an affected area to a healthy area, which occurs during shaving and waxing.

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 way, the pathogenesis of the human papillomavirus is as follows:

1. Infection. The source of viral agents can be another person or common objects. The risks of transmission are significantly increased by microtraumas to 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 length of the incubation period for this disease. The phase lasts from 1 to 3 months or reaches 2 to 3 years.
3. Chronic presence Despite the absence of clinical manifestations, the disease progresses constantly. A person becomes a source of viral agents for other people.
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.

At the initial stage, the pathogen affects the basal epithelial layer, localizing mainly on the mucous membranes of the genital organs, oral cavity and conjunctiva. The viral agent is capable of replicating exclusively in the basal epidermis, without penetrating the bloodstream. Due to this characteristic, the body's immune system cannot combat the pathology in its entirety, but acts in an extremely limited way.

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

Classification

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

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

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

1. Types of HPV 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 these strains are 6, 7, 32, 40-44 and others.
3. Characterized by moderate oncogenicity. The proportion 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 predominantly provoke malignant tumor formations. This includes 16, 18, 64, 73 and others.

Diagnosis of human papillomavirus

Various diagnostic techniques help identify papillomas in men and women. Thus, to establish the diagnosis in a patient with a latent form, only molecular biology 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 strain of HPV. Subclinical and clinical forms can be diagnosed by methods such as:

1. Simple colposcopy. Papillomas, warts and moles can 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 exam, additional tests are used. 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 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 exclude cancerous tumors. Normally, cytology detects only the most oncogenic types of viruses.

It is best 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 your period is more than 5 days away. Before the procedure, you should not douche vaginally. It is worth excluding sexual intercourse two days before collection. 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 your last urination. 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 formation damage. 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. In addition, negative factors that influence the onset of anal cancer include anal sex, smoking and hereditary predisposition. The disease can take a long time to manifest. Typical symptoms of the disease are rectal bleeding, itching and 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 the age of 40. Representatives of the fair sex over 70 years of age are more susceptible to pathology. In the early stages, symptoms can be confused with menstruation. In addition, pain appears in the pelvic region, constipation and tightness in the vagina.
3. Cancer of the oral cavity and pharynx. One third of diagnoses are the result of HPV infection. The patient complains of pain when swallowing and eating food. In a calm state, there is a sensation 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 tumor process located 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 the papilloma virus can be constructed in two ways:

1. Infection warnings. Unfortunately, even regular use of contraceptives 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 people during adolescence, between 15 and 16 years of age. At the age of 25, the first symptoms appear. For a pronounced effect, prevention must be carried out from an early age.
2. Treatment of diseases caused by human papillomavirus. If the strain causes a malignant or benign formation, therapy for the identified pathology will be required. 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. Thus, people who have a normally functioning immune system are able to deal with HPV on their own within two years. Patients infected in adolescence are free of the viral agent at age 30. Unfortunately, those who recover do not acquire 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 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 potential outcomes:

1. There is a virus, but it has not yet changed the cell structure. In this situation, the patient will be classified as a risk group. If a cancerous type is identified, regular monitoring by a gynecologist or urologist is necessary. Additionally, you must undergo testing periodically.
2. Changes in CIN-1 cells were detected at 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. Pronounced changes in NIC-1 were recorded. To exclude dangerous conditions, a biopsy is necessary. 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 in a timely manner. It is recommended that women schedule a visit to the gynecologist 1 to 2 times a year. Men should visit a urologist at similar times. If you have risk factors (frequent changes of sexual partners, refusal of contraception), you should see your doctor more frequently.
2. Minimize visits to public places - swimming pools, saunas, baths. If this is not possible, it is important to use your own towel, do not take other people's razors and do not sit on the surface with your body naked.
3. Use contraceptives. Only barrier methods are effective. The use of oral contraceptives does not affect strains.
4. Refuse bad habits. Quitting smoking and consuming alcohol in moderation will have a moderate impact on the body's condition.
5. Increase the body's immune defense. Proper nutrition, regular physical activity, adherence to 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 test periodically. If there were situations where infection could have occurred, it is best to get an HPV test. There are also people at risk. Then:

• patients aged 21 to 30 need to have a PAP test at least once every five years (preferably using liquid cytology);
• people aged 30 to 65 need to undergo a Pap smear 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 pregnancy. 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 full of:

1. Recurrent juvenile laryngeal papillomatosis. A similar situation is caused by four strains of HPV. Generally, 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 affects susceptibility to cancer in the future.

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

The disease is capable of rapid progression. A little later, the patient develops a cough and constant shortness of breath. Against the background of HPV, a child may suffer from asphyxiation caused by 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 make it possible to identify the main sign of the pathology – growth of the larynx (condyloma). Surgical treatment is usually recommended for the child. Condylomas are removed by destruction (freezing) or cut. However, the aggressive nature of the disease often leads to relapse.

A pregnant woman infected with HPV with a high degree of oncogenicity should inform the obstetrician at 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.