Human papillomavirus. What is it and how to treat it?

Diseases caused by human papillomaviruses have long been known. First of all, these are a variety of warts, which affect one in every six people on the planet. However, the pathogen itself has only attracted scientists' attention in the last 30-40 years. Human papillomavirus (human papillomavirus - HPV) was identified as a separate species in 1971. Since then, scientists have classified HPV types and established their relationships to many pathologies, but research is still ongoing. Meanwhile, doctors are looking for more effective ways to combat this insidious virus.

What is HPV

Human papillomaviruses are a large family of DNA-containing viruses that exhibit an affinity for the epithelial cells that form the skin and mucous membranes. Today, about 170 viruses have been discovered, about 60 of which have been intensively studied.Some papillomaviruses are dangerous because of their oncogenic activity, i. e. they increase the risk of developing malignant tumors. Since the 1980s, studies have shown that human papillomavirus infection plays an important role in the development of adenocarcinoma and squamous cell cervical cancer (the second type of tumor is more common). In 99% of cases, oncology patients are diagnosed with HPV infection and the cells are specifically modified by the virus.Papillomavirus invades epithelial cells. After penetrating the genome, replication (replication of viral DNA) begins. In this case, the cells divide in an atypical way and their structure changes, which can be seen if a cytological analysis is performed.Papillomavirus manifests as specific changes in the epithelium:

• On the skin of the body (warts vulgaris, flat warts, papillomas);
• Epidermis and mucous membranes of reproductive organs (condyloma acuminata, Bowenoid papulosis, cervical tumors, cancer);
• On the mucous membranes of other organs (mouth, throat, bladder, rectum, bronchi, etc. ).

The first group of changes is caused by non-oncogenic viruses. They are unpleasant but not dangerous. The third group of manifestations is considered atypical and is relatively poorly documented.All types of viruses are divided into three groups:

• Low cancer risk (3, 6, 11, 13, 32, 40, 41, 43, 44, 51, 61);
• medium risk (30, 35, 45, 52, 56);
• High risk (16, 18, 31, 33, 39, 59, 64).

Common types 6 and 11 cause multiple anogenital warts and mild cervical tumors. Their detection in pregnant women requires attention because the newborn is at risk of developing laryngeal papillomatosis when exposed to the mother's mucosa during delivery. Therefore, it is important for both women and men to get tested for HPV when planning a pregnancy.The detection of group III viruses in analytical results requires special attention because of the high risk of tissue degeneration and the need for advanced diagnostics in patients.

Mode of infection

The most common route of infection is sexual transmission. Nearly all sexually active adults have been diagnosed with HPV. Most of the time, however, the infection is temporary—the body is able to cope with it, and a year and a half later, the virus is not detected in tests. HPV only occasionally causes mild clinical manifestations and, in rare cases, causes cancer years after infection (10-15).Other routes of infection:

• touch– By touch. This is why you get warts;
• domestic.The virus can remain viable in the external environment for some time. Infections may occur in public places such as bathhouses and swimming pools. Pathogens penetrate through microlesions in the skin.
• vertical.The virus can be passed from mother to child during delivery. In this setting, neonates occasionally develop papillomatosis of the larynx and upper respiratory tract. In some cases, babies are affected by genital warts.
• Autoinfection. Human papillomavirus infection (PVI) can be spread from one place to another throughout the body by things like shaving or scratching warts.

stages of infection development

After infection, the incubation period begins—latency or carriage of PVI. At the same time, the virus is inactive, does not manifest clinically and is not detected during cytological and histological examinations, since it does not replicate its copies and does not alter epithelial tissue. However, its DNA can be detected by PCR analysis.

important!The incubation period does not necessarily lead to the development of the disease. Perhaps the person is simply a carrier himself and will not develop clinical symptoms.

In the second stage (subclinical), tissue changes have begun, but the changes may still be small and not disturbing to the patient. However, when performing cytology, atypical cells are detected, and individual genital warts or small papillomas may be seen upon examination.The third stage is the clinical (overt) stage. Symptoms are evident and the disease requires treatment. More commonly, PVI occurs insidiously or subclinically, with overt signs appearing under the influence of predisposing factors.Phase IV (mutagenesis) is a tragic consequence of PVI. During this time, cells become malignant and cancer begins to grow.

Causes of papillomavirus activation

PVI infection occurs easily, but the body's immune system handles it well and the virus usually goes away on its own. Persistent infections that worsen periodically and do not leave the body are signs of a decreased immune response.The following factors contribute to this:

• age. Healthy adults are less likely to develop PVI. More commonly - children, teenagers and the elderly;
• Long-term chronic illness that weakens the body;
• Endocrine pathologies (diabetes, thyroid disease) and hormonal fluctuations (pregnancy, menopause);
• Ongoing stress, long-term psychological and emotional stress;
• Malnutrition, strict diet, lack of vitamins, minerals and complete protein;
• Severe nutritional obesity and sedentary lifestyle;
• Taking drugs that suppress the immune system, radiation exposure, chemotherapy;
• Primary and secondary immunodeficiencies, HIV;
• Sexual intercourse and indiscriminate intimate contact before the age of 16;
• Co-infection with other sexually transmitted infections;
• Gynecological surgeries that cause mechanical damage to the cervical mucosa (abortion, dilation and curettage, screw installation, etc. ).

The latency period of PVI is highly variable. Pathogens can remain latent and inactive for long periods of time (3 weeks to several years), so the time and circumstances of infection cannot be accurately determined. A person can be infected with more than one type of virus at the same time and be repeatedly infected again, for example from a sexual partner.

Diagnosis of HPV

The first stage of diagnosis is always a doctor's examination and history taking. Women are examined by a gynecologist and men by a urologist or dermatologist. The diagnosis is obvious when exophytic condylomata acuminata are detected, as these tumors are exclusively characteristic of PVI.

Acetic acid test

If the disease is in the subclinical stage, small genital warts may not be visible to the naked eye. Therefore, tests were carried out with acetic acid - after treatment with it, new growth turned white and stood out against the background of the surface.The same happens with the cervical mucosa (by colposcopy) - identifying white areas on it indicates changes in the epithelium at this location. It is from this surface that a cytology smear or biopsy is taken.If the acetic acid test is positive, observation and control will be required after six months, as the disease may progress. Viruses, on the other hand, can enter a latent state and then disappear.

Schiller test

It is performed as part of an extended colposcopy after an acetate test. In this case, areas of fabric previously treated with vinegar are stained with an iodoglycerin solution. Normal cells absorb the solution and turn uniformly brown. In atypical cells, the process of glycogen accumulation is disrupted, and they do not absorb solutions. Mosaic staining occurs, the characteristics of which suggest the diagnosis.

cytology smear

It is also known as the PAP test, named after its inventor, the Greek physician Papanikolaou. To perform the test, the mucous membrane of the cervix (urethra in men) is scraped to obtain epithelial cells for analysis. The biological material is spread on a glass slide, fixed with alcohol, stained and examined under a microscope.The interpretation of the results is left to the doctor, since other data are also taken into account: cytology results, PCR analysis, other infection tests, the presence of inflammation in the vagina, etc. Category A 1-2 results are considered negative, i. e. no virus-induced morphological changes are detected.For grade 3, additional tests are prescribed, but grades 4 and 5 may be signs of grade III tumors or cancer.

PCR analysis

A very sensitive test that detects the presence of viral DNA in epithelial cells. The study can be performed using the same biological materials used for cytological analysis. The polymerase chain reaction is performed in a special device in which a predetermined genetic sequence is copied multiple times.The PCR method is used to detect latent sexually transmitted infections, including HPV, so it is used as part of a screening exam. Genital warts often occur in the context of other sexually transmitted diseases. If a positive PCR result is obtained, in-depth diagnostics are required.Because DNA testing is so accurate, its use often leads to overdiagnosis. After all, detecting viral DNA does not mean a person is sick. It could be a new infection that will go away on its own.Therefore, the PCR test is extended - a quantitative analysis is performed to find out the concentration of the pathogen in the tissue, that is, the viral load (indicated by the letters lg in the results). At the same time, genotyping is performed to determine the exact type of pathogen. If cancer-causing strains are found, control trials are conducted after 3-6 months.

Dual gene test

This method is screening (primary, performed for initial diagnosis). It can also detect viral DNA in tissues. In this case, the carcinogenicity of the virus and its quantity are jointly determined. Digene testing combined with cytology smears is the standard used today in many developed countries to identify clinically significant HPV infection and cancer risk.

Histological examination

This is an advanced diagnostic method. The drug is prescribed to women when a positive screening result is obtained: cytology analysis shows cells of type 3-4-5. Examining a piece of tissue from the biopsy under a microscope.This study allowed us to identify cells specifically modified by the virus - koilocytes and dyskeratotic cells - as well as cells with signs of malignancy. Therefore, histology can determine the extent of tumor formation and identify cancer at an early stage when it can be successfully treated.In some cases, skin and mucosal tumors are submitted for histological analysis if there is doubt about their nature and quality.

Treatment of PVI

During the latent phase of PVI, no treatment is required. Over time, a detected infection becomes only a reason for observation. It is important to note that it is not possible to kill the virus in the body with drugs because it replicates within cells.Infected persons are advised to:

• Avoid factors that lower immunity and take vitamins;
• Recovery from a concomitant STI (if detected) does not progress to chronic disease;
• Maintain a healthy lifestyle and quit bad habits;
• Have sex with a permanent, trustworthy partner.

Treatment of human papillomavirus begins at the subclinical stage. It is still conservative at this stage. Immunomodulatory therapy is often administered. For this purpose, human interferon preparations or their inducers are used.Nonspecific immunomodulators are also effective against HPV. Use antiviral medications.Doctors often prescribe topical medications—ointments, gels, and creams—at the same time.

important!Immunomodulatory treatments can only be prescribed by a doctor based on the results of the immune map; uncontrolled use of the drugs may lead to the opposite result - immune system dysfunction.

In the third stage, radical methods are incorporated into the treatment plan. You can remove genital warts, papillomas, and warts using the following methods:

• chemical removal with cauterizing agents;
• radio knife;
• electrocoagulation;
• laser destruction;
• Freezing damage.

The same approach is used to treat benign lesions of the cervix.For diagnosed cervical cancer, surgery is required to remove the tissue. In this case, the woman will be treated and observed by an oncologist.Because PVI often coexists with other sexually transmitted infections, antibacterial, anti-inflammatory and other medications may be needed.Common warts can be removed at home using a mummifying agent available at pharmacies.

Treatment prognosis

Contrary to the belief that the virus remains in the body forever and a complete cure is impossible, doctors gave a good prognosis. Usually, the infection resolves after an individually prescribed course of treatment, taking into account the carcinogenicity of the virus and the accompanying diseases.Relapses do occur but are relatively rare if treatment is not interrupted. Some people experience one relapse, sometimes several, but the relapses are shorter and weaker. Persistent exacerbation only applies to people with long-term immunity decline due to HIV infection or severe chronic illness.

Prevent PVI

Preventive measures are divided into general preventive measures and special preventive measures. General advice to avoid infection:

• use barrier contraceptive methods;

• having sex with a regular partner;
• Do not initiate sexual activity before the age of 18 because adolescents' immune systems are not fully developed;
• Avoid artificial termination of pregnancy.

So far there is only one specific method of prevention – vaccination. Today, vaccines are available for types 6, 11, 16 and 18 viruses. Vaccination is given in three stages; it is best to start vaccination in adolescence (9 to 10 years old).

Patient testimonials

• "I have genital warts and I didn't know about them, " the gynecologist said after the examination. I immediately asked if I should delete it and I agreed. She then gave me and my husband antiviral medication. It was expensive, but we decided: get treatment until the end. I also bathe with chamomile, rope and calendula. Everything has been clean for two years now. "
• "Doctors have different attitudes towards treatment. I was diagnosed with grade 1 dysplasia and HPV type 18. One doctor told me - just cauterize or you will get cancer later. Another said, 30No treatment is required before the age of 30, and especially before delivery. She prescribed only pills and suppositories. A year later, the virus was still being analyzed, but after two years it was no longer present, and the cervix became normal. But at 30Later, as the second doctor told me, the body can no longer heal on its own. "