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 of age. According to statistics, approximately 22 percent of the world's inhabitants 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, course and potential complications. 30 pathogens can infect the epithelium of the 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, certain factors significantly increase your chances of becoming infected. Exactly:

1. Refusal to use barrier contraception. Only a male or female condom, as well as special latex wipes, can protect against infection.
2. Frequent change of sexual partners. If you pay insufficient attention to your own 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. 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 taking psychoactive substances.
6. Weakened immunity. The causes of the condition can be vitamin and mineral deficiencies, 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 membranes and skin become the "gateway" for infection.
9. Chronic stress. They also affect the patient’s immune system and hormonal background.
10. Gynecological interventions. Risk factors for HPV include spontaneous miscarriages or abortions.
11. Pregnancy. Often the disease first appears 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 5-10 percent of patients. The first symptoms can appear either a few months after infection or after a couple of 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 pathology, and objective characteristic manifestations 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. Skin itching. The patient often complains of itching in the genital area or other areas of the skin.
3. Paresthesia. This is a sensitivity disorder in the affected area. Often the opposite manifestation 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 output may be significantly difficult.
5. Cracks. Bleeding cracks appear on the skin and mucous membranes, causing intense 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. Appear on keratinized areas of the genitals. Can be flat or regular.
3. Stains. The nature of the spots varies. There are bright reds, browns with red undertones, pinkish-reds, whites with gray.
4. Bowen's disease. These are papules or spots that are characterized by a glossy 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, the formations are localized in the oral cavity, respiratory tract and lungs.

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

Transmission routes

Doctors and scientists are still arguing 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 sufficient for the probability of transmitting the pathogen to a healthy partner to reach 70 percent. Other doctors say that such risks are relevant only when in contact with carriers of papillomas. Statistics report that with regular proximity, the transmission of the virus to a healthy person occurs within a period of up to 6 months.

Infection can occur in a variety of ways. How is the papilloma virus transmitted:

1. Sexual transmission. The main method of infection is sexual contact. When using 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 baby. A newborn can become infected with HPV from the mother during passage through the reproductive tract. Typical outcomes of this situation are cases of laryngeal papillomosis and anogenital warts.
3. Contact and household path. The virus is also transmitted through ordinary household contacts. Most often this happens in common areas. The risk of infection is especially 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

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 form, the pathogenesis of 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 are significantly increased by 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 stage takes 1-3 months or reaches 2-3 years.
3. Chronic presence Despite the absence 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 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, mainly localizing on the mucous membranes of the genital organs, oral cavity, and conjunctiva. The viral agent is capable of replication exclusively within the basal epidermis without penetration into the bloodstream. Because of this feature, the body’s immune system cannot fight 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.

Classification

Due to the variety of strains, HPV types also differ significantly from each other. So many experts use several classifications of the pathogen at once. 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 exacerbation are recorded. According to the location they are distinguished:

1. Skin. This type of human papillomavirus causes formation on the skin of the infected person.
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 assessing 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 such strains are 6. 7, 32, 40-44 and others.
3. Characterized by moderate oncogenicity. The proportion of affected cells degenerating into cancer 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 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 is aimed at determining the genetic properties of the material that is 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 spots 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 examination, additional tests are used. A test using 3% acetic acid, which provokes a 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 carry out a diagnostic procedure, you will need material from epithelium or skin cells. The sample is used to determine the DNA of the virus, as well as to exclude 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 on the fifth day. As a last resort, you can donate biological material later, if there are more than 5 days left before your period. Before the procedure, you should not douche the vagina. It is worth excluding sexual intercourse two days before the collection. A similar rule applies to intravaginal ultrasound and colposcopy.

When diagnosing men with HPV, material is collected from the urethra. At least two hours should have passed 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 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 influencing the onset of anal cancer include anal sex, smoking, and hereditary predisposition. The disease may not manifest itself for a long time. Typical symptoms of the condition are bleeding from the rectum, 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 first stages, symptoms can be confused with menstruation. Additionally, pain in the pelvic area, constipation, and tightness in the vagina appear.
3. Cancer of the oral cavity and pharynx. A 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 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 tumor process localized in the male genital organ. The pathology is typical for men over 60 years of age.

HPV treatment

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

1. Infection warnings. Unfortunately, even 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 15-16 years of age. By the age of 25, the first symptoms already appear. For a pronounced effect, prevention must be carried out from an early age.
2. Treatment of diseases caused by the human papillomavirus. If the strain causes a malignant or benign formation, then therapy for the identified pathology is 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. So people who have a normally functioning immune system are able to cope with HPV on their own within two years. Patients infected during adolescence become free of the viral agent by the age of 30. Unfortunately, those who have recovered do not acquire lifelong immunity.

Forecast

A significant proportion of strains are characterized by low or moderate oncogenicity. Only certain types of the virus are associated with an increased risk of developing cancer. This statistics 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 cell damage has three potential 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 carcinogenic type is identified, then regular monitoring by a gynecologist or urologist is required. Additionally, you should undergo tests 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 carried out once a year to ensure that the pathology does not progress.
3. Pronounced changes in CIN-1 were recorded. To exclude dangerous conditions, a biopsy is required. The study will determine whether the formation is of an oncological nature.

Prevention

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

1. Visit doctors in a timely manner. Women are recommended to schedule 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, do not take other people's razors and do not sit on the surface with your naked body.
3. Use contraception. Only barrier 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. Increase the body's immune defense. Proper nutrition, regular physical activity, adherence to a 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 infection could have occurred, then it is better to take a test for HPV. There are also people at risk. So:

• patients 21-30 years old need to take a PAP test at least once every five years (preferably using liquid cytology);
• persons from 30 to 65 years old need to undergo Pap testing 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 risks for bearing a child. Anogenital warts deserve special attention. They are localized 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 risk of infection of the baby during childbirth. This is fraught with:

1. Recurrent juvenile laryngeal papillomatosis. A similar situation is provoked by four strains of HPV. Usually 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 the 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 the child is born. The first symptoms of the pathology are hoarseness. In difficult cases, the baby’s voice completely disappears and breathing difficulties appear.

The disease is capable of rapid progression. Somewhat later, the patient develops a cough and constant shortness of breath. Against the background of HPV, a child may experience asphyxia 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 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 cut out. However, the aggressive nature of the disease often leads to relapse.

An expectant mother infected with HPV with a high degree of oncogenicity should inform the obstetrician from 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.