Human papillomavirus (HPV) is an extremely common sexually transmitted infection in the world.
The peculiarity of this infection is that it can not manifest itself for many years, but eventually leads 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. Species are distinctive "subspecies" of a virus that differ from each other. Species are indicated by numbers assigned to them when discovered.
The high oncogenic risk group consists 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).
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 mucous membrane of the vulva, vagina, perianal region, on the skin of the genitals. They are almost never malignant, but cause significant cosmetic defects in the genital area. Warts on other parts of the body (hands, feet, face) can also be caused by such viruses or have a different origin. In our next articles, we will discuss the "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 with HPV sooner or later: Up to 90% of sexually active women will experience the infection in their lifetime.
But there is good news: Most of those infected (about 90%) will clear HPV within two years without any medical intervention.
This is the normal course of the infectious process that HPV causes in the human body. This time is sufficient for the human immune system to completely get rid of the virus. In such a case, HPV does not cause any harm to the body.So, if HPV was detected a while ago and not detected now, that's perfectly normal!
It should be noted that the immune system works "at different speeds" in different people. In this regard, the rate of getting rid of HPV for sexual partners may be different. Therefore, a situation is possible when HPV is detected in one of the partners and not in the other.
Most people become infected with HPV shortly after becoming sexually active, and many never know they have been infected with HPV. Permanent immunity does not occur after infection, so it is possible to be re-infected both with the same virus that was encountered before, and 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 mucous membrane of the vagina/cervix, menstrual irregularities or infertility.
HPV does not affect the ability to conceive and maintain a pregnancy.
A "high-risk" HPV baby is not transmitted during pregnancy and delivery.
Diagnosis of human papillomavirus
HPV testing for high oncogenic risk before the age of 25 (except for women who start sexual activity early (before 18 years old)) is practically pointless, since at this time it is very likely to detect a virus that will be soon. leave the body alone.
After 25 - 30 years it makes sense to make an analysis:
- together with a cytology analysis (PAP - test). If there are changes in the PAP - test and HPV "high risk", this requires special attention;
- The long-term persistence of "high-risk" HPV in the absence of cytological changes also warrants attention. Recently, the sensitivity of HPV testing in cervical cancer prevention has been shown to be higher than the sensitivity of cytology, and therefore the determination of HPV alone (without cytology) has been approved as an independent study for cervical cancer prevention. in the United States. However, annual cytological examination is recommended in our country, so it seems reasonable to do these two studies together;
- after treatment of dysplasia / pre-cancerous / cervical cancer (absence of HPV in the analysis after treatment almost always indicates successful treatment).
For the study, it is necessary to take a smear from the cervical canal (examination of the material from the vagina is possible, but it is recommended to take the material from the cervix as part of the scan).
Analysis should be given:
- 1 time per year (if "high-risk" HPV was previously detected and the analysis was accompanied by cytological examination);
- 1 time in 5 years if the previous analysis was negative.
Analysis for HPV with low oncogenic risk is hardly necessary. If there are no papillomas, this analysis does not make sense in principle (it is possible to carry the virus, there is no cure for the virus, so it is not known what to do next with the analysis result).
If there are papillomas, then:
- most often they are caused by HPV;
- Whether we find the 6/11 types or not, they must be deleted;
- if we take a smear, not from the vagina / cervix, but directly from the papillomas themselves.
There are tests to detect different types of HPV. If you get tested for HPV periodically, pay attention to which specific strains are included in the analysis. Some laboratories do research on types 16 and 18 only, while others do research on all types together. It is also possible to take a test that will quantitatively identify all 14 types of "high-risk" viruses. Quantitative features are important for estimating the probability of developing precancerous and cervical cancer. These tests should be used in the context of cervical cancer prevention and not as a standalone test. HPV analysis (PAP test) without cytology results often does not allow any conclusions to be drawn about the patient's health status.
There is no such analysis to determine whether the virus in a particular patient will "go away".
human papilloma virus treatment
There is no medical cure for HPV. There are treatments for conditions caused by HPV (papillomas, dysplasia, precancerous, cervical cancer).
This treatment should be performed by surgical methods (cryocoagulation, laser, radioknife).
There are no "immunostimulants" associated with HPV treatment and should not be used. None of the widely known drugs in our country have undergone adequate tests to show 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 the tactics of HPV treatment. You can read more about situations in which erosion treatment is required in the article "Erosion or not erosion? ".
If the patient does not have any complaints, if there is no papilloma/change in the cervix during colposcopy and according to the PAP test, no medical procedure is required.
It is necessary to repeat the analysis only 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 pass, it is not strictly necessary for it to lead to the development of cervical cancer, but control is necessary.
Treatment of sexual partners is not necessary (except when 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, so protection against them is very important. Routine vaccination is practiced in 45 countries around the world.
Condom (does not provide 100% protection).
The only method that provides 100% protection is abstaining from sexual intercourse. I'm not campaigning for it in any way, I'm just giving food for thought.