Symptoms and diseases caused by the human papillomavirus

Symptoms of HPV depend on the provoking factors, that is, papillomatosis does not have a single clinical picture. In children and people with a weakened immune system, the appearance of signs of the disease is much higher than in others.

But there are a number of symptoms that almost all infected people experience:

• Formation of warts and papillomatous growths on the skin and mucous membranes.
• Redness of tissue, burning, irritation and itching.
• Discomfort during urination and sexual intercourse with genital lesions.

Most often, neoplasms have the following localization:

• Skin of the palms and feet.
• Genitals and perianal area.
• Oral cavity.
• Neck and shoulders.

In particularly severe cases, the infection develops in the cervix, bladder and vagina. Subclinical forms occur with the appearance of papillomas prone to endophytic growth. Many patients do not pay due attention to the early stages of the disease, which leads to malignancy of neoplasms.

Psychosomatics

Psychological factors in combination with a weakened immune system are the psychosomatics of HPV. According to medical statistics, 80% of the population has the HPV virus. At the same time, it has been noted that the incubation period of the infection varies in duration in different patients. In some, neoplasms appear a month after infection, while others can live with the infection their entire lives.

• Sometimes warts recur after their surgical removal. In this case, the process of their recurrence is psychosomatic. This indicates that the infection is closely related to psychological problems, that is, organic disorders of the body.
• Another example of psychosomatics is the localization of papillomatosis. Scientists explain this by the fact that the body warns about the emergence of problems, causing deformation of the skin and mucous membranes.
• Psychologists, in turn, claim that HPV is more common in people who have recently experienced severe stress or resentment. Those who have a hereditary predisposition to psychological illnesses are also susceptible to infection.

The issue of treating the psychosomatics of papillomatosis requires a comprehensive approach. Therapy consists of communication with a psychotherapist and a course of drug therapy. Patients are prescribed antidepressants and sedatives, which help minimize anxiety and depression. In particularly severe cases, tranquilizers are used, as they eliminate fears, do not cause drowsiness and restore the functioning of the autonomic nervous system.

The prognosis for recovery depends on the patient’s ability to resist stress and other negative psychological factors.

Human papillomavirus in women

The appearance of various skin growths such as papillomas and warts on the body of women indicates infection with the papillomavirus. Infection occurs in different ways, the main route of viral invasion is sexual contact with a sick person. Transmission from mother to child or through household contact is also possible.

When an infection enters a healthy organism, it can remain dormant for a long period of time. When exposed to certain factors, it wakes up and attacks the immune system. In women, the following HPV risk factors are identified:

• Early sexual activity.
• Frequent change of sexual partners.
• Frequent abortions.
• Bad habits.
• Reduced immune system.
• Unprotected sex.
• Metabolic disorders.
• Gastritis and other gastrointestinal diseases with microflora imbalance.
• Gynecological problems.
• Frequent visits to swimming pools, saunas, baths and other public places with high humidity.

The symptoms of infection, localization and form of skin defects depend on the genotype of papillomatosis. Most often, women experience the following manifestations of the disease:

• Pointed condylomas (genital warts) – appear on the genitals, accompanied by itching, burning, irritation of the affected tissues and mucous membranes.
• Cervical dysplasia is a precancerous condition caused by high-risk HPV.
• Flat condylomas of the cervix are the most dangerous manifestation of the virus, leading to pathological changes in the epithelial cells of the organ.
• Cervical cancer is a malignant transformation of an infection, most often genotypes 16 and 18.
• Plantar warts are painful growths on the feet that occur due to increased growth of the epidermis.

The main symptoms of damage to the genitals are:

• Itching and burning.
• Atypical discharge.
• Painful urination.
• Discomfort during sexual intercourse.
• Condylomatosis.

Often the infection goes unnoticed against the background of inflammatory lesions of the reproductive system: vulvovaginitis, erosions, etc. Also very often HPV occurs with other STIs: herpes, syphilis, chlamydia.

A set of laboratory and instrumental methods is used to diagnose the infection. Treatment consists of local therapy, i.e. removal of altered tissues and a course of antiviral medications. Particular attention is paid to strengthening the immune system with vitamins and immunomodulators.

Human papillomavirus and infertility

According to medical statistics, Human papillomavirus is more often diagnosed in women after 30 years of age. In this case, the patient may not even suspect the infection, since the virus does not manifest itself clinically. Many women discover this problem during a gynecological examination due to the inability to get pregnant.

Infertility due to HPV is most often associated with the virus affecting the cervix and other organs of the reproductive system. Due to the asymptomatic course of the disease, its diagnosis and treatment are carried out at advanced stages, which reduces the ability to conceive to zero.

Regular gynecological examinations, i.e. high-quality and timely diagnostics, allow identifying the problem at an early stage. Thanks to this, a set of treatment measures is carried out that are highly effective, allowing a woman to become pregnant and have healthy children.

Human papillomavirus during pregnancy

Papillomatosis is especially dangerous for pregnant women. The reason for the danger is related to the high risk of transmitting the infection to the unborn child during intrauterine development or during childbirth. Studies indicate that about 25% of women encounter HPV during pregnancy. In this case, the activation of the virus is directly related to the restructuring of the body due to pregnancy.

A weakened immune system combined with a disruption of physiological and physical-chemical processes in the body leads to the virus beginning to manifest itself. That is, pregnancy is an optimal condition for the development of the problem. The disease manifests itself as papillomatous and condylomatous growths on the skin and mucous membranes. At the same time, the localization of neoplasms is very different, they occur on the genitals, in the perianal and periorbital area, on the face, neck, feet and other parts of the body.

At the stage of pregnancy planning, all women should undergo examination for the presence of Human papillomavirus. If it is detected, doctors recommend not to rush to have a child and first cure the infection. Treatment during pregnancy is carried out after the 28th week, when all the baby's organs are formed and cannot be damaged by the effects of the medications used. Women with condylomas in the vagina are not recommended to have natural childbirth, since there is a risk of infecting the baby when passing through the genital tract.

Human papillomavirus in men

Men are the main carriers of HPV, and the infection is less dangerous for them than for women. However, some genotypes can cause malignant processes in the body if they are not diagnosed and treated in a timely manner.

A special feature of papillomatosis is that it may not manifest itself for a long period of time. Infection occurs in the following ways:

• Unprotected sex with a virus carrier.
• Blood transfusion from a sick person to a healthy person.
• Use of non-sterile medical instruments.
• Use of common household and personal hygiene items.
• Bad habits.

The human papilloma virus is not transmitted by air, only by contact or sexual intercourse. Symptoms of infection make themselves known when the immune system is weakened. Most men experience the following signs of the disease:

• Warts are growths that have different locations; they appear both on the skin and on the mucous membranes.
• Papillomas are a clear symptom of HPV. The growths are soft, of different shapes, colors and sizes.
• Condylomas are similar to warts, but have a pointed shape and are localized on the mucous membranes of the genitals.
• Papulosis is a widespread occurrence of warts of various colors and sizes. The disease is dangerous due to the risk of injury to the growths and their malignancy.

In most cases, treatment begins after the appearance of skin lesions. According to statistics, in 9 out of 10 men, the immune system suppresses the virus, so therapy is not required. But in 10% of those infected, the infection becomes chronic and leads to pathological oncological processes.

Treatment of HPV is reduced to surgical removal of skin changes and drug treatment of the pathogen. Strengthening the immune system with vitamin preparations and a balanced diet is also recommended.

Human papillomavirus on the lips

The appearance of any neoplasms on the face, and especially on the lips, causes significant aesthetic discomfort and psychological problems. Warts and papillomas indicate infection with Human papillomavirus. Infection with this pathogen is possible in the following ways:

• Unprotected sexual intercourse.
• Contact infection in domestic conditions.
• Intrauterine infection or during the birth process.

The growths are localized both on the visible surface of the lips and on the internal mucous membrane. Their appearance is associated with the activation of the virus, which can remain in a suppressed state for a long time. The development of the disease is facilitated by weak immunity, vitamin deficiency, bad habits, pregnancy, poor nutrition, chronic diseases, and failure to observe personal hygiene.

When a papilloma appears on the lip, you should carefully examine the skin and mucous membranes in search of other growths. Their injury causes severe bleeding and increases the risk of infection, which contributes to the transformation of the defect into a malignant tumor.

Treatment is carried out to suppress the virus in the body and eliminate the cosmetic problem. Patients are prescribed antiviral and immune system strengthening agents. Removal of growths occurs with the help of laser, electrocoagulation, cryodestruction and other surgical methods.

Human papillomavirus in the mouth, on the tongue

The oral cavity is a common localization of papillomatosis. Growths can occur not only on the tongue, but also on the mucous membranes of the mouth. They are in the form of tubercles and elongated processes. Very often they form on the hard palate, the tip, lateral surface and back of the tongue, in the sublingual region. The peculiarity of such skin defects is the increased risk of their injury.

The appearance of papillomas is associated with genotypes 1, 2, 3, 16 and 18 of the infection. The virus enters the body in several ways: through microtrauma, unprotected oral sex or using personal hygiene items of an infected person. Frequent stress, poor nutrition and chronic diseases also contribute to HPV.

Most often, women and children face the problem, but there are cases of infection of men. Let's consider the features of HPV in the oral cavity and the main localization of growths:

• Warts are altered tissues in the form of a flat rounded tubercle with clearly defined and slightly raised borders. They have a darker color than healthy tissues. They can be located on the root and back of the tongue, reaching more than 2 cm in diameter. As a rule, they do not cause significant discomfort, but are still subject to removal due to the risk of injury.
• Condylomas are pointed growths that most often appear under or on the tongue. Their occurrence is associated with domestic or sexual infection. Without timely treatment, they are complicated by a fungal infection, which aggravates the painful condition.
• Sublingual region – growths in the form of thin threads that hang from the surface of the tongue are formed under the tongue. The size of the neoplasm is 15-30 mm. Due to the large number of blood vessels and active participation in the process of eating, they are easily injured, causing severe pain, bleeding and infection.
• Sky – large flat papillomas grow in this area. They are practically indistinguishable from healthy mucous membranes, but are slightly raised and have a finely lumpy appearance. When they grow, they can affect the tonsils and pharynx. They are found in children and the elderly.
• Gums – located in a visually inaccessible place, so they are difficult to diagnose. Most often, they are detected during a visit to the dentist. The size of papillomas can exceed 15 mm. Their formation is directly related to diseases of the teeth and gums, uncomfortable dentures.
• Inner side of the cheek - the defect can be in the form of a tuberous tumor or a filiform formation. The latter are more common in children. The appearance of HPV in this localization is associated with constant microtraumas of the mucous membrane of the cheeks when using a toothbrush, dentures, braces, splints.

Treatment is most often carried out by medication. Patients are prescribed medications for oral administration, solutions for thorough sanitation of the oral cavity and products for application directly to the growths. Surgical intervention is carried out in rare cases when neoplasms acquire large sizes and constantly increase, causing discomfort and disruption of normal food intake.

Human papillomavirus in the throat

A common problem that people see an otolaryngologist for is papillomatosis in the throat. The neoplasm most often has the shape of a nipple, is localized on the mucous membrane of the throat, which causes significant discomfort. In rare cases, multiple growths occur, complicating the breathing process.

The infected person experiences the following symptoms:

• Difficulty swallowing.
• Feeling of a foreign body in the throat.
• Severe pain.
• Difficulty breathing.

Most often, such benign neoplasms occur in children aged 2-5 years and in women aged 20-40 years. The main reason for their appearance is the entry of HPV into the body due to poor personal hygiene. Infection can also be associated with various infectious diseases, chronic pathologies, unprotected sex, bad habits and unbalanced nutrition.

The growths may be congenital. This is possible when the virus is transmitted in utero or during the birth process, as well as if the woman had viral hepatitis, rubella, chlamydia or mycoplasmosis during pregnancy.

During the diagnostic process, inexperienced doctors mistakenly take papillomas for enlarged tonsils. Treatment consists of a complex of medicinal methods. Surgical removal of growths is mandatory. It is carried out by extralaryngeal or intralaryngeal methods. Preventive measures to improve immunity are also indicated.

Human papillomavirus on the genitals

Pointed condylomas are a sign of HPV infection. They occur on the genitals of both women and men. Genital warts are benign tumors by nature, but due to certain factors they can acquire an oncological status.

According to studies, up to 70% of the population are carriers of the infection. At the same time, about 35 of its varieties manifest themselves in the genital area. In most cases, the disease develops gradually. From the moment of infection with a genotype with low carcinogenicity to the appearance of clinical symptoms, up to 3 months pass, and in some cases even longer.

Genital lesions are caused mainly by HPV types 6 and 11. Most often, they have the following localization:

• Vestibule of the vagina.
• Clitoris.
• Cervix.
• Pubis and labia.
• Urethra.
• Head of the penis.
• The area around the anus.

The neoplasms are asymptomatic and are diagnosed by chance during a gynecological examination or based on tests. The danger of skin growths is that if accidentally injured, they can cause bleeding, pain, and infection. Because of this, the risk of malignant degeneration increases significantly. In particularly severe and advanced cases, genital papillomatosis leads to infertility. There is also a high chance of infecting the child as it passes through the genital tract.

Treatment is carried out using medication and surgical methods. Regular check-ups with a doctor, protected sex, personal hygiene, treatment of chronic diseases and a healthy lifestyle help prevent HPV infection.

Discharge with human papillomavirus

Human papillomavirus, which affects the organs of the reproductive system, causes various diseases. One of the symptoms of such lesions is discharge. In papillomatosis, the mucous discharge consists of the following components: normal mucus, deformed epithelial cells, microorganisms of the microflora. The change in mucus is due to the presence of infection in the body.

The appearance of atypical discharge may indicate the following diseases caused by HPV infection:

• Colpitis is a thick, milky vaginal discharge with an unpleasant odor.
• Erosive inflammation - scanty leucorrhoea with blood streaks and an unpleasant odor. In rare cases, purulent discharge appears.
• Development of a malignant process – bloody discharge, both abundant and scanty.
• Sexually transmitted infection – increased vaginal discharge, itching, pain.
• Genital herpes – increased production of vaginal secretions in the second half of the menstrual cycle, itchy watery blisters on the mucous membranes and skin.

To determine the cause of pathological discharge, it is necessary to seek medical help and undergo a set of both laboratory and instrumental examinations. Timely diagnostics will allow you to establish the cause of the painful condition and begin its treatment.

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Diseases caused by the human papillomavirus

The concept of human papillomavirus includes more than 120 strains capable of causing diseases of various organs and systems. Each virus has its own serial number and unique DNA.

The main routes of infection transmission are sexual and contact. Based on this, we can conclude that the form of infection depends on the type of virus, the route of infection and the individual characteristics of the patient's body.

Today, the following diseases are distinguished, caused by Human papillomavirus:

• Cervical dysplasia and cancer.
• Oncological lesions of the anus, vulva and vagina in women.
• Malignant neoplasms in the anal area and penis in men.
• Genital warts.
• Giant condyloma of Buschke-Loewenstein.
• Neoplasia of 2 and 3 degrees of severity.
• Cancer of the oral cavity and larynx.
• Bowen's disease.
• Erythroplasia of Keir.
• Dental complications and more.

The main signs of the above diseases are: warts, papillomas, pointed condylomas, non-condylomatous lesions of the genitals, carcinomas. Timely medical attention and treatment can prevent the infection from developing into a serious pathology.

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Warts

A common benign skin formation that consists of connective tissue and epithelium is a wart. They arise due to infection with the human papilloma virus, have a variety of localizations and several types:

• Vulgar (common) - papules of a round shape and small size. They have an uneven, rough surface with villi, papillae or cracks. The color of such neoplasms may not differ from healthy tissues, but there are warts from yellow to gray color. Most often, they are localized on the back of the hand and fingers. The growths can merge into large spots. They are painless, but with regular trauma they become inflamed and begin to bleed.
• Flat – rise above the skin surface. Have a flat and smooth surface and are small in size. They can be the same color as the skin, there are also blue and dark yellow warts. Most often appear on the back of the hands, neck, face. Characterized by multiple rashes.
• Plantar - painful neoplasms resembling yellow calluses. They can rise above healthy tissue or grow in the form of a pit in which bundles of papillae appear. They appear on the soles of the feet and in places of greatest friction/pressure.
• Pointed condylomas are localized on the genitals, in the armpits and under the mammary glands. They look like cauliflower or a rooster's comb.
• Senile - a benign neoplasm of the epithelium. Characterized by slow growth. At the initial stage, a brown spot appears, which gradually increases in size and can reach 6 cm in diameter. The surface of the wart is covered with crusts that are easily removed. They are most often localized in closed areas of the body, but can form on the face, neck, limbs, and scalp.

The appearance of warts is associated with infection with Human papillomavirus by contact or by using household items of an infected person. The incubation period is from 1.5 to 6 months.

Treatment depends on the shape and location of the warts. At the same time, plantar and flat warts can disappear on their own. It is also worth noting that with prolonged trauma, the neoplasm becomes inflamed and has oncological risks. In other cases, surgical methods and conservative therapy are used to suppress the infection in the body.

Cervical erosion

Very often, cervical erosion and Human papillomavirus accompany each other. At the same time, a woman may not even suspect these diseases. Both problems lead to damage to the uterine epithelium, have an asymptomatic course in the early stages and a risk of malignancy.

Ectopia or erosion is an inflammatory process occurring in the uterine epithelium. Visually, it looks like a pink spot on healthy tissue. To make an accurate diagnosis, a gynecological examination and a number of laboratory tests are necessary. Very often, the disease occurs when the immune system is weakened and due to the action of a number of other provoking factors.

There is also such a thing as pseudo-erosion. This is an anatomical feature of the body, which occurs in women under 30 years of age, which does not require treatment. With pseudo-ectopia, the cylindrical epithelium comes out of the vagina, replacing the flat one. This occurs with increased acidity of the vaginal microflora.

Treatment of erosion is carried out using anti-inflammatory and antiviral drugs. Patients are also prescribed vaginal suppositories for local action on the lesion. In case of large and deep ulcers, cryodestruction of the affected tissues is carried out. The treated surface gradually heals and comes off as a crust during the next menstruation. In particularly severe cases, an operation is performed, during which the upper layer of the cervix is removed under general anesthesia. Surgical methods are used to stop the inflammatory process and suppress the papillomavirus to reduce the risk of relapse of the disease.

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Cervical cancer

The human papilloma virus and cervical cancer are closely related. The presence of HPV contributes to the development of dysplasia, which is a risk factor for malignant damage to the organ. The risk of oncological processes increases significantly in the presence of a viral infection of this type in the body: 16, 18, 31, 33, 35. In this case, a decrease in local and general immunity acts as a trigger for the development of the disease.

As a rule, the development of cervical cancer is facilitated by advanced dysplasia or erosion. A healthy organ is lined with stratified squamous epithelium. In pathological processes, both infectious and inflammatory, the structure of the epithelium and the structure of the cells are disrupted. HPV 16 most often leads to squamous cell carcinoma, and type 18 to adenocarcinoma. In the early stages, the disease does not manifest itself, but as it progresses, the following symptoms appear:

• Bleeding outside of menstruation.
• Bloody discharge from the genital tract.
• Heavy menstruation.
• Severe pain in the lower abdomen.
• Pain during intercourse.

To diagnose cancer and HPV, the patient needs to see a gynecologist. After a thorough examination and colposcopy, the doctor will give a referral for an ultrasound of the pelvic organs. A laboratory study of smears, a biopsy of the affected tissues and their histological analysis are also indicated.

Treatment depends on the stage of the oncological process. In advanced cancer, antiviral therapy alone is not enough, so surgical treatment is performed with removal of the uterus and its appendages. The patient then undergoes a course of chemotherapy or radiation. If cancer is detected at an early stage, the prognosis for recovery is favorable.

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Genital herpes

Genital herpes is the most common viral infection in humans and a serious medical and social problem. Papillomavirus is in second place. Statistics show that about 90% of the world's population is infected with the herpes simplex virus and about 70% with Human papillomavirus.

Genital herpes and HPV have a number of similarities, and in some cases can occur simultaneously.

• Infection occurs primarily through unprotected sexual contact.
• Blister-like formations form on the genitals, causing severe itching, burning and pain. While HPV does not cause pain, but manifests itself as condylomas.
• The rash is localized on the labia majora and minora, clitoris, vagina, and cervix in women. In men, the foreskin, urethra, and head of the penis are susceptible to damage. Papillomas have a similar localization, but can also occur in the perianal area.

Without timely treatment, both infections can lead to a number of complications. In case of genital herpes, these are severe urogenital infectious processes, and in case of papillomatosis, oncology. Therapy is based on taking antiviral drugs and local treatment of neoplasms. Particular attention is paid to preventive measures and strengthening the immune system.

Condylomas

One of the signs and types of infection with the human papilloma virus are condylomas. They are benign neoplasms that affect the mucous membranes and skin of a person. The growths have a rather unpleasant appearance, their pointed papillary shape causes significant cosmetic problems and psychological discomfort. Most often, such deformations are subject to the genitals and intimate areas, places of skin friction, face, neck, arms, legs.

Condylomas are characterized by an inflammatory nature and are mainly transmitted sexually. In rare cases, household infection is also possible. The incubation period from the moment of infection until the first growths appear takes from 1 week to 6 months. At the same time, the condyloma can grow to its maximum size within a few hours. New growths appear both in groups and individually.

Condylomas have several varieties:

• Wide – have a wide base, holding the growth on the tissue. They appear with syphilis infection and are most dangerous when the cervix is affected. Wide growths change the structure of healthy tissues and contribute to their malignant transformation.
• Pointed (genital) - have a thin stalk and lobular (papillary) structure. They appear on thin, delicate skin and mucous membranes. Initially, they are only a cosmetic defect, but when injured, they begin to bleed and become inflamed, causing painful sensations. There is a risk of infection.

Treatment consists of surgical removal of the condylomas and a course of antiviral therapy. Patients are also prescribed drugs to strengthen the immune system.

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Cervical dysplasia

Precancerous, i.e. intermediate condition between a healthy cervix and its malignancy, is cervical intraepithelial neoplasia (CIN) or dysplasia. According to WHO, more than 40 million women worldwide suffer from this pathology. At the same time, ¾ of patients have the first stage of the disease, and the rest are diagnosed in an advanced state.

In 99% of cases, cervical dysplasia is caused by HPV. The 16th and 18th types of the virus are highly oncogenic in relation to this disease; they are detected in 70% of patients. In the remaining 30%, less oncogenic strains progress: 31, 35, 39, 45, 51, 58. Under the influence of certain factors, they lead to the development of a precancerous condition.

The main reasons for the development of the disease and activation of HPV are:

• Long-term use of hormonal or intrauterine contraceptives (more than 5 years).
• A large number of births and abortions.
• Avitaminosis.
• Immunodeficiency states.
• Genetic predisposition.
• Early sexual activity.
• Frequent change of sexual partners.
• Bad habits.

The peculiarity of CIN is that it can proceed completely asymptomatically for a long time. Dysplasia manifests itself during inflammatory processes in the vagina or cervix. In this case, the symptoms characteristic of the pathology arise:

• Vaginal discharge of abnormal color and consistency.
• Itching and burning.
• Contact bleeding that occurs during sexual intercourse and when using hygienic tampons.
• Pain in the lower abdomen.

Most often, dysplasia is diagnosed in women aged 30-35. It takes time for the disease to develop into a precancerous and cancerous state, usually several years. The disease is often diagnosed when atypical discharge and pain appear, as well as during a routine gynecological examination. To confirm the diagnosis, the patient undergoes an extended colposcopy, examination of smears and scrapings from the cervix. A biopsy of the affected tissues with subsequent histological examination is mandatory.

Treatment of cervical dysplasia caused by papillomatosis involves several specialists at the same time: a gynecologist-endocrinologist, an oncogynecologist and an immunologist. The therapy consists of removing the affected area of the cervix and suppressing HPV. With early diagnosis, the prognosis for the disease is favorable, since the chances of a full recovery are 90%. When treating advanced stages, there is a risk of relapse. 40% of women face recurrent dysplasia.

Carriers of the human papillomavirus

Medical statistics indicate that about 70% of the planet's population are carriers of the papillomavirus.

• This infection leads to the appearance of skin growths of various locations and shapes.
• Papillomas grow not only on the skin, but also on mucous membranes.
• The virus is diverse, there are more than 120 strains. Some of them are absolutely safe, while others, on the contrary, can cause malignant processes.
• The greatest danger is posed by HPV genotypes with a high oncogenic risk.

The infection has become widespread among women. Today, HPV ranks second among viral infections of the female genital tract, second only to genital herpes. Infection occurs through contact. The virus is transmitted through interaction with the mucous membranes or skin of an infected person. There are also carriers of the virus who have received it hereditarily, that is, from an infected mother.

The infection can remain in the body in a suppressed state for a long time. A decrease in the immune system leads to its activation. Infected cells begin to actively grow, affecting healthy tissues and causing the appearance of many new papillomas.

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