Papillomavirus

Papillomavirus – the causative agent of HPV infection (not to be confused with HIV!). It is the HPV infection that is the correct name for the disease, which manifests itself as a papilla on the skin and mucous membranes (including internal and external genital organs) of people of both sexes.

Briefly about HPV

There are palillo-viruses with high oncogenic risk and low. The first of them, if they enter the human body, can provoke cancer (the appearance of tumors). These include HPV types 16, 18, 45 and 56. Patients with high-risk viruses detected should not only receive treatment (which will be described in detail below), but also be observed further by a doctor in order to prevent recurrences and complications.

There are approximately one hundred types of human papillomavirus (HPV). Some of them “attack” the skin, and some cause pathology of the genitals and the urological sphere.

Spread

Infection is spread by both sick people and carriers of the virus without vivid symptoms. Do not think that a virus can be “picked up” only from the genitals of an infected person. HPV is located on:

• integuments
• mucous on any site
• semen
• urine
• saliva

There is a high risk that HPV will be in the patient’s saliva. Then you can get infected even with a kiss. This is a common mode of transmission. This also includes infection through dishes or other household items on which the saliva of an infected person has fallen.

The infection gets into our organisms through small (often even invisible to the eye) injuries on the skin and mucous. Suppose you have cracked skin on your finger, and you made love with an infected person. Or you could have hit somewhere (in that area there were microtraumas that may not let you know about yourself with pain).

Localization of the virus:

• vocal cords
• nose
• mouth
• nasopharynx
• renal pelvis
• bladder
• ureters
• urethra
• genitals

Locations of the virus (probable) in women on the genitals:

• mucous membranes of the vulva
• crotch
• the eve of the vagina
• cervix
• perianal region
• rarely pubis
• rarely urethra

Locations of the virus (probable) in men on the genitals:

• coronary sulcus
• inner leaf of the foreskin
• penis head
• scrotum
• the trunk of the penis
• bridle
• pubis
• groin skin
• perianal region
• crotch

Only in twenty percent of cases out of a hundred, a man’s lesion of the external opening of the urethra is recorded.

Genital papillomavirus infection

This infection is very, very often sexually transmitted. This is one of the leaders in the list of STDs. Infection can cause cervical cancer, half of the other oncology of the anogenital area, malignant neoplasms of the upper respiratory tract and skin.

HPV, according to statistics, fixed in 20-46% of women who are sexually active. The lower part of the genital tract is affected by the papillomavirus in approximately 20% of men who are not virgins. In the case of the genital transmission route, HPV triggers anogenital warts. These are mainly genital warts. If they are detected during the inspection, most often suspect HPV 6 or HPV 11 type.

The effect of 35 HPV is dysplasia and cancer of the genital organs, anus and larynx. Most papillomavirus cases are between 18 and 25 years old. After all, it is during this period that men and women enter into a phase of active sex life, experiment in bed, change partners, etc. After 30 years, HPV is less common, but at this age more cases of dysplasia and cervical cancer are detected. The peak of cervical cancer is 45 years.

It is important to know some facts about the epidemiology of the papillomavirus. There are many subclinical forms of the disease. This means that the symptoms are erased, because a person may not immediately see a doctor (which can have very sad consequences). Or the symptoms appear first, and then “subside,” and the person thinks that he has recovered from the illness that he had.

The incubation period (time from infection to the appearance of the clinic) can be 2-3 months or even 2-3 years. This adversely affects diagnostic and therapeutic options. It has already been noted above that HPV can be different in oncogenicity (the ability to provoke the development of cancer in the body):

• low oncogenic
• medium oncogenic
• high oncogenic

A relatively low chance of developing cancer in infected 6,11,42,43,44 HPV types. Medium carcinogenic viruses:

• 31 type
• 33 type
• 35 type
• 51 type
• 52 type
• 58 type

Highly oncogenic (the most dangerous) are considered to be 16.18, 45, and 56 types. Remember that there is a risk of infecting several of the above and other types of HPV at the same time. The papilloma virus DNA is prone to replication (cloning), and this occurs in the deep layer of the skin or mucous membrane. Because removing the warts from the skin is an ineffective method of treatment, they will grow back, because the virus has remained deeper.

In some cases, the DNA of the virus in question appears to be in a state of hibernation. If the organism is exposed to risk factors, the virus “wakes up” and leads to the development of pathology. These factors may be:

• imbalance of hormones in the body
• smoking
• genital diseases, mainly genital herpes (provoked by HSV-2)

The virus can penetrate the human body through the genitals, if there were bacterial microdamages, mechanical traumatization (for example, using tampons, active sexual intercourse or epilation of the genitals). Moreover, as noted above, for infection is not required contact of the sperm with the genitals. The virus can be in another secret, in other secretions of a sick person.

With genital warts, symptoms may appear after 2 months or a few years, and the symptoms will not be very pronounced. In the presence of high oncogenic HPV, cancer develops over a period of 5-30 years. But in very rare cases, cancer appears in just a year. There can be many foci of infection on the genitals of an infected person. If in parallel there are pathogens of other STDs in the body, the diagnosis becomes more complicated.

Genital HPV infection is considered highly contagious. This means that 1-3 contacts with the patient will suffice for infection. In 60% of cases, a person becomes infected when he has the first intimate relationship with an infection carrier. More than 65% of warts caused by papillomavirus occur in two people who are sleeping with each other.

The risks of genital HPV increase with active sex life:

• homosexual orientation regardless of gender
• many sexual partners (simultaneously and over the years)
• early deprivation of virginity
• numerous sexual experiments
• sexual intercourse with an unfamiliar person
• treason your permanent sexual partner

Doctors discover multiple papillomas (warts), which tend to merge, if the patient has diagnoses such as diabetes or immunosuppression.

HPV in pregnant women and babies

Infected HPV pregnant women are more likely to transmit the disease to their baby when it is still in the mother’s stomach. Infection is also possible when passing through the genital tract of a woman.

HPV 6, 11, 16, 18 types can be in the baby’s mouth for years (who has been infected by an infected pregnant mother). There he does not multiply much, but he becomes a provocateur of the juvenile papillomatosis of the larynx. This disease can occur if the mother once had genital warts (even if they were cured), as well as with genital papillomavirus, which passes in a latent or semi-developed form. With a caesarean section, the child still risks getting infected from the mother.

In a pregnant woman, you can find a virus in the genital tract, which is called in the medical literature, pregnant thrush. At that time, the fetus becomes infected. Clinical cases indicate that the infection can be transmitted to the fetus through the placenta (cases of caesarean sinus in mothers with HPV have been investigated).

Children may become infected:

• through the towels used by sick adults
• when bathing with a sick person in one bath or one pool
• during sexual intercourse with a sick adult

If the pregnant woman’s immunity is strong, she will not become infected during the process of carrying the child. The virus can get into her body, but will be removed from it, without provoking the development of symptoms. The same can be said about non-pregnant women who are under 30 years old. In many countries, women over the age of 30 have screening programs for the early detection of HPV, which at this age can cause cancer at high risk.

Features of papillomavirus in the human body

A high risk of infection with HPV (without removing it from the body in a natural way) is for those who have inflammation in the cervix in various diseases. HPV changes its local defenses, it is easier for it to infiltrate the genitals, because they are affected by inflammation. Injured cervix during abortion, which is also a fertile ground for papillomavirus.

In countries with a Muslim religion, fewer women are infected with the papillomavirus (respectively, and there are fewer cases of cervical cancer). This is due to the peculiarities of hygiene, which lies in their traditions, and lesser sexual promiscuity than in democratic countries. Those countries where active implementation of special screening programs is practiced are also characterized by a rather low incidence of HPV.

We can talk about the onset of pathology when the papilloma virus begins embedding into the chromosomal apparatus of the cell, because there it will multiply. Dysplasia of the cervical epithelial layer develops. If this is not treated, then the situation threatens to develop a cancerous condition.

Screening

Screening tests play a huge role in preventing the development of genital cancer (cervix). In our country, they are not as common as in industrialized countries. In Finland and Switzerland, literally in 10 years, the incidence due to timely screening was reduced by 40-60%. The period between preventive examinations can be 1-5 years. From the cervix and cervical canal take material for research, doing cytological examination. Doctors also identify carriers of HPV, which allows, inter alia, to prevent unwanted infection of the sexual partners of the carrier.

Over the past few years, research tactics have changed. It used to be considered obligatory to reveal HPV of a high oncogenic type. But this tactic today is considered harmful. The explanation is that in order to integrate into the cervical genome (which leads to the development of oncological processes), it must be present in a fairly large number (10 * 5 viral copies per 1 ml of material sample from the patient). Doctors agree that if the virus is smaller, it will be eliminated from the body without consequences. Therefore, the detection of pre-threshold concentration of the virus can lead to terrible psychological consequences for the patient. It is worth noting that not all doctors are aware of such a development of medical thought in this matter.

In connection with the above, it is not strange that in many countries, qualitative virus detection tests are a thing of the past. Their place was taken by quantitative. In our country, for example, unfortunately, the Digine test is not used, which is a fairly significant quantitative study. We have a common colposcopy, which allows you to identify changes at the cellular level of the cervix. But in other countries, colposcopy is not part of the screening programs, because the equipment is very expensive, and doctors must take special training courses.

Treatment

If the papillomavirus carriage is found, take into account the patient’s age (we wrote about his role above) and the results of cytology. If cytology shows the first type, but you have a carrier of the virus, then you do not need special medication. In such cases, should be examined 2 times a year, along with cytology. Do not be afraid and know that at a young age there is a very big chance of the papillomavirus excreting itself from the body.

In cases where HPV is detected in humans, as well as cervical pathology using colposcopy or cytology, it is necessary to be treated. The only exceptions are pregnant women and puberty patients (and not always, but only with minor changes in the cervix).

Developed and actively used radical method of therapy for the prevention of cervical cancer. This excision of the modified zone with a radio wave or high-temperature electric knife. Even general anesthesia is not needed for this, patients are given local. But in some cases, the doctor may talk about the need for short-term intravenous (general) anesthesia. The area that was dissected during the operation should be examined histologically.

In some cases, before or after this operation, the doctor prescribes interferon preparations to the patient. They stimulate local defenses, as well as accelerate the excretion of the virus, help the wounded site to heal. Such drugs are in the form of vaginal tablets or suppositories. The consequences of the operation may be in women who want to get pregnant. This may be cervical insufficiency: the muscles of the uterine throat can not normally hold the ovum. The result is a miscarriage. There may also be problems with cervical dilatation during labor.

The above operation can be replaced by the destruction of the patient area with a cryosurgery method or a carbon dioxide laser. Thanks to these methods, the tissue is injured to a lesser extent. Therefore, in the future, a woman can give birth normally. But with this method, researching a remote area is impossible, because there is a risk of a fatal error. Be sure to do a biopsy to avoid mistakes. It is carried out before the operation. If benign, but not malignant changes are identified, then further therapy is gentle.

The sexual partner is not necessarily treated. The exceptions are cases when a partner is found warts on the genitals. They need to chemically destroy or excise. For this there are special medical procedures.

Even if a sick woman has undergone surgical treatment, the disease can return. This happens if, after surgery, the patient did not adhere to the rules that the attending physician told her about. If you continue to change sexual partners after surgery and stop using condoms, the risk of infection increases. And the treatment becomes even more expensive and long.

In recent years, preventive measures have been developed to prevent persistence and replication of papillomavirus in the body. In 2005, clinical trials of a preventive vaccine against 6.11, 16, 18 types of HPV were completed, and in many countries of the world it can be purchased. This vaccine is used by some countries in the state programs for the prevention of the pathology in question.

Infection of HPV through this vaccine is not possible. It is obtained by genetic engineering. This means that the vaccine contains no virus particles in any form (neither living nor killed). This preventive measure helps for several years. Is it worth repeating it – the issue has not yet been resolved by doctors, there is no consensus. Studies were conducted on girls 9-17 and 18-26 years old, because the vaccine is used only from them.

You have been screened. What’s next?

• If the gynecologist did not find any changes in your cervix, and the cytology does not show pathology, and additional research says that you do not have HPV, then the doctor should be re-consulted for the purpose of prevention and early warning after 12 months
• If the cytology is normal, the cervix is ​​unchanged, but tests have found the papillomavirus, then it is necessary to pass the test for the virus again and to undergo cytological examination after half a year; treatment in such cases is not prescribed
• If you have HPV, as well as mild cytological changes, your doctor will do a colposcopy; if the method showed no pathology, after half a year you need to be examined again
• If you have HPV, as well as mild cytological changes, and colposcopy confirmed the diagnosis, or the doctor has doubts, then they do a biopsy to see if there is a lesion and what degree of it is
• If you have a papillomavirus, and there is a slight dysplasia, and you are still not giving birth to a woman / girl, then you need to be observed for six months; if the disease does not regress, then resort to surgical methods of therapy
• If you have a papillomavirus, and moderate or severe cervical dysplasia, then you should urgently prescribe the surgery mentioned above
• If a person is a carrier of papillomavirus and also has mild or moderate dysplasia, and is pregnant or adolescent, most likely the doctor will prescribe interferons topically and monitor

Today there are no drugs for HPV. It is important to strengthen the immunity of a sick person, stimulants for the production of interferons, interferons, immunomodulators are used for treatment, antiviral preparations of a wide spectrum are used. The treatment regimen in each case is different, and its design is based on the results of research and analysis. Because in no case do not resort to self-healing!

Remember that you can have not only the papillomavirus, but also cytomegalovirus, recurrent herpes, etc. The doctor may order an immunological examination. You may need to restore the body’s defenses. Difficult situations are considered the combination of HPV infection and candidiasis, genital herpes or chlamydia. This increases significantly the risk of complications.