Human papilloma virus infection

HPV infection (genital warts) is caused by the human papillomavirus.

HPV is considered the cause of both benign and malignant neoplasms of stratified squamous epithelium or mucous membranes.

[1], [2], [3], [4], [5], [6], [7], [8]

Causes of the human papillomavirus infection

The causative agent is the human papillomavirus (HPV), a small virus that contains a double-stranded DNA. Types of HPV risk: 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68. 5 types of HPV remain low-risk cancer viruses - 6, 11, 42, 43, 44.

[9], [10], [11], [12], [13], [14]

Risk factors

• Age over 35 years.
• Pathology of the cervix.
• STI in history.
• Prostitution.

[15], [16], [17], [18], [19], [20], [21], [22], [23], [24], [25]

Pathogenesis

Ways of transmission - contact, including sexual. The virus can be transmitted from mother to child during childbirth.

Perinatal transmission of human papillomavirus infection during labor is rarely observed. Clinically, perinatal infection usually occurs within 2 years. The presence of genital warts in children over 18 months, especially over 2 years, should indicate the possibility of committing sexual violence. HPV is detected both in damaged tissues and in unchanged epithelium. In 80% of cases with unchanged cervix, HPV type 16 is detected. Among young women (mean age 22.9 years), HPV is determined in 33%. Most often, this virus is detected in the cervical canal of the cervix and vulva (46%). In most cases, the cause of the infection is HPV type 16 and 18. Far from all women infected with oncogenic HPV types, including those of the 16th, 18th types, develop a clinically significant disease, which turns into cervical cancer.

The incubation period is 2–3 months for external warts, not exactly established (years) for precancer and cancer.

[26], [27], [28], [29], [30], [31], [32], [33], [34], [35], [36], [37], [38]

Symptoms of the human papillomavirus infection

• Development on the skin and / or mucous membranes of the anogenital area of exophytic growths similar to cauliflower; keratinizing, nodules rising above the skin. Sometimes they can cause bleeding, itching, and discharge.
• In women, frequent localization - the cervix. Often, several sites are affected simultaneously (for example, the cervix, vagina, vulva, etc.).
• The size and number of warts are different.
• Warts can increase in size and number during pregnancy.
• External clinical manifestations rarely malignized.
• Only some types of HPV cause cervical and anorectal cancer, as well as vulvar and penile cancer.

[39]

Complications and consequences

Cervical cancer.

[40], [41], [42], [43], [44], [45]

Diagnostics of the human papillomavirus infection

Laboratory Diagnostic Methods

• For the detection of the virus, only molecular-biological diagnostic methods (PCR, real-time PCR, PCR using a hybrid trap, etc.) with typing of oncogenic and non-oncogenic types are used.
• For the detection of malignancy - cytological and histological examination.

Taking clinical material

• In asymptomatic forms - scraping the epithelium of the urethra and / or cervical canal to detect oncogenic types of human papillomavirus.
• When detecting oncogenic types of human papillomavirus, it is imperative to conduct a cytological study with the establishment of the degree of epithelial dysplasia.
• With the localization of warts on the cervix spend colposcopy, and with localization in the area of the external opening of the urethra - urethroscopy.
• If there are external genital warts, then typing of HPV is not performed.
• Serological testing is not carried out.
• To visualize subclinical manifestations of papillomavirus infection on the skin and mucous membranes, a method of detecting damage using acetic acid is used: 5% acetic acid is applied to the skin of the genitalia or cervix, within 3-5 minutes subclinical damage can be detected in the form of whitened patches. Patients with clinically visible injuries do not use this technique.

[46], [47], [48]

Differential diagnosis

• Contagious mollusk.
• Micropapillomatosis of the genital lips.
• Pearly papules of the penis.
• Seborrheic keratosis.
• Intradermal nevus.
• Cancer on site.

Patients with HIV infection often have anogenital warts that are difficult to treat.

[49], [50], [51], [52]

Treatment of the human papillomavirus infection

At development of complications consultation of adjacent experts is required. If a malignancy is suspected, consult an oncologist.

The procedure of the doctor in the diagnosis of human papillomavirus infection

1. Message to the patient about the diagnosis.
2. Presentation of information about the recommended regimen during treatment.
3. Collection of sex history.
4. To identify and screening attract all sexual partners of the patient.
5. Conducting epidemiological measures among contact persons:
   • inspection and examination of contact persons;
   • ascertaining laboratory data;
   • deciding on the need for treatment, its scope and timing of observation.
6. If high-risk human papillomavirus is detected in women in the cervical canal of the human papilloma, a colpocytology study should be carried out once a year, and in case of detecting cervical dysplasia of the III degree or cervical cancer, the oncogynecologist will observe and treat.
7. In the absence of results from treatment, it is recommended to consider the following possible causes:
   • failure to comply with treatment regimens, inadequate therapy;
   • recurrence of the disease.

Prevention

Prevention is common to all sexually transmitted infections.

[53], [54], [55], [56], [57], [58], [59], [60], [61], [62], [63], [64], [65], [66], [67]

Forecast

The persistence of the virus is possible without the development of cervical cancer, as well as the elimination of the virus without treatment. However, with prolonged persistence of the same genotype with increased oncogenic activity of the virus, with the integration of the virus into the genome of a human cell in combination with cervical dysplasia, the development of cervical cancer is possible.

[68], [69], [70], [71], [72], [73]