Human papillomavirus is the most common cause of cervical cancer in women. However, HPV cannot be cured. Vaccination remains the only effective way to protect against infection.
What is HPV?
The human papillomavirus (HPV) is known to cause flat and pointed warts on the skin and mucous membranes. In medicine, such neoplasms are called papillomas and condylomas, respectively. But the most dangerous thing about HPV is that it is a common cause of cervical cancer.
Causes of HPV infection
HPV infection occurs through damaged mucous membranes and microcracks in the skin. It is a common misconception that the disease is only spread through sexual contact, but it can also be contracted through close contact with an infected person.HPV is distinguished by its high resistance to the action of antiseptics, not to mention soap, so it can be picked up even by shaking hands!
Important!There are several ways of transmitting HPV. You can become infected with this virus not only through unprotected sex, but also at home.
Methods of transmission of HPV:
- Sexual. This includes all types of sexual contact - vaginal, oral, anal.
- touch.The virus can be contracted through skin abrasions, abrasions, cuts and microtears - through handshakes, kisses and other close contact with sick people.
- During childbirth from mother to child.
It is thought that infection is often preceded by a weakened immune system caused by chronic illness, regular stress, hypothermia, lack of sleep, alcohol consumption, smoking and general fatigue.All this increases the risk of infection and the infection becoming chronic.
Important!Using a condom does not guarantee protection against HPV. The virus can be transmitted even through minor contact with skin or mucous membranes.
HPV is very common, with approximately 14 million people infected by it each year. During their lifetime, almost every sexually active unvaccinated person gets it, but very few people learn about the disease. Even if you took HPV tests and all of them were negative, there is still a chance that you became infected and cleared the virus between tests.
Is it possible to get infected with HPV again?
Unfortunately, yes. After exposure to the virus, lasting immunity does not develop, and infection from new sexual partners is quite likely. In addition, if you have been infected with one type of virus, you do not develop immunity against other types.
HPV types
There are many types of HPV, more than 200.They are usually classified based on their carcinogenic potential.All types of viruses are divided into three groups:
- Conditionally oncogenic HPV (safest),
- Average cancer risk HPV,
- HPV with high cancer risk (most dangerous).
High cancer-causing HPV types include only 15 viruses (types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68, 73 and 82), and types 16 and 18 are the most cancer-causing: accounting for about 70% of all cervical cancer cases – and they work.The rest are associated with cancer much less frequently.
Important!If you are infected with one of these "dangerous" viruses, it does not mean you will develop cancer.In most cases, our immune system defeats HPV within 1-2 years on average.Even if HPV persists in the body, precancerous lesions or cancers may never develop.
It should be understood that different types of HPV can affect different parts of the body.Not all of these are related to gynecology.For example, "cutaneous" viruses (types 1, 2, 3, 4, and 10) cause common or flat warts.In addition, not all viruses that affect the skin and mucous membranes of the genitals (penis, scrotum, perineal or anal area, vagina, vulva, or cervical mucosa) can cause cancer.Therefore, HPV types 6 and 11 cause genital warts in 90% of cases, but they do not cause cervical cancer.
stage of disease development
In most cases, HPV causes no symptoms or problems and the immune system clears it up after a few months.However, in 10-20% of women, HPV infection becomes chronic - the virus continues to live in the body and does not go away for a long time.In this case, HPV sooner or later causes cellular changes: dysplasia (precancerous changes) and then cervical cancer.
Important!If HPV is detected, don’t panic!It may disappear next time you check.Having a virus does not mean you are sick.If HPV persists in your body, get tested regularly, at least once a year.Viruses only pose a threat if they are not controlled.Dysplasia must be treated promptly to prevent it from developing into cancer.
This development of the disease is rare (infection leads to cell transformation in less than 1% of infected people), but it poses a real danger.
The duration of development of the disease in this case is individual. In some patients, the initial stage can last for years without leading to cancer. The likelihood of developing cancer increases with age. On average, 10–20 years pass from infection to the appearance of dysplasia (precancerous condition) and cervical cancer.
Symptoms
At the initial stage, a person, as a rule, does not know about his disease, but is contagious to others. HPV usually does not manifest at all, but some types can cause flat or pointed warts (papillomas or genital warts) on the skin and mucous membranes.Their appearance may occur several weeks or even months after infection.
The number and nature of tumors caused by HPV varies. In some patients everything is limited to the appearance of 1-2 small warts, while in others the number of affected areas and individual elements is quite large.Genital warts can be single or multiple, and have different shapes, from dome-shaped or linear to mushroom-shaped and plaque-shaped, with smooth or uneven surfaces.Some genital warts grow extensively, giving them some resemblance to cauliflower. The color of condylomas is usually white or flesh-colored, less often pink, red or brown.
Genital warts are benign formations and are not dangerous, but in many people they form complexes that cause increased anxiety and reduced quality of sex life.
In women, condylomas can form on the cervical mucosa. The growth of condylomas in the anus and urethra (or urethra) can make it difficult to go to the toilet. Sometimes condylomas can hurt or itch, and when injured, they can bleed.
diagnosis
The effectiveness of treatment and prevention of cancer development largely depends on the timely detection of high-oncogenic risk HPV. It is believed that all women over 25 years of age should be regularly diagnosed with HPV.
Which doctor should I contact?
If you are a woman and you do not have any symptoms or complaints, you still need to see a gynecologist once a year. Your doctor may order an HPV test as part of your general health check.
You should also consult a doctor if you find suspicious growths on your body. The choice of specialist will depend on the location of the warts or new moles. If you are concerned about the genital area and anus, it is advisable to make an appointment with a venereologist, urologist or gynecologist. Otherwise, a dermatologist will help you.
What tests should I take?
As part of a women's health screening, a Pap smear is usually performed and analyzed for the presence of high-risk HPV (co-test).
The PAP test (Papanicolaou smear) is familiar to most women. It is taken from the cervical canal, as well as its outer surface and from the vaginal vaults. This cytological study allows you to see the slightest changes in cells. To make it even more informative, they resort to HPV testing.
Important!When given a choice between “conventional” and “liquid-based” cytology, “liquid-based” should be selected. This method allows you to purify the sample and save a larger number of cells for study.
The HPV test is a vaginal smear. It is taken to find the DNA of “dangerous” viruses (types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68, 73 and 82). The amount of virus is not taken into account; the analysis can be either positive or negative.
If both tests are negative (no changes in cells, no HPV detected), the next scheduled examination can be carried out after 3 years. If the PAP test is negative, but HPV is detected, the patient is at risk. She is asked to have a colposcopy (examination of the inside of the vagina and cervix), a biopsy (removal of a small piece of biological material for further examination) if necessary, and regular examinations at least once a year.
Treatment begins only if cervical dysplasia is diagnosed based on the results of a PAP test and biopsy.
Do I need to look for HPV if I have genital warts?
If you find yourself with condylomas, you do not need examination. The appearance of warts in itself indicates infection with a virus. An analysis from the cervix or vagina will be unnecessary, but if necessary, you can take an analysis from the condylomas themselves.
HPV and pregnancy
Experts recommend that women planning pregnancy undergo a comprehensive examination to detect HPV infection. During pregnancy, a woman with HPV may develop genital warts or abnormal cellular changes in the cervix. They can be detected through routine screening.
The vaccine is not recommended for pregnant women. Research suggests it does not cause problems in babies born to women who were vaccinated during pregnancy, but more research is still needed. The expectant mother should not receive any doses of the HPV vaccine until after her pregnancy.
The risk of passing HPV to your baby during childbirth is very low. Even if infants become infected with human papillomavirus, their bodies usually clear the virus on their own.
treat
There is no effective treatment for HPV; only the manifestations of the disease can be treated. Women who are diagnosed with human papillomavirus should simply monitor the infection. In this case, you should take a PAP test (cytological smear) once a year. It will help prevent the development of cervical cancer.
Genital warts: to remove or not to remove?
Condylomas caused by HPV are usually simply monitored (in about half of the cases they disappear on their own), resorting to treatment only if there are unpleasant symptoms - itching, bleeding, burning or pain. Usually, for each patient, the doctor selects individual therapy for condylomas, which takes into account their character and the patient’s health characteristics. Such treatments may include:
- the use of local antitumor, cauterizing drugs or catechins - creams or solutions that are applied pointwise to condylomas (some of them are contraindicated during pregnancy),
- injections of interferons into condylomas (cannot be used during pregnancy),
- surgical treatment - removal, freezing or cauterization (under local anesthesia).
Surgery is usually recommended if the warts have grown significantly, are causing discomfort, are in the vagina, urethra, or around the anus, and do not respond to other types of treatment. Condylomas should be removed if the doctor has reason to believe that they can cause cancer (for example, they are combined with a precancerous skin condition).
It is useless to remove condylomas in order to protect your sexual partner from the virus, since the virus can remain in the body. Getting rid of warts also does not reduce the risk of developing cancer in the future. After removal of condylomas, there is always a chance that they will appear again.
local preparation
Among the local drugs that can be prescribed for the treatment of condylomas:
- Cauterizing agents and keratolytics (salicylic, acetic, lactic acids),
- Cytotoxic and cytostatic antitumor drugs,
- topical retinoic acid
- Catechins.
How HPV is NOT treated: immunomodulators and antiviral drugs
A positive test for HPV often becomes a reason to take various medications, despite the fact that this infection has no cure. The following will not help you against HPV:
- immunomodulators and any means “to enhance immunity”,
- Antiviral drugs.
HPV cannot be cured, you can only protect against it through vaccination.
predict
Once HPV is detected, the prognosis is generally favorable. Diagnosis of highly oncogenic types of HPV is not carried out for women under 25 years of age, since the virus is detected very often at a young age and just as often disappears over time. At an older age, a positive test for HPV is a reason to visit regularly a gynecologist and undergo additional examinations. Don't forget that having a virus is not a disease.
complication
Complications due to the human papillomavirus can be dangerous, but they can be avoided if the body is regularly examined for tumors.
genital warts
A small number of condylomas may not cause discomfort to a person, but their growth in some cases significantly affects the quality of life: sexual activity, psychological state. In addition, condylomas can:
- bleed
- Injury, causing burning sensation and itching,
- Obstructing going to the toilet,
- Interference during labor.
cervical cancer
The most common complication of HPV infection is cervical cancer.The risk of infection depends on the type of virus.We already know that doctors can identify the 15 most "dangerous" HPV types, and routine screening for women's health includes analyzing their presence in the body.
Additionally, HPV can cause other types of cancer that are much less common than cervical cancer.HPV types 16 and 18 are the leading causes of anal cancer.In contrast, cancers of the vulva, vagina, or penis are not always associated with HPV (the same goes for oropharyngeal cancer).
HPV is often associated with problems not caused by HPV:
- HPV does not cause infertility,
- HPV is not a cause of inflammatory disease of the cervix and vagina,
- HPV does not disrupt the menstrual cycle;
- HPV does not cause miscarriage or missed pregnancies,
- HPV often causes cancer but is not spread during pregnancy and childbirth; if HPV is present, natural birth is allowed.
disease prevention
Considering that HPV has no cure, the importance of preventing infection cannot be underestimated.
How not to get infected
First, you need to improve your body’s defense level.If you have bad habits, it's best to quit them, or at least significantly reduce your alcohol and tobacco intake.Girls should also avoid using oral contraceptive pills, which can also predispose them to the disease.
Physical activity, proper balanced nutrition and the use of vitamin complexes help strengthen the immune system.Add variety to your diet by adding more vegetables and fruits.Not only are they rich in vitamins, they also improve intestinal motility and help remove internal toxins from the body that weaken the immune system.
An important point in preventing HPV is to be selective in your partner choices.Healthy monogamous relationships exclude sexual transmission.The task of parents is to educate their children about sex.Using condoms and refusing sex with someone who has HPV can reduce your risk.
Vaccination
The most effective protection against HPV is vaccination.Today, HPV vaccination is an integral part of vaccination programs in most developed countries around the world.First, it concerns girls under 18 who have not yet begun sexual activity.Since HPV infection usually occurs during first sexual contact, the ideal age for girls to be vaccinated is 12-14 years.If an adult woman plans to change sexual partners, it makes sense to get vaccinated.Vaccination will help prevent infection by new viruses.
Boys also need to be vaccinated.Not only does it help reduce the spread of infection, it can also prevent genital warts.
The HPV vaccine protects against many types of viruses:
- Bivalent vaccine - against the most dangerous types 16 and 18,
- Quadrivalent vaccine - against viruses 6, 11, 16 and 18,
- Nine-valent vaccine – against viruses 6, 11, 16, 18, 31, 33, 45, 52 and 58.
The vaccination schedule depends on age.For children and adolescents under 15 years of age, the vaccine is given in two doses, 6-12 months apart; in adults, three doses are given (schedule 0, 1-2, 6 months).No additional revaccination is required; the effects of vaccination last for at least 10 years.
Important!The HPV vaccine is very safe and does not contain live viruses.Adverse reactions after vaccination include: redness at the injection site, headache, dizziness, and nausea.The HPV vaccine does not affect fertility and does not cause infertility.
in conclusion
Infections caused by human papillomavirus usually do not manifest themselves in any way and may go undetected for the rest of life.Many patients only become aware of the infection when characteristic warts appear on the skin or mucous membranes.The main danger of HPV is the risk of cancer, which women are more likely to develop than men.All women over the age of 25 are recommended to be regularly screened for the presence of the virus and have a Pap smear test.