Human papilloma virus (HPV) is an extremely common sexually transmitted infection in the world.
The peculiarity of this infection is that it may not manifest itself for years, but eventually lead to the development of benign (papillomas) or malignant (cervical cancer) diseases of the genital organs.
Types of human papilloma virus
More than 100 types of HPV are known. Types are distinctive "subtypes" of viruses that differ from each other. Types are indicated by the numbers assigned to them as they are detected.
The group of high oncogenic risk consists of 14 types: 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, 68 (these types are associated with the development of cervical cancer).
In addition, low oncogenic risk types are known (mostly 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 genital organs. 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 the following articles, we will discuss the types of "high-risk" and "low-risk" HPV separately.
Human papilloma virus infection
The virus is transmitted mainly through sexual contact. Almost all women become infected with HPV sooner or later: up to 90% of sexually active women will experience this infection during their lifetime.
But there is good news: most infected people (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 completely get rid of the virus. In such a situation, HPV will not cause any harm to the body.That is, if HPV was discovered some time ago and it is not now, it is absolutely normal!
It must be borne in mind that the immune system in different people works at "different speeds". In this regard, the rate of HPV release may be different for sexual partners. Therefore, it is possible that HPV is detected in one of the partners and notat another.
Most people become infected with HPV soon after becoming sexually active, and many will never know they are infected with HPV. After the infection, permanent immunity is not formed, so re-infection is possible with the same virus that has already been encountered, as well as with other types of viruses.
"High risk" HPV is dangerous because it can lead to the development of cervical cancer and some other types of cancer. High-risk HPV does not cause other problems.
HPV does not cause inflammation of the vaginal / cervical mucosa, menstrual irregularities or infertility.
HPV does not affect the ability to conceive and bear a pregnancy.
High-risk HPV is not transmitted during pregnancy and childbirth.
Diagnosis of human papilloma virus
It is practically pointless to do an HPV test for high oncogenic risk before the age of 25 (except for those women who start sexual activity early (before the age of 18)), because at this moment there is a high probability that a virus will be detected that will soon leave the body alone.
After 25-30 years, it makes sense to do an analysis:
- together with cytological analysis (PAP - test). If there are changes in the PAP test, and HPV is "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 HPV testing in the prevention of cervical cancer has been shown to be higher than the sensitivity of cytology, and therefore only the determination of HPV (without cytology) has been approved as a stand-alone study for the prevention of cervical cancer. in the United States. However, in our country, an annual cytological examination is recommended, so the combination of these two studies seems reasonable;
- after treatment of dysplasia / precancer / cervical cancer (absence of HPV in the analysis after treatment almost always indicates successful treatment).
For the study, it is necessary to take a swab from the cervical canal (it is possible to study the material from the vagina, however, as part of the screening, it is recommended to take material from the cervix).
The analysis must be given:
- 1 time per year (if "high risk" HPV has been detected earlier, and the analysis is given together with the cytological examination);
- 1 time in 5 years if the previous analysis was negative.
It is almost never necessary to do an analysis for low-risk HPV. If there is no papilloma, then this analysis does not make sense in principle (transmission of the virus is possible, there is no treatment for the virus, so it is not known what to do with the result of the analysis).
If there are papillomas, then:
- they are most commonly caused by HPV;
- must be deleted regardless of whether we found types 6/11 or not;
- if we take a swab, then directly from the papillomas themselves, not from the vagina / cervix.
There are tests to detect different types of HPV. If you are periodically tested for HPV, pay attention to which specific types are included in the analysis. Some laboratories work only on types 16 and 18, others - on all types together. It is also possible to make a test that will identify all 14 types of "high risk" viruses in quantitative format. Quantitative characteristics are important for predicting the likelihood of developing precancerous lesions and cervical cancer. These tests should be used in the context of cervical cancer prevention, not as a stand-alone test. Analysis for HPV without cytological results (PAP test) usually does not allow making any conclusions about the patient's health condition.
There is no such analysis that will determine whether the virus will "go away" in a certain patient or not.
Treatment of human papilloma virus
There is no medical treatment for HPV. There are treatments for conditions caused by HPV (papillomas, dysplasia, precancerous lesions, cervical cancer).
This treatment should be reported by surgical methods (cryocoagulation, laser, radio knife).
No "immunostimulants" are associated with HPV treatment and should not be used. None of our well-known drugs has passed adequate tests to 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 the tactics of HPV treatment. You can read more about those situations when it is necessary to treat erosion in the article "Erosion or not erosion? ".
If the patient has no complaints and no papillomas / changes in the cervix during colposcopy and according to the PAP test, no medical procedures are required.
It is only necessary to repeat 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 does not go away, it will not necessarily 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 papilloma virus infection
Vaccines that protect against HPV types 16 and 18 have been developed (one of the vaccines also protects against types 6 and 11). HPV types 16 and 18 are responsible for 70% of cervical cancers, 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 provides 100% protection is abstinence from sexual intercourse. I am not campaigning for him in any way, I am just giving food for thought.