The 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 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. Types are peculiar "subspecies" of a virus that differ from each other. The types are designated by the numbers that were assigned to them when they were 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 uterine).
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 found on the mucosa of the vulva, vagina, in the perianal region, on the skin of the genital organs. They almost never become malignant, but they do cause significant cosmetic defects in the genital area. Warts on other parts of the body (hands, feet, face) can also be caused by this type of virus or they can have a different origin. In later articles, we'll discuss "high-risk" and "low-risk" HPV types 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 infected people (about 90%) will be free 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 detected a while ago and now it is not, it is absolutely normal!
Keep in mind that the immune system works at "different speeds" in different people. 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 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, therefore it is possible to re-infect both with the same virus that has already been found, 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 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 carry a pregnancy.
A baby with "high-risk" HPV is not transmitted during pregnancy and delivery.
Diagnosis of human papillomavirus
There is practically no point in having a high-risk oncogenic HPV test before the age of 25 (except for those women who start sexual activity early (before the age of 18)), since at this time it is very likely that detect a virus that will soon disappear. leave the body alone.
After 25 to 30 years, it makes sense to do an analysis:
- together with a cytology analysis (PAP - test). If there are changes in the "high risk" PAP and HPV test, then this situation requires special attention;
- the long-term persistence of "high-risk" HPV in the absence of cytologic changes also deserves attention. Recently, the sensitivity of HPV testing in the prevention of cervical cancer has been shown to be greater than the sensitivity of cytology, and therefore HPV testing alone (without cytology) is approved as a stand-alone test for the prevention of cervical cancer. in the U. S. However, in our country an annual cytological examination is recommended, so a combination of these two studies seems reasonable;
- after treatment for dysplasia/precancer/cancer of the cervix (the absence of HPV in the post-treatment test almost always indicates successful treatment).
For the study, it is necessary to obtain a smear from the cervical canal (it is possible to study the material from the vagina, however, as part of the screening, it is recommended to obtain the material from the cervix).
The analysis must be given:
- 1 time a year (if "high-risk" HPV was previously detected and the analysis is carried out together with a cytological examination);
- 1 time in 5 years if the previous analysis was negative.
Testing for low-risk oncogenic HPV is almost never necessary. If there are no papillomas, then this analysis does not make sense in principle (it is possible that the virus is a carrier, 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 removed regardless of whether we find types 6/11 or not;
- 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 get tested for HPV regularly, pay attention to the specific types that are included in the test. Some laboratories investigate only types 16 and 18, others, all types together. It is also possible to run a test that will identify the 14 "high risk" virus types in a quantitative format. Quantitative characteristics are important in predicting the probability of developing cervical precancer and cancer. These tests should be used in the context of cervical cancer prevention and not as a stand-alone test. HPV analysis without cytology results (Pap smear) in most cases does not allow any conclusions to be drawn about the patient's state of health.
There is no such test 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 performed using surgical methods (cryocoagulation, laser, radio knife).
No "immunostimulants" are related to the treatment of HPV and should not be used. None of the widely known drugs in our country have passed 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 the tactics of HPV treatment. You can read more about those situations in which 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 colposcopy and according to the Pap smear, no medical procedures are needed.
It is only necessary to take up the analysis once a year and monitor the condition of the cervix (annually Pap smear, 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 monitoring is necessary.
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 cancer cases, which is why it is so important to protect against them. 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'm in no way campaigning for him, I'm just giving him pause.