HPV very often practically does not manifest itself in any way. The main symptoms of the 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 methods of its treatment 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 diseases of the genital organs. Each of the viruses of the HPV group has its own sequence number and differs from other viruses in its unique DNA composition.
At present, the role of certain types of human papillomaviruses in the development of malignant tumors of various organs has been proven: for example, cervical cancer, penis 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 more frequently found in cervical cancer.
How HPV enters the body
The most common way of transmission of the human papillomavirus (HPV) is sexual contact, so this infection is classified as a group of sexually transmitted diseases (STDs). 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 childbirth is possible.
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 infection for both women and men begins immediately after they become sexually active. HPV is transmitted sexually, but penetrative sex is not required to transmit the virus. Skin-to-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 acquiring them, and about 90% clear up within 2 years. A small proportion of infections with certain types of HPV can persist and develop into cancer.
Cervical cancer is by far the most common HPV-associated disease. 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 cancers 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.
HPV types that do not cause cancer (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 disease. Genital warts are widespread and highly infectious.
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, infected people 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 is also quite common to get infected by household means. 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 more often caused by HPV of 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 "cockscomb" or "cauliflower" in shape and are located on a narrow base (leg). Most often, women find warts to the touch during washing, which is felt as an unevenness. With a large number or size of genital warts, they can be injured and bleed, interfere with normal sexual life and childbirth, and cause psychological discomfort. Itching rarely accompanies manifestations of human papillomavirus infection.
- Papillomas (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-existing viral infection that caused changes in the cells of the epithelium 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 get 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. It is necessary to have additional factors so that the cells can degenerate into malignant ones. The fact of detecting high-risk types of virus gives the patient a significant head start in the fight against the disease; here the formula "forewarned is forearmed" is the 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.
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 on the labia minora, in the vagina, on the cervix, cervical canal, on the skin around the anus.
Outwardly, they are small formations that are located on a wide "leg" and have uneven edges. At the same time, those types of HPV that cause genital warts are not those that cause cancer.
The 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 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 types 16 and 18. Also, cancer is provoked by 31, 33, 35 and 39 types.
Symptoms of HPV in both women and men may 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 carcinogenic types of the virus that cause the development of outgrowths on the skin in a man rarely provoke tumors in the stronger sex, then a woman, having contracted them from a man, runs the risk of developing cervical cancer.
The course of pregnancy
During pregnancy, visible warts often recur, tend to increase significantly, become loose, large formations can cause difficulties during childbirth. There is evidence that primary infection with HPV during pregnancy can lead to a threat of termination, but whether such infection causes malformations in the fetus is a moot point.
The frequency of transmission of HPV from mother to fetus, according to different researchers, varies quite significantly - from 4 to 80%. How the virus is transmitted is still not known exactly. It is most likely that through the cervical canal and fetal membranes in an ascending way or by contact when the child passes through the mother's birth canal.
Recently, the development of papillomatosis of the larynx, trachea and bronchi and anogenital warts in infants has been associated with HPV infection during childbirth. The disease is quite rare, in addition, cases of this disease in children born by caesarean section are described, so the presence of HPV and its manifestations in a pregnant woman is not an indication for caesarean 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 childbirth, HPV detected during pregnancy is most often not detected, and clinical manifestations in the form of massive growths significantly decrease or disappear. It should be noted that HPV first detected 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 (for example, HIV-infected people are at increased risk of HPV infection and are infected with a wider range of HPV types).
The main method for diagnosing PVI is a routine clinical examination. To confirm this diagnosis, colposcopy is used (examination of the mucous membrane of the cervix and vagina using a special magnifying device) and cytological examination (for this, a scraping is taken from the cervical canal and from the surface of the cervix).
Cytological examination does not reveal the virus itself, but changes in the cells of the epithelium of the cervix that are characteristic of this infection. A histological examination helps to clarify the cytological diagnosis: in this case, not a scraping of surface cells is taken, as for cytology, but a piece of tissue, and not only the structure of the cells is studied, but also the correct arrangement of their layers. During pregnancy, a biopsy is usually not performed.
To determine the types of the virus and their oncogenic risk, polymerase chain reaction (PCR) is used, which determines the DNA fragments of the pathogen. It allows you to accurately determine the presence of the HPV virus in the cervix. This is important for the prognosis of the development of diseases of the cervix.
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 methods of treatment is 50-70%, and in a quarter of cases the disease reappears already a few months after the end of treatment.
Given the possibility of self-resolution of genital warts, it is sometimes advisable not to carry out any treatment. The question of the appropriateness 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 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, physical destructive methods and trichloroacetic acid preparations can be used. Treatment with destructive methods is desirable to be carried out only in the early stages of pregnancy, taking special care. At the same time, it is necessary to take into account the risk of possible side effects during treatment (bleeding and secondary infection due to altered blood circulation, toxic complications), and the possibility of reappearance of genital warts after their removal.
Cytotoxic drugs are STRICTLY CONTRAINDICATED during pregnancy. For women of childbearing age, reliable contraception or abstaining from sexual activity is recommended for the duration of treatment.
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. Immunoglobulin preparations are used in conjunction with 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 drugs
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.
- Itching can be caused by PVI, but to confirm this cause, all other possible causes of itching transmitted by contact must be excluded. This is not an STD, and infection may not necessarily come from a sexual partner and not necessarily from sexual life at all. A condom, virginity, a regular sexual partner, abstinence - do not mean the impossibility of contracting PVI.
- HPV is widespread, its detection in the body is more a pattern than an oddity.
- 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 on OK of the external genital organs and not treat, then the cervix must be examined and treated without fail. PVI is the most common cause of cervical cancer.
- If HPV is detected, an examination of the partner is necessary, since penile cancer is the same consequence of PVI as cervical cancer. Examination is also an eye, not PCR.
- The 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 is antiviral drugs, incl. - locally. Immunomodulators are an auxiliary and optional component of treatment.
- Itching can be caused by PVI, but all other possible causes of itching must be excluded to confirm this cause.
- PVI recurs with a decrease in immunity. This does not indicate the ineffectiveness of previous treatment. No treatment can completely remove the virus from the body and does not guarantee complete elimination of OK.
- PVI can be transmitted during childbirth from the mother to the child, causing papillomatosis of the larynx. This is easily treatable. Condylomatosis is not an indication for a caesarean section.
The human papillomavirus (HPV) can be in a woman's body for years and not manifest itself in any way, while constantly jeopardizing the risk of developing cancerous and precancerous diseases of its "mistress".