HPV often does not manifest itself in any way. The main symptoms of human papillomavirus are, of course, warts that can appear in the most unexpected places: on the genitals, palms, arms, neck and other parts of the body. Read about the hidden manifestations of this virus and its treatment methods in the next article.
What is human papillomavirus?
Human papillomavirus (HPV) is the general 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 genital organs. Each of the viruses belonging to the HPV group has its own sequence number and differs from other viruses due to 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, throat cancer, etc. Different types of human papillomaviruses are divided into groups according to their ability to cause malignant neoplasms. Thus, it is customary to distinguish 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. more common in cervical cancer.
How does HPV enter 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 as a result of contact of damaged skin or mucous membranes with the secretions of a sick person (for example, underwear, towels, etc. ). Human papillomavirus can be passed from mother to child during childbirth. .
Overview
Human papillomavirus (HPV) is the most common viral infection of the genital tract. Most sexually active women and men are infected at some point in their lives, and some may become infected again.
For both women and men, the peak period for acquiring the infection begins immediately after becoming sexually active. HPV is sexually transmitted, but penetrative sex is not required for transmission of the virus. Skin-to-sexual contact is a well-established route of transmission.
Many types of HPV do not cause problems. HPV infections usually clear up on their own within a few months of getting them without any intervention, and about 90% clear up within 2 years. A small percentage of infections with certain types of HPV can persist and turn into cancer.
Cervical cancer is the most common disease associated with HPV. Almost all cases of cervical cancer can be caused by 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 by using the same primary prevention strategies as cervical cancer.
Non-cancerous types of HPV (especially types 6 and 11) can cause genital warts and respiratory papillomatosis (a disease in which tumors grow in the airways from the nose and mouth to the lungs). And while these conditions rarely lead to death, they can often cause morbidity. Genital warts are common and highly contagious.
How HPV is transmitted and manifested
More than 150 types of viruses have been identified in modern medical science. Depending on its type, it affects the work of all organs and systems of the human body. For example, infected people observe various neoplasms in the form of genital warts and wart-like growths on the skin and mucous membranes.
The main mode of transmission is physical contact with the carrier, including unprotected sex. However, household infection is also quite common. 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 papillomavirus infection manifest itself?
The most common manifestations of human papillomavirus infection are:
- Pointed warts. The development of genital warts and papillomas is mostly caused by low oncogenic risk HPV. Condylomas are solitary and focal, usually occurring at sites of injury during sexual intercourse. The size of the elements is from 1 millimeter to several centimeters, they are shaped like a "cock's comb" or "cauliflower" and are located on a narrow base (foot). Often, women find warts when touching them during washing, which feels like an unevenness. A large number or size of genital warts can scar and bleed, interfere with normal sex life and childbirth, and cause psychological distress. Itching is rarely accompanied by manifestations of human papillomavirus infection.
- Papillomas (warts). Unlike papilloma of a tumor nature, viral papillomas appear, disappear and reappear, because their severity currently depends on the state of the body's defenses. The color of viral papillomas does not differ from normal skin and can grow anywhere.
- Flat condyloma of the cervix. Flat condyloma is a manifestation of a chronic, long-lasting viral infection that causes changes in the cells of the epithelium of the cervix. It can be combined with genital warts on the external genitalia. Cervical changes characteristic of HPV always alert the doctor, because cervical cancer is 65 times more common in women who have had this virus for a long time than in those without. However, the presence of a high-risk virus in the body does not necessarily mean that a woman will get cancer. In order for cells to become malignant, additional factors must be present. The fact that high-risk virus types are detected gives the patient a significant head start in the fight against the disease; here the formula "forewarned, armed" is most 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.
Symptoms of HPV in women
In women, human papillomavirus infection can cause the appearance of genital warts - genital warts, in many cases, are detected only during a gynecological examination.
They grow about three months after infection. Most often, they are formed in the labia minora, vagina, cervix, cervical canal, skin around the anus.
Externally, they are small joints located on a wide "leg" and with 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 that causes cell maturation. Currently, 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 viruses of type 16 and 18. Also, cancer is provoked by types 31, 33, 35 and 39.
In both women and men, the symptoms of HPV can be the presence of small growths not only on the genitals, but also in other places - under the mammary glands, in the armpits, on the neck, and on the eyelids.
The disease is less dangerous for men than for women. If some types of carcinogenic viruses that cause the development of growths on the skin in a man rarely provoke tumors in the stronger sex, a woman who received them from a man is at risk of developing cervical cancer.
The course of pregnancy
Warts that appear during pregnancy are often repeated, tend to increase significantly, become loose, and large formations can cause difficulties during childbirth. There is evidence that primary infection with HPV during pregnancy may increase the risk of termination, but whether this infection causes malformations in the fetus is controversial.
The frequency of transmission of HPV 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. Most likely, in an ascending manner through the cervical canal and fetal membranes, or by contact as the child passes through the mother's birth canal.
Recently, the development of papillomatosis of the larynx, trachea and bronchi and anogenital warts in babies is associated with HPV infection at birth. The disease is extremely rare, in addition, cases of this disease have been 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 may be the presence of a giant condyloma, which complicates childbirth only through the natural birth canal. However, such condylomas occur only in women with severe immunodeficiency, such as AIDS.
After birth, HPV detected during pregnancy is 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 childbirth.
Risk factors for cervical cancer
- first sexual intercourse at an early age;
- multiple sexual partners;
- tobacco use;
- immunosuppression (eg, HIV-infected people are at increased risk of HPV infection and are infected with a wider range of HPV types).
Diagnostics
The main method of PVI diagnosis is regular clinical examination. To confirm this diagnosis, colposcopy (examination of the mucous membrane of the cervix and vagina using a special magnifying device) and cytological examination (for this, a scrap is taken from the cervical canal and the surface of the cervix) are used.
Cytological examination does not detect the virus itself, but it detects changes in the cells of the cervical epithelium that are characteristic of this infection. Histological examination helps to clarify the cytological diagnosis: in this case, as in cytology, a piece of tissue is taken, and not only the structure of the cells, but also their correct location is studied. their layers. Biopsies are not usually performed during pregnancy.
To determine the types of viruses and their oncogenic risk, polymerase chain reaction (PCR) is used, which determines DNA fragments of the pathogen. This allows you to accurately determine the presence of the HPV virus in the cervix. This is important for the prognosis of the development of cervical diseases.
HPV treatment
Since it is currently impossible to achieve complete treatment of human papillomavirus infection (in addition, spontaneous, spontaneous recovery is often observed), HPV manifestations are treated, 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 several months after the end of treatment.
Given the possibility that genital warts will resolve on their own, it is sometimes advisable not to carry out any treatment. The question of appropriateness of treatment for each pregnant patient is solved individually.
In this case, factors that reduce immunity (hypothermia, severe emotional stress, chronic work, beriberi) should be avoided. There are studies showing the preventive effect of micronutrients such as retinoids (beta-carotene and vitamin A), vitamin C and folic acid against HPV infections.
The most commonly used treatments for genital warts are:
Destructive methods
Destructive methods are local treatment aimed at eliminating 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.
Physical destructive methods and trichloroacetic acid preparations can be used in pregnant women. It is desirable to carry out treatment with destructive methods only in the early stages of pregnancy with special care. At the same time, it is necessary to take into account possible side effects during treatment (bleeding and secondary infection due to changes in blood circulation, toxic complications) and the possibility of reappearance of genital warts after their removal.
Cytotoxic drugs
Cytotoxic drugs are STRICTLY CONTRAINDICATED during pregnancy. For women of reproductive age, it is recommended to use reliable contraception or abstain from sexual activity during treatment.
Immunological methods
Interferons are most often used to treat HPV infection. They are a family of proteins produced by cells of the immune system in response to viral stimulation. Immunoglobulin preparations are used together with local administration 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.
Special antiviral drugs
special antiviral drugs. These drugs are not used in pregnant women with papillomavirus infection, as their effects on the fetus have not been sufficiently studied. By the way, the well-known antiviral drug has no effect on HPV.
Summary
- Pruritus may be caused by PVI, but all other possible causes of sexually transmitted pruritus must be ruled out to confirm this cause. It is not an STD, and the infection may not necessarily come from a sexual partner or sex life in general. Condom, virginity, regular sexual partner, abstinence - does not mean the impossibility of contracting PVI.
- HPV is widespread, its detection in the body is more of an example than an oddity.
- The diagnosis of PVI is made "by eye" according to clinical manifestations, not by PCR.
- If PVI is detected, colposcopy, if necessary, biopsy and treatment are necessary. If you can refuse the OC of the external genitalia and do not treat it, you should definitely examine and treat the cervix. PVI is the most common cause of cervical cancer.
- If HPV is detected, the partner should be tested because penile cancer is the same consequence of PVI as cervical cancer. The examination is also not PCR, but an eye.
- Manifestations of PVI - OK or straight condyloma - and not the presence of a virus in the body, are subject to treatment.
- The first step of treatment is conservative. The basis of therapy is antiviral drugs, including. - local. Immunomodulators are an auxiliary and additional 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 recurs with reduced 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 OC.
- PVI can be passed from mother to child during childbirth, which causes papillomatosis of the larynx. It is easily treated. Condylomatosis is not an indication for caesarean section.
Human papillomavirus (HPV) can be in a woman's body for years and not manifest itself in any way, but at the same time, it constantly threatens the risk of the development of cancer and precancerous diseases of its "mistress".