Diseases caused by the human papilloma virus have been known for a long time. First of all, these are warts of all kinds, from which one in six people on the planet suffers. However, the pathogen itself has only attracted the attention of scientists in the last 30 to 40 years. The group of human papillomaviruses (Human Papillomavirus - HPV) was identified as a separate species in 1971. Since then, scientists have classified HPV types and established their connection with many pathologies, but the research is still ongoing. At the same time, doctors are looking for more effective ways to combat this insidious virus.
What is HPV?
Human papillomaviruses are a large group of viruses that contain DNA and have an affinity for epithelial cells that make up the skin and mucous membranes. Today, about 170 species of the virus have been discovered and about 60 have been well studied.
Some papilloma viruses are dangerous due to their oncogenic activity, that is, they increase the risk of the formation of malignant tumors. Since the 1980s, research has been carried out proving that infection with human papillomavirus plays a role in the development of adenocarcinoma and squamous cell carcinoma of the cervix (the second type of tumor is much more common). In 99% of cases, oncological patients are diagnosed with HPV infection and cells specifically altered by the virus.
The papilloma virus penetrates epithelial cells. After entering the genome, replication (reproduction of the virus's DNA) begins. In this case, the cells divide in an atypical manner and their structure changes, which becomes visible through cytological analysis.
The papilloma virus is manifested by specific changes in the epithelium:
- on the skin of the body (vulgar and flat warts, papillomas);
- on the epidermis and mucous membranes of the genital organs (genital warts, bowenoid papulosis, cervical cancer, cancer);
- on the mucous membranes of other organs (oral cavity, larynx, bladder, rectum, bronchi, etc. ).
Changes in the first group are caused by non-oncogenic viruses. They are unpleasant but not dangerous. The third group of manifestations is considered atypical and is recorded relatively rarely.
All types of viruses are divided into three groups:
- with low oncogenic risk (3, 6, 11, 13, 32, 40, 41, 43, 44, 51, 61);
- with moderate risk (30, 35, 45, 52, 56);
- with high risk (16, 18, 31, 33, 39, 59, 64).
The most common types 6 and 11 cause multiple anogenital warts and mild cervical neoplasms. Its detection in a pregnant woman requires attention, since a newborn is at risk of developing laryngeal papillomatosis upon contact with the mother's mucous membranes during childbirth. Therefore, women and men must undergo an HPV test when planning a pregnancy.
The detection of viruses of the third group in the analysis results requires special attention, since the risk of tissue degeneration is high and the patient needs advanced diagnostics.
Infection methods
The most common route of infection is sexual. Almost all sexually active adults are diagnosed with HPV. However, most often the infection is of a temporary nature - the body copes with it and after a year and a half the virus is no longer detected in tests. Only occasionally does HPV cause minor clinical manifestations and, in extremely rare cases, cancer that develops many years after infection (10–15).
Other routes of infection:
- Contact– through touch. This is how you can become infected with warts;
- Domestic.The virus remains viable in the external environment for some time. Infection is possible in bathhouses, swimming pools and other public places. The pathogen penetrates the skin through microdamage.
- Vertical.The virus can be transmitted from mother to child during birth. In this case, the newborn occasionally develops papillomatosis of the larynx and upper respiratory tract. In some cases, the baby is affected by genital warts.
- Autoinfection.Human papillomavirus (PVI) infection can spread from one place to another throughout the body, for example through shaving or scratching warts.
Stages of infection development
After infection, the latent stage begins - latent or carrier of PVI. At the same time, the virus is inactive, it does not manifest itself clinically and is not detected during cytological and histological examination, since it does not reproduce its copies and does not change the epithelial tissue. However, its DNA can be detected using PCR analysis.
Important!
It is not at all necessary for the latent stage to develop into a disease. Perhaps the person himself remains only a carrier and has no clinical manifestations.
In the second stage (subclinical), the tissue changes have already begun, but they may still be minimal and not bother the patient. However, during cytological analysis, atypical cells are detected, and individual condylomas or small papillomas may be visible on examination.
The third stage is clinical (manifest). The symptoms are pronounced and the disease requires treatment. PVI is more often latent or subclinical, and obvious signs appear under the influence of provoking factors.
The fourth stage (mutagenesis) is a sad consequence of PVI. During this time, the cells become malignant and the carcinoma begins to grow.
Reasons for activation of the papilloma virus
A PVI infection is very mild, but the human immune system copes with it well and often the virus goes away on its own. A persistent infection that regularly worsens and does not leave the body is a sign of a reduced immune response.
The following factors contribute to this:
- Age. Healthy adults are less likely to develop PVI. More common – children, adolescents and the elderly;
- Long-term chronic diseases that weaken the body;
- Endocrine pathologies (diabetes mellitus, thyroid diseases) and hormonal fluctuations (pregnancy, menopause);
- Constant stress, persistent psycho-emotional stress;
- Poor nutrition, strict diets, lack of vitamins, minerals and complete proteins;
- Severe diet-induced obesity and physical inactivity;
- taking medications that suppress the immune system, exposure to radiation, chemotherapy;
- Primary and secondary immunodeficiencies, HIV;
- beginning sexual activity before the age of 16 and indiscriminate intimate contacts;
- Concomitant infection with other sexually transmitted infections;
- Gynecological procedures leading to mechanical damage to the mucous membranes of the cervical canal (abortion, curettage, installation of a spiral, etc. ).
The incubation period for PVI varies greatly. The pathogen can remain in a latent, inactive state for a long period of time (from 3 weeks to several years), making it impossible to accurately determine the time and circumstances of infection. A person can be infected with several types of viruses at the same time and constantly become reinfected, for example from a sexual partner.
Diagnosis of HPV
The first step in diagnosis is always a medical examination and taking an anamnesis. Women are examined by a gynecologist, men by a urologist or dermatovenereologist. When exophytic genital warts are discovered, the diagnosis is obvious, since these neoplasms are characteristic only of PVI.
Acetic acid test
If the disease is at a subclinical stage, small condylomas may not be visually visible. Therefore, a test is carried out with acetic acid - after treatment with it, the new growths become white and stand out against the background of the surface.
The same thing happens with the mucous membrane of the cervix (examined by colposcopy) - the identification of white areas on it indicates that the epithelium in this place is changed. A cytological smear is taken from this surface or a biopsy is performed.
If the acetic acid test is positive, observation and control is necessary after six months as the disease may progress. On the other hand, the virus can enter a latent state, then the manifestations disappear.
Schiller test
It is carried out as part of an extended colposcopy after a test with acetic acid. In this case, areas of fabric previously treated with vinegar are stained with a solution of iodine in glycerin. Normal cells absorb this solution and turn brown evenly. In atypical cells, the processes of glycogen accumulation are disrupted and they do not absorb the solution. Mosaic discoloration occurs, the characteristic features of which suggest a diagnosis.
Cytological smear
It is also called the PAP test after the name of its inventor, the Greek doctor Papanikolaou. For the test, a swab is taken from the mucous membrane of the cervix (the urethra in men) to obtain epithelial cells for analysis. The biomaterial is applied to a microscope slide, fixed with alcohol, stained and examined under a microscope.
The interpretation of the results is carried out by a doctor, since other data is also taken into account: the results of cytology, PCR analysis, tests for other infections, the presence of inflammation in the vagina, etc. A result of class 1-2 is considered negative, d. H. no morphological changes caused by the virus were detected.
For grade 3, additional examination methods are prescribed, but grades 4 and 5 are a possible sign of a neoplasm or cancer grade III.
PCR analysis
A very sensitive test that detects the presence of viral DNA in epithelial cells. The study can be carried out using the same biomaterial taken for cytological analysis. The polymerase chain reaction is carried out in a special device in which a given gene sequence is copied many times.
The PCR method is used to detect hidden sexually transmitted infections, which also includes HPV, and is therefore used as part of a screening examination. Genital warts often occur against the background of other sexually transmitted diseases. If PCR results are positive, detailed diagnostics are required.
Because DNA testing is so accurate, its use often leads to overdiagnosis. The detected DNA of a virus does not mean that a person is sick. It may be a new infection that goes away on its own.
Therefore, the PCR test is expanded - a quantitative analysis is carried out to determine the concentration of the pathogen in the tissue, i. e. the viral load (marked with the letters lg in the results). At the same time, genotyping is carried out to determine the exact type of pathogen. If oncogenic strains are found, control tests are prescribed after 3-6 months.
Digene test
This method is a screening (primary, carried out for initial diagnosis). It also detects viral DNA in tissues. In this case, the oncogenicity of viruses and their number are determined together. The Digene test in combination with a cytological smear is now the standard for identifying clinically significant HPV infection and cancer risk in many developed countries.
Histological examination
This is an advanced diagnostic method. It is prescribed to a woman if there are positive screening results: cytological analysis revealed cell class 3-4-5. A piece of tissue obtained through a biopsy is examined under a microscope.
The study allows us to identify cells specifically altered by the virus - koilocytes and dyskeratocytes - as well as cells with signs of malignancy. Thus, histology makes it possible to determine the degree of neoplasia and detect cancer at an early stage when it can be successfully treated.
In some cases, tissues from neoplasms of the skin and mucous membranes are subjected to histological analysis if there are doubts about their nature and quality.
Treatment of PVI
No treatment is required in the latent stage of PVI. A detected infection over time becomes just a reason for observation. It is worth noting that it is impossible to kill the virus in the body with drugs, as it replicates in the cells.
An infected person is advised to:
- Avoid factors that affect immunity, take vitamins;
- recover from concomitant sexually transmitted infections, if any are detected, do not develop chronic diseases;
- lead a healthy lifestyle, give up bad habits;
- Have a sex life with a steady, trustworthy partner.
Treatment of human papillomavirus begins at the stage of subclinical manifestations. At this stage it is conservative. Immunomodulatory therapy is usually prescribed. For this purpose, human interferon preparations or their inducers are used.
Non-specific immunomodulators are also effective against HPV. Antiviral drugs are used.
Doctors often prescribe local medications at the same time - ointments, gels and creams.
Important!
Immunomodulatory treatment is prescribed only by a doctor based on the results of an immunogram; Uncontrolled use of medications can lead to the opposite result - a malfunction of the immune system.
At the third stage, radical methods are included in the treatment regimen. You can get rid of genital warts, papillomas and warts using the following methods:
- chemical removal with cauterizing drugs;
- radio knife;
- electrocoagulation;
- laser destruction;
- Cryodestruction.
The same methods are used in the treatment of benign diseases of the cervix.
If cervical cancer is diagnosed, surgical tissue removal is indicated. In this case, the woman is treated and observed by an oncologist.
Since PVI is often combined with other sexually transmitted infections, antibacterial, anti-inflammatory and other medications may be prescribed.
Vulgar warts can be removed at home using mummifying agents available in pharmacies.
Treatment prognosis
Contrary to the belief that the virus remains in the body forever and a complete cure is impossible, doctors give favorable prognosis. As a rule, the infection resolves after individually developed therapy, taking into account the oncogenicity of the virus and concomitant diseases.
Although relapses do occur, they are relatively rare unless treatment is interrupted. Some people experience one relapse, sometimes several, but shorter and weaker ones. Constant exacerbations are typical only for people whose immunity has been weakened for a long time due to HIV infection or serious chronic diseases.
Prevention of PVI
Prevention measures are divided into general and specific measures. General recommendations to avoid infections:
- Use barrier methods of contraception.
- have sex with a steady partner;
- Do not begin sexual activity before the age of 18, as adolescents' immune systems are not yet fully developed;
- Avoid artificial abortion.
So far there is only one specific method of prevention - vaccination. Today it is possible to be vaccinated against virus types 6, 11, 16 and 18. The vaccination takes place in three stages; It is best to start vaccination in adolescence - between the ages of 9 and 10.
Reviews from patients
- "I had condyloma, I didn't know about it, " said the gynecologist after the examination. I immediately asked if we would delete it, and I agreed. Then she prescribed me and my husband to take an antiviral drug. Expensive, but we"We decided: to carry out the treatment to the end. I also did baths with chamomile, string and calendula. Now everything has been clean for two years. "
- "Doctors have different attitudes to treatment. I was diagnosed with grade 1 dysplasia and HPV type 18. A doctor told me - just cauterize it, otherwise cancer will develop later. Another said that no treatment is needed before the age of 30, especially before childbirth. She only prescribed tablets and suppositories. A year later the virus was still in analysis, but two years later it was no longer there and the cervix was normal. But after 30, as the second doctor told me, the body no longer recovers on its own. "