Cervical Papilloma

Warty multiple growths on the walls of the cervix, provoked by a viral pathogen papilloma, are called papilloma of the cervix. Such a virus can get into the sexual way after unprotected sexual contact with the source of infection. For this reason, it is commonly believed that this disease is more likely to affect women who do not have a permanent sexual partner.

[1], [2],

Causes of the papilloma of the cervix

Several possible causes of the penetration of the papilloma virus into the body are described:

• sexual relations with a man who is a carrier of the papilloma virus. In this case, the method of sexual contact and even the presence of a condom have no value, the main role is played by the very fact of the penetration of the virus into the body. Thus, the virus can get to a woman even through a kiss;
• getting the virus can happen in everyday ways, in public baths, solarium, swimming pool, sauna, on the beach;
• infection can affect a newborn child during childbirth, from an infected mother;
• Sluggish immunity of a person, weakened by alcohol, smoking, frequent stresses, digestive disorders creates a favorable background for the development and progression of the disease.

The papilloma virus of the cervix is able to live for some time in the external environment, so it is not recommended to use other people's toiletries, underwear and towels.

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

Symptoms of the papilloma of the cervix

The disease often occurs without any characteristic symptoms, so that it is not easy to diagnose the papilloma. A later stage of the disease can be manifested by the following symptoms:

• burning external genital area;
• an increase in regional lymph nodes;
• the appearance of uncharacteristic earlier secretions.

The clinical picture of papilloma largely depends on the type of pathogen. For example, genital warts usually indicate an acute stage of the infectious process. But the flat papilloma of the cervix is considered a sign of a chronic lesion that causes a disruption in the structure of the upper epithelial layer. In addition, the infection may not externally manifest itself due to a good immune defense of the body.

Visual manifestations of pathology can be noticeable when examined by a gynecologist. What can the doctor see?

• Appearance of warty elements on the cervix. And these elements can alternately appear or disappear. The color of the cover epithelium is not changed.
• The sites of dysplasia are a condition close to oncology. Cervical cancer and papilloma virus are very closely related concepts. Unfortunately, often specialists can find out the stage of malignant papilloma much later than it would be necessary for successful treatment. This situation is connected with the fact that a woman for a long time does not know about the existing disease and does not consult a doctor. Complex pathology is found only on a casual preventive examination.
• The tuberosity of the integumentary epithelium of the cervix, which can not only be seen, but also probed. Such a condition is a sign of the appearance of genital warts, multiple or independent outgrowths on the skin. Such condylomas usually appear during the exacerbation of viral pathology.
• Cervical papilloma and erosion can successfully adjoin each other. In the presence of erosion on the surface of the cervix, ideal conditions are created for the vital activity of the viral infection. The presence of two diseases simultaneously - erosion and papilloma - increases the danger of the pathology transition into a cancer tumor.

Papilloma of the cervix in pregnancy

The papilloma detected during pregnancy planning must be cured, since in addition to the risk of malignization of the process, there is a fact of recurrence of condylomas during the period of gestation, as well as growth of the formations, which can become a hindrance during childbirth.

If infection with the papilloma virus occurred during pregnancy, it could become a threat of miscarriage. About whether the virus affects the fetus, whether it causes the development of various vices, experts argue until now. It is only known that the transmission of the virus from the mother to the embryo can be from 5 to 80%: how this happens, science has not yet determined. The most likely is the ascending path from the cervix, or the contact one - during labor. The defeat of the baby with the papilloma virus can manifest as a papillomatous lesion of the respiratory system, signs of warty formations on the areas of the child's genitalia. In this case, it does not matter whether the child naturally appeared on the light, or by a caesarean section.

It is interesting that the virus of papilloma, which was found in a woman during the period of gestation, after birth in most cases disappears completely. Visual signs of the disease decrease in size, or disappear at all. The papilloma virus detected in a pregnant woman is usually not determined subsequently, that is, a so-called spontaneous cure is observed.

If the virus was found before the onset of pregnancy, the percentage of self-healing is significantly reduced.

Diagnostics of the papilloma of the cervix

The main diagnostic techniques for the definition of the papilloma virus:

• gynecological examination of a woman;
• conducting colposcopy;
• taking a smear for cytology;
• histological analysis of tissues;
• PCR.

The visual signs of the disease are so characteristic that it can often be a simple gynecological examination to make a diagnosis. If a woman has papillomas on the external genitalia, the cervix is examined without fail, perhaps even using the urethroscopic method of diagnosis.

The method of colposcopy and biopsy can be used for dysplastic changes in the cervical integument. It is possible in such cases to carry out a sample using acetic acid. The essence of this method is as follows: the cervix is exposed in mirrors, treated with acetic acid and iodized Lugol solution. If the papilloma virus is present, the treated area looks unevenly colored, as if in a mosaic.

Cytological examination of the smear is performed according to the method of Pap test (Pap test). The results of this method are divided into five classes:

• I and II class means no disturbed tissue structure;
• Class III requires ancillary histological examination;
• IV and V class confirm the definition of atypical cells - a characteristic feature of the malignant process.

Histological examination also gives an idea of the possibility of malignancy of pathology.

Macroscopically, the papilloma of the uterine cervix is defined as a warty growth of pink or whitish in the form of rosettes.

The histological structure of the papilloma of the cervix is due to the peculiarities of its development: the papilloma is formed as a result of rapid focal proliferation of the flat epithelium; while the surface layers of the epithelium protrude above the mucosa in the form of a small fold, into which connective tissue and vessels grow, forming the basis of the "leg" of the papilloma. In a number of observations, papillomas tend to be submerged, which can lead to malignancy of the background process.

The method of polymerase chain reaction allows to determine the presence of the virus, as well as to clarify and specify its variety. The study also determines temporary viral forms that are capable of self-healing. This fact should be taken into account, and for this reason, positive PCR should in no case be considered as confirmation of a malignant process. The sample is recommended to be conducted, at least, to 15 types of the papilloma virus (just as many kinds of the virus are capable of provoking the appearance of oncology).

If the diagnosis of papilloma is already established against the background of dysplasia, PCR can help in identifying atypical cells.

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

Differential diagnosis

Differential diagnosis should be carried out with the following diseases:

• squamous cell papilloma of the cervix is a benign formation of non-viral etiology, which often appears after the mechanical trauma of the cervix, or as a consequence of the inflammatory process. By colposcopy, small smooth tumors can be considered, with hyperkeratotic and parakeratosis changes. Such papillomas are surgically removed;
• leiomyoma - a small tumor of smooth muscle tissue, is often observed against the background of other myomas;
• the phenomenon of endometriosis on the cervix - spots of bluish-red and dark hue are often confused with cystic lesions. When examining such spots, a microscope can detect endometrial and endometriotic gland cells;
• erosive pathology - a violation of the integrity of the epithelial cover due to the irritating effect of chemical agents (detergents, liquids for douches, etc.), or mechanical factors (the use of tampons, intrauterine spirals). In this case, the tissues of the cervix become loose, hyperemic, there may be bruising.

Accurate diagnosis is often possible only with qualified comprehensive diagnosis.

[15], [16], [17], [18], [19], [20], [21]

Treatment of the papilloma of the cervix

Due to the fact that the virus may behave inadequately during the treatment (possibly as a spontaneous cure or repeated relapse after the therapy), often the treatment is directed not at the virus itself, but in the fight against papillomatous manifestations. The decision on the appropriateness of treatment is generally taken by the specialist individually.

Medical measures should be directed, first of all, to increase the body's defenses. Such measures include the prevention of hypothermia and stress, the use of the necessary amount of vitamins and microelements, an active lifestyle and a full rest.

Among the main therapeutic methods of fighting the papilloma virus can be identified the following:

• method of destruction - locally applied therapy, involving the removal of affected areas by several methods: cold therapy, laser exposure, cauterization of the papillomas on the cervix, excision with electrosurgery, use of chemical destruction (trichloroacetic acid preparations, solcoderm, feresol). Such methods can be used during pregnancy, taking into account the possible danger of developing bleeding and secondary attachment of the infection.
• the use of cytotoxins (condylina, podophylline, fluorouracil) is contraindicated in pregnant women, but it is effective in fighting the papilloma virus.
• method of immunology - implies the use of interferons (special proteins of immunity). These drugs include viferon, kipferon, reaferon.
• the use of special antiviral drugs (alpirazin, cidofovir, panavir).

Unfortunately, the removal of papillomas on the cervix can not guarantee a complete cure for the disease and a further absence of relapses. A woman can remain a passive carrier of a latent infection, which can activate at any time comfortable for her. For this reason, at the end of the treatment, it is necessary to follow the preventive measures for the repeated defeat of the disease.

Prevention

It has been proven that even protected sexual contact with a condom does not reduce the risk of contracting a papilloma virus. Therefore, you should be reinsured and visit a gynecologist for a preventive examination at least once a year.

Additional preventive measures:

• presence of a constant sexual partner, avoiding promiscuity;
• the onset of sexual activity is recommended from the age of 18, when the cervical tissues are already mature enough, and mucous membranes can independently determine the level of protection from infection;
• Prevention of rudeness in sex, artificial abortion, curettage;
• active lifestyle, strengthening immunity;
• vaccination.

Vaccination from the papilloma of the cervix is carried out simultaneously from several of the most dangerous types of the papilloma virus. The introduced serum does not contain living organisms, so it can not do any harm to a person. It is important to understand that the vaccine is not used to treat an already present disease, but only for prevention.

Vaccination can be prescribed to both women and men in order to prevent the following pathologies:

• malignant disease of the cervix;
• malignant lesions of external genitalia, including males;
• genital warts;
• precancerous pathologies.

Vaccination is carried out in three stages: the second inoculation can be done 1-2 months after the first, and the third - 2-4 months after the second vaccination. The efficiency of the completed procedure is estimated as 95-100%.

Among the side effects of this vaccine is some deterioration in the general state during the first few days after the injection, redness of the place of introduction of serum.

Vaccination is not carried out for persons who are prone to allergic reactions to any of the components of the drug, pregnant women, as well as with the acute course of any diseases. After treatment of exacerbations, you can vaccinate.

[22], [23], [24], [25]

Forecast

The prognosis of papilloma can be beneficial only when the body is completely rid of the virus. The greatest chance of a complete cure can be achieved only with a comprehensive approach to treatment - this is the application of methods of destruction and antiviral therapy. With a monotonous or interrupted treatment, the risk of recurrence is significantly increased.

Often, people with frivolity refer to diseases that are sexually transmitted. And if infectious pathologies can be cured by properly selected antibiotics, then fighting with viral lesions will be somewhat more difficult: viruses are harder to detect, and they sometimes behave extremely unpredictably.

Papilloma of the cervix is one of such diseases, which in some cases is difficult to treat, and sometimes can self-cure.

[26], [27],