Papillomavirus: clinical manifestations, transmission routes, as well as diagnostic and treatment methods

HPV - Human Papilloma Virus HPV is one of the most common diseases.

According to the World Health Organization, half of the sexually active population of the planet suffers from it, but according to other authors, this figure is much higher and is about 80%.

Problems of diagnosis and treatment of pathologies associated with HPV infection attract the attention of researchers all countries, since today it has been clearly proven that the papillomavirus is closely associated with the development of cervical cancer uterus.

In addition, now doctors admit the influence of HPV on cancer of the prostate, larynx and rectum. The first mention of the papillomavirus was relatively recent - in 1977 and 1979.

To date, more than a hundred HPV genotypes are known, of which about 40 can become a potential cause of the oncological process.

No wonder in 2008 the Nobel Prize in Physiology or Medicine was awarded to Harald zur Hausen "for the discovery of human papillomaviruses that cause cervical cancer." According to a complex classification system, the papillomavirus belongs to the Papovaviridae family, which, in addition to HPV, includes polyomaviruses and vacuolating viruses. However, in medical virology, HPV occupies a special place, therefore, in the latest guidelines, they distinguish into a separate family Papillomaviridae, which includes 5 genera, 27 species and more than 170 strains.

It is characterized by species-specificity, in other words, the disease is transmitted only from person to person. The virion is devoid of a shell, its diameter is 40-55 nm. The genome is represented by a circular double-stranded DNA molecule. Despite its small size, the structure of the causative agent of human papillomavirus infection is very complex.

It consists of:

• three oncogenes E 5 - 7, which are involved in the transformation of the host cells;
• two regulatory proteins E1 and E2 that affect viral transcription;
• two structural proteins L1 and L2, which form the outer shell of the virion.

The papillomavirus belongs to the group of oncogenic viruses, since it is capable of disrupting cell differentiation and provoke rapid proliferation (division) of structural units of the epithelium of the skin and mucous membranes shells.

Outwardly, this manifests itself in the form of various warts and papillomas, as well as dysplasia, which can transform into a cancerous tumor. Currently, it is reliably known that the papillomavirus has a stable and mutation-free genome, therefore it became possible to create a vaccine that prevents a healthy person from becoming infected with HPV.

Skin warts (common, flat and plantar), which everyone recognizes without a photo, more often occur in adolescents and can remain unchanged for many years. The danger is posed by genital genital warts, which affect the mucous membranes of the vagina and cervix in women and the skin of the penis in men.

The causes of HPV infection are:

• Sexual contact with an infected person. Papillomavirus is the most common sexually transmitted disease and does not affect only the genitals, but also the perianal region, and after orogenital contact - the oral mucosa cavity.
• Through damaged skin in contact with contaminated objects, especially in a humid environment. This often happens in swimming pools, gyms, shared changing rooms, etc. In the same way, the virus is transferred from towels and linen between family members.
• From an infected mother to a child. The exact transmission mechanism has not yet been clarified. Most doctors are inclined to think that this happens when there are foci of HPV in the vagina and on the cervix. But intrauterine infection through the placenta is also possible, which depends on the type of virus. Therefore, a positive blood test for papillomavirus is not an indication for a caesarean section.
• Self-infection, when the causative agent of the disease is transferred from one part of the body to others, for example, while shaving, using an epilator, etc.

Once in the body, HPV does not always lead to symptoms of the disease. According to the survey conducted on the basis of the Belarusian Medical Academy, after diagnostic screening for papillomavirus, a latent infection proceeding without any external signs was found in 65% patients.

The predisposing factors that contribute to the development of HPV symptoms are:

• high sexual activity, promiscuous sexual intercourse, both own and a partner, especially contact with a woman with cervical cancer or a person with anogenital warts;
• early onset of sexual activity, gynecologists say that before 17-18 years, the mucous membrane covering the cervix and cervical canal has insufficient immune activity, which promotes the introduction virion into a healthy cell, in addition, sexual intercourse at an early age is often accompanied by microtrauma of the cervix and mucous membranes of the genital paths;
• the presence of other sexually transmitted diseases;
• smoking;
• excessive alcohol consumption;
• weakening of immunity during pregnancy;
• avitaminosis;
• inflammatory diseases affecting the cervix;
• immunodeficiency when taking cytostatics and other drugs similar in action for the treatment of, for example, autoimmune diseases;
• adolescence, since children are more susceptible to the action of the pathogen.

Given that the papillomavirus is very common and dangerous with consequences, HPV diagnostics must be carried out regularly, starting with 18-20 years old, this is especially important at the stage of pregnancy planning. Currently, the treatment of the disease is possible with the help of injections and tablets of immunostimulants and antiviral drugs, especially drug therapy effective in the initial stages of the course of the infection.

Papilloma virus: main varieties, stages of infection

All the variety of the HPV pathogen is subdivided into genera, designated by the Greek letters α, β, γ, etc., species and types, which are defined by Arabic numerals.

For example, papillomavirus can be indicated as follows: α1, genotype 61.

Most of the virions infecting the mucous membrane of the anogenital area are type α.

Depending on the type of changes that occur in the body, several forms of HPV are distinguished:

• HPV genotypes 1-4, 7, 10, 41, as well as some others, closely related in structure, cause only benign skin changes like warts;
• HPV 6 and 11, 42-44 characterized by slow progression, they are also called papilloma virus with low cancer risk, they usually cause the formation of genital warts and respiratory papillomatosis;
• HPV 13 and 32 are the causative agents of Heck's disease, the main symptom of which is the formation of volumetric growths on the oral mucosa;
• HPV 16, 18, 31, 33, 35, 39, 41, 45, 51, 52, 56, 58, 59 are defined as viruses with high carcinogenicity risk, they are associated with the occurrence of precancerous and tumor changes in the epithelium of the area around the genital organs. Papilloma virus type 16 is more common in squamous cell carcinoma, and type 18 in glandular cancer. According to the St. Petersburg Research Institute of Epidemiology and Microbiology. Pasteur, high-risk HPV is detected in 99.7% of patients with cancer of the cervix, vagina, vulva, as well as in men with cancer of the penis and anal region.

Depending on the clinical picture caused by the papilloma virus, several options for the course of the infectious process are possible:

• The first stage, it is also called latent. At this stage, there are no external manifestations of the disease, a lot of HPV can remain in this state years and be detected during random diagnostics, and only the data of the study by the method are informative PCR.
• The second stage, the stage in the development of clinical symptoms as a result of the influence of the virion on the cell. The range of effective diagnostic tests is expanding, in addition, specific signs of HPV are clearly visible on the body or mucous membranes.
• The third stage, the stage of dysplasia. It is characteristic of carcinogenic changes in the structure of the cell.
• The fourth stage, the stage of carcinoma formation, in other words, the malignant transformation of the cell.

The prognosis of the disease caused by the papilloma virus depends on the properties of the virion itself. If it enters the cell and is incorporated into human DNA, malignant formation cannot be avoided. But in some cases, HPV does not affect the genome of the infected cell, then the infection acquires recurrent course, but it is quite amenable to therapy, although this requires high prices medications.

Human papillomavirus: the main clinical manifestations, the influence of HPV on the course of pregnancy and diagnostic methods

The disease can occur in several ways. A pronounced form of HPV implies the presence of certain clinical symptoms, subclinical is accompanied by periodic manifestations of signs of the disease, latent proceeds latently and may not appear at all throughout human life.

The most common symptom that characterizes the human papillomavirus is the appearance of warts.

Their localization can be different, but most often they are located on areas of the skin prone to injury and microcracks. These are the sole, hands, palms.

No less common are papillomas, which are small growths that are attached to the skin by a thin bridge. They can form anywhere - on the neck, face, armpits, etc. However, HPV infection of both low and high carcinogenic risk, can lead to the formation of genital warts in the labia, vaginal mucosa, cervix, skin around the anus.

In men, similar formations also occur near the anus and on the penis. Warts are somewhat similar to papillomas, but they spread quickly and are located next to each other. The human papilloma, which is located in the genital area and anus, is usually sexually transmitted. Moreover, the risk of infection is almost 80% even with a single sexual contact with an infected partner.

The virus disappears on its own within 9-15 months from the date of ingestion. However, in the presence of certain risk factors, the oncogenic human papillomavirus causes the transformation of healthy cells and the development of a tumor. On average, this process can take up to 20 years.

In women, HPV localized in the genital area is characterized by the following manifestations:

• due to the peculiarities of the bacterial flora of the vagina, a mucous secret with an unpleasant specific odor accumulates under the genital warts;
• itching worries;
• in case of accidental injury during hygiene procedures or sexual contact, pain appears, damage to the warts is accompanied by slight bleeding.

In men, papilloma is characterized by the formation of fused warts on the scrotum, under the head and on the frenulum of the penis. Skin growths are not dense to the touch, however, during sexual intercourse, their constant friction causes severe discomfort. The growth of condyloma around the anus is often accompanied by pain and itching, since this area is constantly susceptible to microtrauma during bowel movements and subsequent hygiene procedures.

In addition, unconventional sex can lead to pain and bleeding, which increases the risk of contracting other sexually transmitted diseases, especially HIV. Infection of young children occurs either during childbirth, or when using common hygiene items with infected parents (towels, washcloths, etc.).

In addition to warts and papillomas of various localization, damage to the mucous membranes of the oral cavity, conjunctiva and upper respiratory tract is possible. In this case, the human papillomavirus causes the formation of the so-called laryngeal warts. With weakened immunity, especially in newborns, they spread to the lower respiratory tract, which can even cause asphyxia.

In girls with papillomavirus infection from age 3-4 weeks to 7-8 years, with any vulvovaginitis and vaginal dysbiosis, a tendency to pronounced inflammation is noted.

In this case, the affected area is very extensive and often passes into the perineal area, inguinal and femoral folds. Erosion sometimes occurs.

Such manifestations are associated with the immaturity of the mechanisms of local immunity, which is aggravated by violation of hygiene rules (too frequent or, conversely, insufficient washing, the use of unsuitable gels and soaps for these purposes, poor rinsing of the underwear after washing, excessive wrapping and etc.).

As a rule, papilloma does not affect either the course of pregnancy or the intrauterine development of the fetus. At least to date, doctors have not identified any connection between congenital pathologies in a child and HPV. In accordance with the protocols developed in gynecology, any woman, when registering with the clinic takes a smear from the vagina for infections, and during the examination, the doctor pays attention to the presence genital warts.

Currently, there are many ways to prevent and treat HPV. These are a variety of tablets and injections, antiviral drugs are also produced in the form of rectal suppositories, antibiotics are used to eliminate the concomitant bacterial inflammation of the genital organs.

Considering the possible side effects of such therapy, homeopathy and homeopathy and homeopathic preparations based on a variety of herbs are equally popular. But before deciding on the method of treating papillomavirus, it is necessary not only to confirm its presence by laboratory methods, but also to carry out genotyping, that is, to determine what type the detected HPV belongs to and evaluate it cancer risk.

There are several methods for diagnosing an infection:

• Visual examination of the cervix in combination with a specific test with 3-5% acetic acid and Lugol's solution.
• Cytological examination with an assessment of the results according to the Papanicolaou classification, according to which 5 classes are distinguished. The first two indicate the absence of HPV, changes corresponding to the third class require re-diagnosis or the use of additional examination methods, the fourth class is characterized by the presence of individual cells with signs of malignant transformation, the fifth class implies the presence in the analyzed sample of a large number atypical cells. In this case, the diagnosis of a malignant tumor is practically beyond doubt.
• Colposcopy and biopsy of the tissues of the cervix and cervical canal are necessary to clarify the cytological picture.
• Polymerase chain reaction (PCR) is the most reliable diagnostic method even if the human papillomavirus is latent, since the presence of virion DNA is determined during the analysis. Blood for this study is not taken, since the localization of symptoms of infection outside the genital area usually indicates a benign course of the disease. Therefore, tissue obtained from urogenital scraping is used as a material for PCR.

As a rule, with a positive result for papillomavirus, additional tests are performed to determining the cause of the disease, since the clinical manifestation of infection usually indicates immunodeficiency.

How to treat HPV: the main methods of drug therapy, clinical manifestations of infection

The papillomavirus can be accompanied by a variety of symptoms, ranging from completely harmless warts to cancer. How HPV is treated depends on the external manifestations of the infection.

For example, vulgar warts are found in more than half of patients with papillomavirus. The predominant places of their localization are hands, although such formations can appear on any part of the body, including mucous membranes.

Plantar warts are also common, but they usually form on the heels and metatarsal area of ​​the foot, which are the places that are exposed to the most pressure while walking. The same factor leads to the growth of warts (also called Spitz) inward, which distinguishes them from vulgar warts or genital papillomas. Flat warts usually form on the face, neck, arms, and legs.

They, as a rule, do not protrude above the surface of the skin, their size varies from 2 to 5 mm, color - from flesh to red and brown. A variety of genital warts account for the smallest percentage of cases. Treatment for papillomavirus depends on the results of a cytological examination. The size of genital warts ranges from small formations to bulky.

The manifestations of rare bowenoid papulosis and Bowen's disease are characterized by visible lesions of the skin and mucous membranes, usually in men. Rough growths of irregular shape appear. In some cases, the symptoms go away on their own. Epidermolysplasia warty often occurs during adolescence, accompanied by numerous rashes that resemble ordinary flat warts in appearance.

When infected with HPV types 5, 8 and 47, there is a high risk of developing skin cancer. Giant condyloma Buschke-Levenstein occurs in isolated cases. It is characterized by aggressive growth of the formation deep into the underlying structures of the dermis, but rarely causes the transformation of cells into malignant ones.

Cervical cancer is a very common disease, according to domestic statistics, only in Russia every year from pathology, 20 women die, and as indicated by the WHO, 500,000 new cases of such oncological defeat.

More than 70% of pathology is caused by HPV types 16 and 18. Cancer of the vulva and vagina occurs with HPV genotypes 16 and 18 (in 36% and 58% of patients, respectively). The cause of every 10 cases of pathology becomes HPV types 6 and 11, which are considered low oncogenic.

Anal cancer is one and a half times more common in women than in men. Experts believe that in most cases, the infection is transmitted through anal sex, although other routes of infection are possible.

HPV types 16 and 18 are found in 75% of patients with this disease. According to WHO estimates, penile cancer accounts for almost 0.5% of all cancer pathologies in men. In 38% of cases, it is associated with HPV 16 and 18 genotypes, 5% - HPV 6 and 11 types. As for the question of how to treat papillomavirus, combination therapy is considered the most effective. Removal of the formations caused by HPV is carried out by chemical and physical methods.

In the first case, treatment with acids, formaldehyde, antimetabolites, etc. is used. Mechanical removal, cryotherapy, laser and electrosurgery also give good results. Local applications of interferons and their inducers (in the form of ointments) have a therapeutic effect. As a systemic therapy, antiviral and immunomodulatory drugs are prescribed. These are, for example, Groprinosin, Cycloferon and other medicines similar in action.

How to treat the papilloma virus: folk remedies, prevention methods and vaccination

Many people suffering from HPV manifestations postpone the removal of papillomas all the time. However, if the lesions are localized in the neck, abdomen and other places where there is a risk of damage by items of clothing, it is better to remove them under medical supervision.

However, there are recipes on how to treat the papilloma virus on the forums devoted to alternative therapy:

• Peel and cut a clove of garlic. Apply to affected skin areas. After a few minutes, a burning sensation will appear, you should keep the garlic until the discomfort disappears.
• Add 100 g to half a liter of 70% alcohol. dry herb celandine, insist for two weeks and drink 20 drops three times a day half an hour before meals. At the same time, lubricate the foci of manifestation of the disease with fresh juice of this plant. For the treatment of young children or for the treatment of mucous membranes, a decoction is used (2 tablespoons per glass of water).
• A decoction of eucalyptus leaves has a good antiviral effect. A tablespoon of plant materials is poured with half a liter of water, brought to a boil and tormented 3-5 minutes. You need to drink immediately after cooling in small sips approximately 2-3 tbsp several times a day without straining.
• Also, a tincture of sabelnik is taken inside at the rate of 100 g. dry plant per 1 liter. vodka. Drink a tablespoon three times a day on an empty stomach. To stop the infectious process, it is necessary to carry out a full course of treatment (3 times a month with a week break).

To date, doctors offer specific conservative methods for the prevention of HPV, with special attention paid to genotypes 16 and 18. Since papillomavirus cannot be obtained in cell cultures in sufficient quantities, genetically engineered preparations of the L1 protein are used to create modern vaccines.

They are similar to the HPV capsid, but do not contain viral DNA, therefore they are devoid of infectiousness. There are now two prophylactic vaccines on the market. Bivalent Cervarix contains the L1 protein of the two most carcinogenic types 16 and 18.

The tetravalent Gardasil vaccine includes the HPV 16/18/6/11 genotype protein. Vaccination is carried out intramuscularly three times for six months. The greatest effect was achieved when using vaccinations in girls aged 9-15 years old. The drugs are harmless; from side effects, an increase in body temperature was noted.

How effective the vaccination of women and men of mature age is today is not reliably known due to the lack of accumulated clinical experience. The main method of HPV prevention is the careful choice of sexual partners, since even the use of condoms, and even more so other means of contraception, does not protect against the disease. Women and men of sexual maturity are advised to undergo regular screening for HPV and, if necessary, decide with a doctor how to treat human papillomavirus infection.