Human papillomavirus (HPV)
- Etiology of papillomavirus
- Risk factors provoking the development of HPV
- Pathways of transmission of papillomavirus
- Stages of the infectious process
- Infections that cause papillomavirus
- Human papillomavirus: symptoms
- HPV and pregnancy
- HPV Diagnosis
- HPV: treatment
Papilloma, or papillary fibroepithelioma - is a benign skin neoplasm of a viral nature, consisting of a connective tissue stroma covered with epithelium, permeated with a variety of blood vessels. This formation is presented in the form of papillae protruding outwards, growing in different directions and resembling the color of cauliflower by their appearance. A condition in which a person is exposed to a lot of papillomas is called papillomatosis.
According to the nature of the epithelium, the papillary polyp is squamous (covered with a flat, multilayered, non-coring epithelium) and a transitional cell (covered with a transitional epithelium). At the same time, the connective tissue stroma can be dense or loose, sometimes with characteristic signs of inflammation. The condition, in which the stroma of the papillary polyp is highly developed and sclerotized, is diagnosed as fibropapilloma.
Skin papillomas are characterized by a significant hyperkeratosis (increased thickening of the epidermis), while in formations developing on mucous membranes, the keratinization is less pronounced.
Etiology of papillomavirus
Human papillomavirus (HPV) belongs to the family of papoviruses, subgroup A. It is a small, thermostable causative agent that survives well in the environment and transfers heat treatment. He is devoid of supercapsid, and his capsid (the envelope that protects the viral genome from external influences) consists of 72 capsomers. The virus slowly multiplies and is not found in the blood.
Papillomavirus is an etiotropic pathogen, that is, it is capable of affecting a multilayer flat keratinized and non-coronary epithelium (skin and mucous membranes), as well as a cylindrical epithelium lining the lungs, the cervical canal and the prostate.
Penetrating into the organism of its host, the virus, spreading through the bloodstream, is fixed on the epithelial cells, is implanted in the DNA and forces them to work differently. The virus infected cell is intensively growing and dividing, and as a result, after some time, a characteristic growth occurs on the affected area.
At the moment, science has data on more than 120 serotypes of the virus, 35 of which affect the cover epithelium and mucous membranes. Some HPV serotypes can cause the development of oncopathologies. Depending on the ability to provoke cancer, they are divided into 2 main groups: HPV of low and high oncogenic risk.
Note: oncogeneity is the ability of the papillomavirus to induce the degeneration of the infected basement epithelium into cancer.
6, 11, 42-44 and 73 types of HPV are considered to be viruses of low oncogenic risk. And 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, 68 are types of papillomavirus, which are considered dangerous, that is, under certain conditions they are capable of provoking the development of malignant process . The most unfavorable, according to experts, are 16 and 18 types that cause squamous cell carcinoma and adenocarcinoma.
Risk factors provoking the development of the PIU
In the first place, according to experts, there are features of sexual behavior and sexual orientation of a person. This includes the early sexual life, the frequent change of sexual partners, disregard for personal protective equipment. However, many authors argue that almost always PVI is associated with STDs (trichomoniasis, chlamydia, myco-and ureoplasmosis, as well as genital herpes).
Most often, the disease is detected at a young age (between 18 and 30 years). However, at the same time, self-healing (the phenomenon of elimination) can occur, reaching 70%. At the same time, the malignancy of PVI occurs most often at the age of 45-50 years.
Pathways of transmission of papillomavirus
HPV is an infectious agent that affects and transforms the basal cells of the epidermis. As a consequence, they begin to divide, forming a papillary polyp, or papilloma (Papilla in translation from Latin means a nipple, oma in translation from the Greek - a tumor).
Transmission of infection occurs when in contact with infected people or animals that have obvious signs of the disease, as well as with virus carriers that do not have clinical manifestations of the disease.
Entrance gates for the introduction of infection are various microtraumas of the skin. Infection often occurs in places of greatest concentration of people, especially where the air is sufficiently moist (in gyms, baths and swimming pools).
Also very often people suffering from papillomavirus infection who cut meat, poultry and fish (wings of butchers).
Genital warts, which are popularly called genital warts, are transmitted through traditional sexual intercourse, as well as oral or anal sex.
Infection of newborns can occur during passage through the birth canal of an infected mother. However, there are data on intrauterine infection with the virus, which is proved by the birth of infected children by caesarean section.
Also, the airborne pathway of transmission of infection from the patient to the medical staff during surgical intervention (laser vaporization or radio-wave coagulation) is not excluded.
However, in clinical practice, there is another type of spread of HPV - self-infection (autoinoculation). So, after hair removal or shaving, flat warts can appear on the chin, cheeks or on the lower legs, and people who have nails gnawing often have warts in the perihotic region.
Stages of the infectious process
- Primary infection.
- Persistence (ability to long-term survival) of the viral genome outside chromosomes with the production of viral particles.
- Integration (interpenetration) of viral DNA into the genome of the host cell.
- Mutations in the cellular DNA, which cause instability of the genome.
- Integration of viral DNA into the "master" chromosome.
- The emergence of a clone of cells with mutated DNA and tumor formation.
Science has proven that papillomavirus infection can exist in the body in two forms:
In the first case, the virus lives and multiplies, but its DNA is not embedded in the host's cellular genome.
In the second case, after infection and penetration into the host cell, the viral DNA is inserted into the cellular genome, and, as a consequence, triggers the tumor process.
Infections that cause papillomavirus (from a wart to cancer)
HPV can selectively affect the basal epithelium of skin and mucous membranes, causing the appearance of warts, genital warts and other characteristic benign and malignant formations. However, very often the infectious process can take place in an asymptomatic form.
Until recently, papillomavirus infection related to benign diseases. However, to date, it is considered one of the most serious pathologies that are sexually transmitted.
More often, the development of the pathological process is caused by non-oncogenic types of the virus, and the skin lesions that arise in this case are rather perceived as a cosmetic defect. However, with human papillomavirus infection 16, 18, 31, 33, 35, 39, 45, 52, 55, 56 and 58 types, moderate or severe cervical dysplasia, noninvasive and invasive cancers of the female genitalia (vulva, vagina , cervix), rectum and penis.
Symptoms and forms of HPV
With the development of papillomavirus infection, the incubation period usually lasts 2-3 months. However, in some cases it may contract or increase. At the same time, HPV is able to be in the human body from its very birth, but because of the high stability of the immune system, many people do not suspect its existence, and only if the immunity decreases, the virus can manifest itself.
According to statistics, more than 85% of the world population is infected with papillomavirus, therefore, its presence in the body is more expected than absence.
When a virus enters the body, it can behave differently, that is, manifested as various types of benign formations on the skin and mucous membranes. That is why in clinical practice several forms of PVI are considered:
- Clinical, or manifested form. It develops during transient disorders of the cellular immunity (for example, in pregnancy), in HIV-infected patients and in persons with genetically limited specific HPV immunity.
- Subclinical form of papillomatosis is revealed in immunocompetent persons.
- A latent or latent form that occurs in the absence of symptoms is observed when viral DNA penetrates into the cellular genome.
What is a wart?
The wart is the most common and frequent symptom of papillomavirus infection. It is a dense convex formation of a rounded shape with clearly defined boundaries, reaching 1 cm in diameter. The wart is characterized by a rough uneven surface, and its color can vary from beige to black. Most often these formations are localized on the hands, fingers, elbows and knees. It should be noted that they are easily traumatized.
What is papilloma?
Papillomas are soft round warts that can appear on the most varied areas of the skin (on the face, in the mouth, on the arms and legs, under the arms, in the neck and neck area, and on the genitals). They are light brown, pearly, white or pink single rounded, tubercular, dense formations on the pedicel, reaching a height of 1 cm. At the same time, they are able to grow rapidly and occupy a considerable area of the skin. Papillomaviruses are quite amenable to treatment, and over time, in 20% of cases, they are able to disappear on their own. At the same time, the risk of developing a malignant tumor is low, and the neoplasm, most likely, remains a simple cosmetic defect.
What is condyloma?
Condyloma is a benign neoplasm on the short leg, which causes HPV types 6 and 11. According to many authors, it is the condylomas that can regenerate into cancer tumors. Most often they are localized in the urogenital area, near the mouth or near the anus. In this case, papillary polyps are presented in the form of a rash, which consists of many elements and has a characteristic property for fusion. Very often on the mucous membrane of the genital organs it becomes like a cock's comb. For this form of pathology, provoked by HPV, characterized by rapid growth. One of its consequences is the appearance of the Bushek-Levenshtein tumor, which is huge and can grow both outside and inside tissues.
The color of condyloma varies from red to dirty-brown, but, at the same time, in the genital area these formations can be more light. To the touch they are softer and more gentle than the papillomas and outwardly resemble a lot of villi, fused at the base.
In clinical practice, there are three types of genital warts: peaked, intraepithelial (with characteristic endophytic growth inside) and flat. All of them, according to experts, should be urgently removed.
When papillary growth occurs, exudate accumulates between them, their surface moistens, becomes shiny and painful, and unpleasant odor, maceration, infiltration and swelling may appear. As a rule, genital warts occur in the places of greatest friction and traumatization occurring during sexual intercourse.
With deeper damage to the urethra, the patients develop symptoms of urethritis (burning, discomfort during urination, pain in the genital area and in the lower abdomen). In the case when giant peaked condylomas appear in patients, they lead to complete destruction of tissues, very often ulcerate, which in turn leads to the development of secondary infection.
Flat condyloma is a barely noticeable growth, localized on the walls of the vagina or on the cervix uterus. Because of their inconspicuousness, flat warts are very poorly diagnosed, but, at the same time, they provoke the development of a number of unpleasant symptoms. This is the occurrence of heavy vaginal discharge, as well as blood discharge after sexual contact and itching in the urogenital area.
In men, these formations can occur on the penis and in the urethra. Most often, they do not rise above the skin surface, and therefore are also almost invisible, however, they are able to deliver to the wearer a certain discomfort, burning and itching.
HPV and pregnancy
In pregnant women infected with papillomavirus, external condylomas can reach gigantic proportions, and in this situation the percentage of development of various clinical manifestations of the disease becomes much higher. However, after the birth of a child, self-healing may occur. This situation is explained by changes in the hormonal background of a woman, increased vascularization of tissues (the formation of new blood vessels), a violation of the microbiocenosis of the vagina, and, most likely, an effect on the functional activity of the cells of the immune system.
All women planning to become pregnant, experts recommend a comprehensive examination to detect HPV infection. In the presence of one of the degrees of dysplasia of the cervix or other clinical forms of the disease, a pregnant woman is prescribed anti-inflammatory and antiviral therapy.
However, the latent form of papillomavirus infection is not considered a contraindication for pregnancy.
Treatment of IVI should be carried out in the first trimester of pregnancy. During the same period, the existing exophytic condylomas should be removed, since at later dates, their rapid growth may occur, leading to various complications of pregnancy and childbirth. At the same time, in the presence of genital warts, a child passing through infected birth can get infected with papillomatosis of the larynx.
Diagnostics of PVI
In recent years, medicine has made significant progress in diagnosing PVI. This became possible due to the systematization of data on HPV and diseases associated with it, the study of all existing routes of infection, many mechanisms of the pathogenesis of the infectious process and the state of the immune system, as well as possible morphological changes.
There are several ways to diagnose papillomavirus infection, and in this case, experts adhere to the generally accepted algorithms:
- Without fail, sexually active women and men are subject to screening for HPV.
- HIV-infected patients and those with symptoms of sexually transmitted diseases should also be examined.
- People with proven risk factors for PVI.
- Patients with pointed papillomas in the oral cavity and in the anogenital region.
- Patients suffering from various pathologies of the cervix.
- Couples planning a pregnancy.
The main diagnostic methods of PVI
- Visual inspection of lesions.
- Use magnifier and colposcope.
- Cytological methods of research.
- Molecular biological methods.
- Histological (pathomorphological) study.
All patients being examined for the presence of PVI are simultaneously examined for syphilis , hepatitis and HIV, smears are taken for the bacterioscopic examination of the separated urethra, vagina and cervix, and PCR and bacteriological testing for urogenital infections are prescribed.
As a rule, the detection of papillomavirus does not cause difficulties: the infection is detected with standard examinations at a gynecologist or dermatologist. With the appropriate symptomatology, a targeted biopsy is performed. In the case when flat condylomas, localized in the anogenetic region, are detected in the patient to prevent the development of malignant diseases, serotypes of human papillomavirus with an oncogenic marker are tested.
Необходимо подчеркнуть, что удаление папиллом не следует считать полным излечением от папилломавирусной инфекции, так как в данном случае человек не перестает быть вирусоносителем, то есть, в течение нескольких лет сосочковые полипы могут появиться снова. Именно поэтому в целях профилактики медики рекомендуют проводить оздоровление всего организма в целом.
В том случае, когда у человека обнаруживается папилломавирус, лечение назначается не всегда, а только при необходимости, то есть, при наличии характерной симптоматики. Успех в лечении ВПЧ достигается только тогда, когда пациенту будет назначена адекватная противовирусная и иммуномодулирующая терапия. В клинической практике применяется несколько методов удаления папиллом и кондилом:
1. Криодеструкция, или удаление новообразований жидким азотом.
2. Лазерное лечение.
3. Радиоволновой метод.
Сегодня большинство специалистов рекомендуют своим пациентам удалять сосочковые полипы при помощи лазера или радиоволнового ножа. Данные методики обеспечивают полную стерильность выполняемой процедуры, а также позволяют добиться максимального эстетического результата, то есть, после их применения на теле пациентов не остаются рубцов и шрамов.
Что касается процедуры лазерного удаления формирований, то помимо непревзойденной точности, лазерный луч прекрасно дезинфицирует рану, а также оказывает регенерирующее действие на кожу, то есть, стимулирует процессы заживления. Это идеальная методика, прекрасно себя зарекомендовавшая в гинекологии при лечении папилломатоза наружных половых органов, а также с её помощью удаляются кожные и слизистые новообразования, спровоцированные ВПЧ у мужчин.
Чаще всего после удаления сосочкового полипа иссеченный материал направляется в гистологическую лабораторию для проведения диагностического исследования.
4. Всем пациентам, подвергнутым ликвидации папиллом, показана иммуномоделирующая терапия, позволяющая закрепить полученный результат. С её помощью снижается активность вируса, а также осуществляется профилактика возникновения новых проявлений ВПЧ.
5. Очень часто при лечении палломавирусной инфекции назначаются препараты интерферона (средства белковой природы, усиливающего иммунную защиту организма от вирусных инфекций).
6. Ozone therapy is not bad. This is an innovative technique that involves setting up ozone droppers that strengthen immunity and inhibit viral activity. In this case, a normal saline solution saturated with gas, which retains its properties for 20 minutes after saturation, is used. Ozone droppers, which have an antiviral effect, saturate tissues and organs with oxygen, restore the cellular composition of the affected tissues, remove toxins and improve the overall well-being of the patient. After such treatment, all manifestations of PVI disappear for 5 or even 10 years.
In the case of HPV treatment of high oncogenic risk, the patient must necessarily consult an oncologist and undergo a cytological examination.
7. All patients after treatment are prescribed drugs that accelerate the healing of skin.
Note: only after smooth healing of the skin, the therapy is considered successful.
Treatment of PVI anogenital zone
If anterior genital warts are found in the anogenital area, the following measures are taken during treatment:
Destructive intervention aimed at destroying papillary polyps and removing the altered epithelium;
Immunomodulating and immunostimulating therapy;
The purpose of antiviral drugs that affect the replication, transcription and transformation of viral DNA;
The use of cytotoxic drugs damaging or destroying the multiplying virus-infected cells;
Symptomatic treatment and treatment of concomitant pathologies.
Note: Currently, some specialists carry out photodynamic therapy, which involves the use of photosensitizers (photosensitive substances). However, such treatment in general practice has not yet found its application. Also, there is one more technique that is at the stage of clinical trials. It is called preventive and therapeutic vaccination.
When detecting exophytic condylomas and in the presence of a typical clinical picture of papillomatosis, patients are prescribed combined treatment with subsequent removal of tumors. A few days before surgery, immunomodulators, interferons and antitumor agents are treated. However, it should be noted that this method, according to most experts, does not have a pronounced therapeutic effect.
At the same time, some patients try to get rid of papillary polyps with the help of chemical preparations. I would like to emphasize that such a technique is ineffective, and requires repeated exposure, and also leads to the formation of scar tissue.
Subclinical, that is not visible to the naked eye, manifestations of PVI are treated in the same way as exophytic forms, however, the physician should have a full understanding of the volume of the tissues infected with the virus. Otherwise it will be more reasonable to conduct dynamic observation and use of local immunotherapy.
With the latent form of papillomavirus infection, treatment is usually not performed, since in this case, expensive drug therapy is ineffective, and yet, very often within 1-2 years, the viruses are self-healing (more often in young women and men).
However, sometimes the latent form of PVI (in 10-15% of cases) turns into subclinical. As a rule, some unfavorable factors contribute to this, as well as infectious and inflammatory processes developing in the anogenital area or in another zone of injury. With the weakening of the body's immune forces and the development of chronic endocrine diseases, the PVI can go into a manifest form.
Most often, the predictions for this disease are positive, however, in some cases, after the removal of papillary polyps, relapses may occur, as well as relapses that turn into malignant forms. That is why all immunosuppressive persons within two years are recommended dynamic observation, monitoring of the immune status, as well as regular colposcopy followed by cytological studies. In each case, the treatment of PVI is administered individually, taking into account the patient's age, immune status, localization of the pathological process, the nature of the changes in the cervical canal, and concomitant urogenital infections and somatic chronic pathologies.
Prevention of PVI
According to experts, only the prevention of HPV can reduce the risk of cervical cancer and penile cancer. To date, the following preventive methods are used:
- Primary prophylaxis of papillomavirus infection. It provides for the timely identification of risk factors and prevention of the spread of infection, and also includes the development of preventive vaccines and other methods of preventing the development of papillomatosis.
- The section of secondary prevention is screening diagnostics, that is, a comprehensive medical examination of the human body, which allows to identify the disease at the earliest stages of its development.
- Tertiary prevention of PID provides a reduction in the frequency of recurrence of the disease in previously infected individuals.
At the same time, an important preventive aspect is the use of sanitation to explain the aspects of the disease among the population, in particular among adolescents who are just beginning to live sexually.
A very simple, but at the same time, effective way to prevent HPV infection is the use of barrier methods of contraception and a preliminary examination of couples planning to have sexual intercourse.
According to many experts, preventive vaccination against human papillomavirus is also an effective method of primary prevention (especially if the vaccine is introduced before the onset of sexual activity).
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