Human papillomavirus (HPV) is an extremely common sexually transmitted infection worldwide.
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
Over 100 types of HPV are known. Types are particular "subspecies" of a virus that differ from each other. Types are designated by numbers assigned to them as they were discovered.
The high oncogenic risk group includes 14 types: 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, 68 (these types are linked to the development of cervical cancer). 'uterus).
In addition, types with low oncogenic risk are known (mainly 6 and 11). They lead to the formation of anogenital warts (genital warts, papillomas). Papillomas are located on the mucous membrane of the vulva, vagina, in the perianal region, on the skin of the genitals. They almost never become malignant, but 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 have a different origin. In subsequent articles, we will discuss "high-risk" and "low-risk" types of HPV separately.
Human papillomavirus infection
The virus is mainly transmitted through sexual contact. Almost all women are infected sooner or later with HPV: up to 90% of sexually active women will experience this infection during their lifetime.
But there is good news: the majority of people 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 is enough for the human immune system to get rid of the virus completely. In such a situation, HPV will not cause any harm to the body.In other words, if HPV was detected a while ago, and now it's not, that's completely normal!
It should be kept in mind that the immune system works in different people at "different speeds". In this respect, 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 does not form after infection, so it is possible to reinfect both with the same virus that has already been encountered, and with other types of viruses.
"High-risk" HPV is dangerous because it can lead to the development of cervical cancer and certain other types of cancer. "High-risk" HPV does not cause any other problems.
HPV does not lead to the development of inflammation of the mucous membrane of the vagina / cervix, menstrual irregularities or infertility.
HPV does not affect the ability to conceive and carry a pregnancy.
A "high risk" HPV baby is not transmitted during pregnancy and delivery.
Diagnosis of human papillomavirus
It is practically useless to do a high oncogenic risk HPV test before the age of 25 (except for women who begin sexual activity early (before age 18)), because at that time it is very likelyto detect a virus that will soon leave the body on its own.
After 25-30 years, it makes sense to do an analysis:
- as well as a cytological analysis (PAP - test). If there are changes in the PAP test and the "high risk" of HPV, 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 HPV testing in the prevention of cervical cancer has been shown to be superior to the sensitivity of cytology. Therefore, HPV determination alone (without cytology) is approved as a stand-alone study for the prevention of cervical cancer. in the USA. However, in our country, an annual cytological examination is recommended, so a combination of these two studies seems reasonable;
- after treatment for cervical dysplasia/precancer/cancer (absence of HPV in post-treatment analysis almost always indicates successful treatment).
For the study, it is necessary to obtain a smear from the cervical canal (it is possible to study material from the vagina, however, as part of screening, it is recommended to obtain material from the cervix).
The analysis must be given:
- 1 time per year (if a "high risk" HPV has already been detected and the analysis is carried out at the same time as a cytological examination);
- 1 time in 5 years if the previous analysis was negative.
It is almost never necessary to do an analysis for HPV with low oncogenic risk. If there are no papillomas, this analysis does not make sense in principle (carrying the virus is possible, there is no treatment for the virus, so what to do next with the result of the lanalysis is unknown).
If there are papillomas, then:
- most often they are caused by HPV;
- they should be removed whether or not we find 6/11 types;
- if we take a smear, then directly from the papillomas themselves, and not from the vagina / cervix.
There are tests to detect different types of HPV. If you are regularly tested for HPV, pay attention to the specific types included in the scan. Some laboratories research only types 16 and 18, others - all types together. It is also possible to take a test that will identify the 14 "high risk" virus types in a quantitative format. Quantitative characteristics are important in predicting the likelihood of developing precancer and cervical cancer. These tests should be used as part of cervical cancer prevention and not as a standalone test. HPV analysis without cytology results (PAP test) most often does not allow any conclusions to be drawn about the patient's state of health.
There is no such analysis that will determine whether the virus in a particular patient will "go away" or not.
Human papillomavirus treatment
There is no medical treatment for HPV. There are treatments for conditions caused by HPV (papillomas, dysplasia, precancer, cervical cancer).
This treatment must be carried out by surgical means (cryocoagulation, laser, radioknife).
No "immunostimulants" are related to HPV treatment and should not be used. None of the widely known drugs in our country have passed adequate tests that would show their effectiveness 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 it is necessary to treat erosion 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 procedure is needed.
It is enough to repeat the analysis once a year and monitor the condition of the cervix (annual PAP test, colposcopy). In most patients, the virus "leaves" the body on its own. If it does not disappear, it is not at all necessary for it 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 to 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 protect 100%).
The only method that offers 100% protection is abstinence from sex. In no way am I campaigning for him, just giving food for thought.