Human papillomavirus (HPV) is a very common sexually transmitted infection in the world.
The peculiarity of this infection is that it may not manifest itself for many years, but ultimately leads to the development of benign (papiloma) or malignant (cervical cancer) diseases of the genital organs.
Types of human papilloma virus
More than 100 types of HPV are known. Types are strange "subspecies" of viruses that differ from one another. Types are designated by the number assigned to them when found.
The high oncogenic risk group consisted 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 (mainly 6 and 11). They lead to the formation of anogenital warts (genital warts, papillomas). Papillomas are located on the mucosa of the vulva, vagina, in the perianal area, on the skin of the genital organs. They almost never become 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 this type of virus, or they may have a different origin. In the next article, we will discuss "high-risk" and "low-risk" HPV types separately.
Human papilloma virus infection
This 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 develop this infection during their lifetime.
But there is good news: the majority of those infected (about 90%) will get rid of HPV without medical intervention within two years.
This is a normal process of the infection 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 harm the body.That is, if HPV was detected some time ago, and now it is not, this is completely normal!
It must be remembered that the immune system acts in different people at "different speeds". In this case, the speed of getting rid of HPV can be different for sexual partners. Therefore, a situation may occur when HPV is detected in one partner, and not in the other.
Most people become infected with HPV as soon as they become sexually active, and many will never know that 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 been discovered, and with other types of viruses.
"High-risk" HPV is dangerous because it can lead to the development of cervical cancer and several other types of cancer. "High-risk" HPV causes no other problems.
HPV does not lead to the development of inflammation of the mucous membranes of the vagina / cervix, menstrual irregularities or infertility.
HPV does not affect the ability to conceive and carry a pregnancy.
"High-risk" HPV babies are not transmitted during pregnancy and delivery.
Diagnosis of human papillomavirus
It is practically useless to carry out an HPV test for high oncogenic risk before the age of 25 (except for women who start sexual activity earlier (before 18 years)), because at this time it is quite possible to detect a virus that will soon leave the body on its own.
After 25 - 30 years, it makes sense to take an analysis:
- together with cytological analysis (PAP - test). If there is a change in the PAP test, and the HPV is "high risk", then this situation requires special attention;
- Long-term persistence of "high-risk" HPV in the absence of cytologic changes also warrants attention. Recently, the sensitivity of HPV testing in cervical cancer prevention has been shown to be higher than that of cytology, and therefore HPV alone (without cytology) determination was approved as a stand-alone study for cervical cancer prevention. in the United States. However, in our country, annual cytological examination is recommended, so the combination of these two studies seems reasonable;
- after treatment of dysplasia / precancerous / cervical cancer (absence of HPV in the analysis after treatment 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 the screening, it is advisable to obtain material from the cervix).
Analysis should be provided:
- 1 time per year (if "high-risk" HPV was previously detected, and analysis was administered concurrently with cytologic examination);
- 1 time in 5 years if previous analysis was negative.
It is almost never necessary to analyze for HPV with low oncogenic risk. If there are no papillomas, then this analysis makes no sense in principle (a possible carrier of the virus, there is no treatment for the virus, so what to do next with the results of the analysis is unknown).
If there is a papilloma, then:
- most often caused by HPV;
- they should be removed regardless of whether we find the 6/11 type or not;
- if we take a smear, it is directly from the papilloma itself, 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 which specific types are included in the analysis. Some laboratories conduct research only on types 16 and 18, others - on all types simultaneously. It is also possible to take a test that will identify 14 "high-risk" virus strains in a quantitative format. Quantitative characteristics are important for predicting the likelihood of developing precancerous and cervical cancer. This test should be used in the context of cervical cancer prevention and not as a standalone test. Analysis for HPV without cytology results (PAP test) most often does not allow drawing any conclusions about the patient's health status.
No such analysis will determine whether the virus in a given patient will "go away" or not.
Human papilloma virus treatment
There is no medical treatment for HPV. There are treatments for conditions caused by HPV (papiloma, dysplasia, precancerous, cervical cancer).
This treatment should be carried out using surgical methods (cryocoagulation, laser, radioknife).
There are no "immunostimulants" associated with HPV treatment and should not be used. None of the drugs that are widely known in our country have passed adequate tests that would demonstrate their effectiveness and safety. None of the protocols/standards/recommendations includes these drugs.
The presence or absence of cervical "erosion" does not affect HPV treatment tactics. 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 there are no papillomas/changes on the cervix during colposcopy and according to the PAP test, no medical action is required.
You only need 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 is not at all necessary that it will lead to the development of cervical cancer, but control 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 vaccine 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. Vaccination is routinely used in 45 countries around the world.
Condoms (does not provide 100% protection).
The only method that provides 100% protection is abstinence from sexual intercourse. I'm not campaigning for him at all, I'm just giving him food for thought.