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 special "subspecies" of viruses that differ from each other. Types are identified by the numbers assigned to them when they were detected.
The group with high oncogenic risk consists of 14 types: 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, 68 (these species are associated with the development of cervical cancer).
In addition, species with a 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, perianal area, 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 (arms, legs, face) can also be caused by these types of viruses or have different origins. In the following articles, we will discuss HPV "high risk" and "low risk" separately.
Human papillomavirus 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 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 is enough for the human immune system to completely get rid of the virus. In this situation, HPV will not harm the body.That is, if HPV was detected some time ago and it is not now, it is absolutely normal!
It should be borne in mind that the immune system works in different people at "different speeds". In this regard, the rate of HPV elimination may be different for sexual partners. not with the other.
Most people become infected with HPV shortly after becoming sexually active and many will never know they have been infected with HPV. Permanent immunity is not formed after infection, so re-infection with both the same virus that has already been encountered and other types of virus is possible.
"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 inflammation of the lining of the vagina / cervix, menstrual irregularities or infertility.
HPV does not affect the ability to conceive and conceive.
High-risk babies do not get HPV during pregnancy and childbirth.
Diagnosis of human papillomavirus
It is practically pointless to test for HPV for high oncogenic risk before the age of 25 (except for those women who start sexual activity early (before the age of 18)), as the virus is very likely to be detected at that time. which will soon leave the body alone.
After 25 - 30 years it makes sense to make an analysis:
- together with 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 HPV tests for the prevention of cervical cancer has been shown to be higher than the sensitivity of cytology, and therefore the determination of HPV alone (without cytology) has been approved as a stand-alone study for the prevention of cervical cancer in the United States. In our country, however, an annual cytological examination is recommended, so the combination of these two examinations seems reasonable;
- after treatment of dysplasia / precancer / cervical cancer (the absence of HPV in the analysis after treatment almost always indicates successful treatment).
For the examination it is necessary to take a smear from the cervical canal (it is possible to examine the material from the vagina, but as part of the screening it is recommended to obtain the material from the cervix).
The analysis must be given:
- Once a year (if "high-risk" HPV has been detected before and the analysis is given together with a cytological examination);
- Once every 5 years, if the previous analysis was negative.
It is almost never necessary to test for HPV with low oncogenic risk. If there are no papillomas, then this analysis does not make sense in principle (transmission of the virus is possible, there is no cure for the virus, so what to do next with the result of the analysis is not known).
If there are papillomas, then:
- most often they are caused by HPV;
- they must be deleted, whether we find types 6/11 or not;
- if we take a smear, it is 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, note which specific species are included in the analysis. Some laboratories perform tests only on types 16 and 18, others on all types together. It is also possible to perform a test that will identify all 14 types of "high risk" virus in quantitative format. Quantitative characteristics are important in predicting the likelihood of developing precancerous 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) often does not allow conclusions to be drawn about the patient's health.
There is no such analysis to determine whether a virus in a particular patient will "leave" or not.
Treatment of human papillomavirus
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 performed using surgical methods (cryocoagulation, laser, radio knife).
No "immunostimulants" are associated with the treatment of HPV and should not be used. None of the widely known drugs in our country has passed adequate tests to show their effectiveness and safety. None of the protocols / standards / recommendations includethese drugs.
The presence or absence of "erosion" of the cervix does not affect the tactics of HPV treatment. You can read more about these 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 re-analyze 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 does not necessarily lead to the development of cervical cancer, but control is needed.
Treatment of sexual partners is not required (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 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.