HPV (human papilloma virus)

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

At present, 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. Therefore, the virus often causes life-threatening complications: malignant tumors of the vagina, vulva, anal tract, penis.

Causes of HPV

The only cause of infectionhuman papilloma virusit is contact with the causative agent of the disease. However, some factors significantly increase the chances of contracting the infection. Exactly:

1. Refusal to use barrier contraceptives. Only a male or female condom and special latex wipes can protect against infection.
2. Frequent change of sexual partners. If you do not pay enough attention to your safety, the risk of infection increases significantly.
3. Early initiation into sexual intercourse. Sexual intercourse during adolescence often leads to HPV infection due to an irresponsible attitude towards preventing the transmission of the pathogen.
4. Failure to comply with hygiene standards. 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 influenced by addictions: alcohol abuse, smoking and taking psychoactive substances.
6. Weakened immunity. The causes of the condition can be deficiencies of vitamins and minerals, previous diseases and psycho-emotional overload.
7. Long-term drug treatment. Hormonal drugs taken for 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 influence the immune system and hormonal background of the patient.
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 some diseases, such as uterine dysplasia. Regular preventive visits to the gynecologist and urologist help to significantly reduce the risks.

Symptoms

Of the total number of carriers of the pathogen, clinical manifestations of the papilloma virus are detected in only 5-10% of patients. The first symptoms may appear 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 the pathology, and objective characteristic manifestations of HPV. Subjective symptoms include:

1. Papules. These are single or multiple growths that protrude above the skin or resemble spots. They appear on the skin and mucous membranes of the urogenital area.
2. Itching on the skin. The patient often complains of itching in the genital area or other areas of the skin.
3. Paresthesia. This is a disturbance of sensitivity in the affected area. The opposite manifestation often occurs: dyspareunia. In this case, any contact brings pain.
4. Urinary dysfunction. You feel a burning, itching and painful sensation when emptying your bladder. If the urethra is affected, urine production may be significantly difficult.
5. Cracks. Bloody 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 for an accurate diagnosis. Such signs include:

1. Genital warts. It 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 ring-shaped.
2. Papular warts. They appear on the keratinized areas of the genitals. It can be flat or regular.
3. Staines. The nature of the spots varies. There are bright reds, browns with red undertones, pinkish reds, whites with grays.
4. Bowen's disease. These are papules or spots characterized by a shiny or velvety surface. The shade varies from red to almost black.
5. Giant warts. 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, in the respiratory tract and in the lungs.

Additionally, HPV in women in advanced stages can manifest as uterine cancer. In 2008, it was discovered 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 heavy bleeding, pain in the abdomen and lower back, discomfort during intimacy, etc.

Routes of transmission

Doctors and scientists still debate the contagiousness of the human papillomavirus. Some experts believe that just one contact without the use of barrier contraceptives with an asymptomatic carrier is enough for the probability of transmitting the pathogen to a healthy partner to reach 70%. Other doctors say that such risks are relevant only in case of contact with carriers of papillomas. Statistics report that with regular proximity, transmission of the virus to a healthy person occurs within a maximum period of 6 months.

Infection can occur in various 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 kissing.
2. From mother to child. A newborn baby can become infected with HPV from the mother while passing through the reproductive tract. Typical outcomes of this situation are cases of laryngeal papillomosis and anogenital warts.
3. Family contact and path. The virus is also transmitted through normal household contact. Most often this happens in common areas. The risk of infection is particularly high in bathrooms, saunas, gyms and swimming pools. Public bathrooms.
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 capacity 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 the viral agents can be another person or everyday 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 duration of the incubation period of this disease. The phase lasts 1-3 months or reaches 2-3 years.
3. Chronic presence Despite the absence of clinical manifestations, the disease constantly progresses. A person becomes a source of viral agents for others.
4. Visual manifestations on the skin. The result of the infection is the appearance of a benign or malignant formation at the site of entry of the virus.

In 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 able to replicate exclusively within the basal epidermis without penetration into the bloodstream. Due to this characteristic, the body's immune system is not able to fully fight the pathology, but acts in an extremely limited way.

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. Therefore, 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. Based on location, the following are distinguished:

1. Skin. This type of human papillomavirus causes it to form 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 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 there are 6. 7, 32, 40-44 and others.
3. Characterized by moderate oncogenicity. The percentage of affected cells that degenerate into tumor 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 mainly cause 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. Therefore, to establish a 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 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. Additional tests are used during the exam. A test with 3% acetic acid is indicative, which causes a narrowing of unchanged blood vessels. Additionally, an epinephrine 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 and to rule out cancerous tumors. Typically, cytology detects only the most oncogenic virus types.

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 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 wash the vagina. It is worth excluding sexual intercourse two days before harvesting. A similar rule applies to intravaginal ultrasound and colposcopy.

When diagnosing HPV in men, 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% of cases of detection of this malignant tumor are associated with HPV infection. Furthermore, negative factors that influence 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% 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 the age of 70 are more susceptible to pathology. In the early stages, symptoms can be confused with menstruation. In addition, pain in the pelvic area, constipation and a feeling of tightness in the vagina appear.
3. Cancer of the oral cavity and pharynx. One-third of diagnoses are the result of an 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. Penis cancer. 50% of cases are caused by viral agents. It is a rare malignant tumor, which involves a tumor process localized in the male genital organ. The pathology is typical of men over the age of 60.

HPV treatment

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

1. Infection alerts. Unfortunately, even regular use of contraception and a careful approach to hygiene do not protect a person from infections. Of course, this significantly reduces the chances. However, most cases of transmission of the pathogen occur in people during adolescence, between the ages of 15 and 16. At 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 human papillomavirus. If the strain causes a malignant or benign formation, therapy for the identified pathology is necessary. 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 clear the viral agent by age 30. Unfortunately, those who have recovered do not acquire permanent immunity.

Forecast

A significant percentage 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 diagnosis 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 cancerous type is identified, regular monitoring by a gynecologist or urologist is necessary. Additionally, you should get tested periodically.
2. Changes in CIN-1 cells were detected at early stages. In most cases, this condition also does not require medical intervention. Typically, a follow-up exam is performed once a year to ensure that the condition does not progress.
3. Pronounced changes in CIN-1 were recorded. To exclude dangerous conditions, a biopsy is necessary. The study will determine whether the training is oncology in nature.

Prevention

It is possible to prevent HPV infection by following the main prevention rules. Important:

1. Visit doctors in a timely manner. Women are advised to schedule a visit to the gynecologist 1-2 times a year. Men should visit a urologist with a similar program. If you have risk factors (frequent changes in sexual partners, refusal of contraception), you should visit the doctor more often.
2. Minimize visits to public places: swimming pools, saunas, bathrooms. 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 naked body.
3. Use contraception. Only barrier methods are effective. The use of oral contraceptives does not affect the strains.
4. Reject bad habits. Quitting smoking and consuming alcohol moderately will have a moderate impact on the condition of the body.
5. Increase the body's immune defense. Proper nutrition, regular physical activity, compliance with the daily routine and physical exercise have a beneficial effect.
6. Avoid stress. Psycho-emotional overstrain can negatively affect the immune system, so it is better to exclude them.

It is important to get tested periodically. If there were situations where an infection may have occurred, then it is best to get tested for HPV. There are also people at risk. AS:

• patients between the ages of 21 and 30 should have a PAP smear at least once every five years (preferably using liquid cytology);
• people aged 30 to 65 must undergo a Pap test for HPV every three years with a mandatory PCR test for the oncogenic forms (16 and 18).

HPV in pregnant women

Human papilloma in women, as a rule, does not pose any particular risks for pregnancy. 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 baby's risk of infection during birth. This is fraught with:

1. Recurrent juvenile laryngeal papillomatosis. A similar situation is caused by four strains of HPV. Usually the pathology is a consequence of anogenital warts or genital HPV.
2. Increased risk of developing cancer in adulthood. Virus infection at such an early age significantly affects susceptibility to cancer in the future.

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

The disease is capable of rapid progression. A little later, the patient develops cough and constant shortness of breath. Against the background of HPV, a child may experience asphyxia caused by blockage of the airways. Most often this happens when papillomas appear on thin legs.

A special medical device called a laryngoscope is used to diagnose the disease. It can be replaced by a bronchoscope. The devices allow us to identify the main sign of the pathology – growth of the larynx (warts). Surgical treatment is usually recommended for the child. Warts are removed by destruction (freezing) or cut. However, the aggressive nature of the disease often leads to relapse.

A future mother infected with HPV with a high degree of oncogenicity should inform the obstetrician of the antenatal clinic about this. In this case, doctors will take all necessary measures to ensure that the virus does not affect the health of the child.