Human papillomavirus (HPV) is an extremely common sexually transmitted infection in the world.
The peculiarity of this infection is that it may not manifest itself for many years, but eventually lead to the development of benign (papilloma) or malignant (cervical cancer) diseases of the genital organs.
Types of human papillomavirus
More than 100 types of HPV are known. Types are peculiar "subspecies" of a virus that differ from one another. Types are designated by numbers assigned to them as they were discovered.
The high oncogenic risk group is composed of 14 types: 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, 68 (these types are related to the development of cervical cancer of the uterus).
In addition, low oncogenic risk types are known (mainly 6 and 11). They lead to the formation of anogenital warts (genital warts, papillomas). Papillomas are located on the mucosa of the vulva, vagina, in the perianal region, on the skin of Organs genitals. They almost never become malignant, but they lead to significant cosmetic defects in the genital area. Warts on other parts of the body (hands, feet, face) can also be caused by these types of viruses, or they can have a different origin. In upcoming articles, we will discuss "high-risk" and "low-risk" HPV types separately.
Human papillomavirus infection
The virus is mainly transmitted through sexual contact. Almost all women are infected with HPV sooner or later: up to 90% of sexually active women will have this infection in their lifetime.
But there is good news: the majority of those infected (about 90%) will get rid of HPV without any medical intervention within two years.
This is the normal course of the infectious process caused by HPV in the human body. This time it is enough for the human immune system to completely get rid of the virus. In such a situation, HPV will not bring any harm to the body.That is, if HPV was detected some time ago, and now it is not, this is absolutely normal!
It should be borne in mind that the immune system works in different people at "different speeds". In this sense, the speed of HPV elimination may be different for sexual partners. Therefore, a situation is possible when HPV is detected in one of the partners and not in the other.
Most people are infected with HPV soon after becoming sexually active, and many will never know they have been infected with HPV. Permanent immunity is not formed after infection, so it is possible to reinfect with either the same virus that has already been found or with other types of viruses.
"High-risk" HPV is dangerous because it can lead to the development of cervical cancer and some other cancers. "High-risk" HPV does not cause other problems.
HPV does not lead to the development of inflammation in the mucous membrane of the vagina/cervix, menstrual irregularities or infertility.
HPV does not affect the ability to conceive and become pregnant.
A "high-risk" HPV baby is not transmitted during pregnancy and delivery.
Diagnosis of human papillomavirus
It is practically useless to take a high-risk oncogenic HPV test before the age of 25 (except for those women who initiate sexual activity early (before the age of 18)), as at this time it is very likely to detect a virus that soon leaves the body alone. .
After 25 to 30 years, it makes sense to do an analysis:
- together with a cytological analysis (PAP - test). If there are changes in the PAP - test, and HPV "high risk", then this situation requires special attention;
- the long-term persistence of "high-risk" HPV in the absence of cytological changes also deserves attention. Recently, the sensitivity of the HPV test in the prevention of cervical cancer has been shown to be greater than the sensitivity of cytology, and therefore, the determination of HPV alone (without cytology) is approved as a stand-alone study for the prevention of cervical cancer. uterus in the United States. However, in our country, annual cytological examination is recommended, so the combination of these two studies seems reasonable;
- after treatment of dysplasia/pre-cancer/cervical cancer (absence of HPV in the post-treatment analysis almost always indicates successful treatment).
For the study, it is necessary to obtain a smear of the cervical canal (it is possible to study material from the vagina, but as part of the screening it is recommended to obtain material from the cervix).
The analysis must be given:
- 1 time per year (if "high-risk" HPV was previously detected, and analysis is done in conjunction with a cytological examination);
- 1 time in 5 years if previous analysis was negative.
An analysis for low oncogenic risk HPV is almost never necessary. If there are no papillomas, then this analysis makes no sense in principle (the transport of the virus is possible, there is no treatment for the virus, so what to do next with the result of the analysis is unknown).
If there are papillomas, then:
- most of the time they are caused by HPV;
- they should be excluded whether or not we find 6/11 types;
- if we take a smear, directly from the papillomas themselves, and not from the vagina/cervix.
There are tests to detect different types of HPV. If you do periodic testing for HPV, pay attention to which specific types are included in the analysis. Some laboratories research only on types 16 and 18, others - on all types together. It is also possible to run a test that will identify all 14 types of "high risk" viruses in a quantitative format. Quantitative characteristics are important for predicting the likelihood of developing precancer and cervical cancer. These tests should be used in the context of cervical cancer prevention and not as a standalone test. The analysis of HPV without cytology results (PAP test) most of the time does not allow to draw conclusions about the health status of the patient.
There is no such analysis that will determine whether the virus in a given patient will "come out" or not.
Treatment of human papillomavirus
There is no medical treatment for HPV. There are treatments for conditions caused by HPV (papillomas, dysplasia, pre-cancer, cervical cancer).
This treatment must be performed by surgical methods (cryocoagulation, laser, radioknife).
No "immunostimulants" are related to the treatment of HPV and should not be used. None of the drugs that are widely known in our country have undergone adequate tests to prove their efficacy and safety. None of the protocols/standards/recommendations include these drugs.
The presence or absence of "erosion" of the cervix does not affect HPV treatment tactics. You can read more about these situations where erosion needs to be addressed in the article "Erosion or not erosion? ".
If the patient has no complaints, and there are no papillomas/changes on the cervix during the colposcopy and according to the PAP test, no medical procedures are required.
It is only necessary to redo the analysis once a year and monitor the condition of the cervix (annual PAP test, colposcopy). In most patients, the virus will "leave" the body on its own. If it doesn't go away, it doesn't have to lead to the development of cervical cancer, but control is necessary.
Treatment of sexual partners is not necessary (except in cases where both partners have genital papillomas).
Prevention of human papillomavirus infection
Vaccines have been developed that protect against HPV types 16 and 18 (one of the vaccines also protects against types 6 and 11). HPV types 16 and 18 are responsible for 70% of cervical cancer cases, which is why protection against them is so important. Routine vaccination is used in 45 countries around the world.
Condom (does not provide 100% protection).
The only method that offers 100% protection is abstinence from sexual intercourse. In no way am I campaigning for him, I'm just giving him food for thought.