Human papillomavirus (HPV) is an extremely common sexually transmitted infection around the world.
The peculiarity of this infection is that it may not manifest itself for many years, but eventually lead 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 unique "subspecies" of a virus that differ from each other. Types are designated by numbers that were assigned to them when they were discovered.
The oncogenic high-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) .
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 mucous membrane of the vulva, vagina, in the perianal region, on the skin of the genital organs. They almost never become malignant, but lead to significant cosmetic defects in the genital area. Warts on other parts of the body (hands, feet, face) can also be caused by these types of viruses or have a different origin. In subsequent articles, we will discuss the "high-risk" and "low-risk" HPV types separately.
Human papillomavirus infection
The virus is mainly transmitted through sexual contact. Almost all women at one time or another become infected with HPV: up to 90% of sexually active women will experience this infection in their lifetime.
But there is good news: most of the infected (about 90%) will get rid 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 get rid of the virus completely. In such a situation, HPV will not harm the body.That is, if HPV was detected some time ago, and now it is not, it is absolutely normal!
It should be borne in mind that the immune system works in different people at "different speeds". In this regard, the speed of getting rid of HPV can 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 are infected with HPV. Permanent immunity is not formed after infection, so it is possible to reinfect 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 and other cancers. "High-risk" HPV does not cause any other problems.
HPV does not lead to the development of inflammation on the mucous membrane of the vagina / cervix, menstrual irregularities or infertility.
HPV does not affect the ability to conceive and carry a pregnancy.
A "high-risk" HPV baby is not passed on during pregnancy and delivery.
Human papillomavirus diagnosis
It is practically useless to do an HPV test for high oncogenic risk before the age of 25 (except those women who start sexual activity early (before the age of 18)), as at this time it is very likely that it detects a virus that will soon leave the body alone.
After 25 - 30 years, it makes sense to do an analysis:
- together with a cytological analysis (PAP - test). If there are changes in the PAP - test and "high risk" HPV, this situation requires special attention;
- the long-term persistence of "high-risk" HPV in the absence of cytological alterations also deserves attention. Recently, the sensitivity of the HPV test in cervical cancer prevention has been shown to be superior to the sensitivity of cytology, and thus the determination of HPV alone (without cytology) has been approved as a standalone study for cervical cancer prevention in the United States. However, in our country, annual cytology is recommended, so a combination of these two studies seems reasonable;
- after treatment of dysplasia / precancer / cervical cancer (absence of HPV in post-treatment analysis almost always indicates treatment success).
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 take the material from the cervix).
The analysis must be given:
- 1 time per year (if "high risk" HPV was previously detected and the analysis is provided together with a cytological examination);
- 1 time in 5 years if the previous analysis was negative.
Testing for low oncogenic risk HPV is almost never necessary. If there are no papillomas, this analysis does not make sense in principle (virus transport is possible, there is no treatment for the virus, so it is not known what to do next with the result of the analysis).
If there are papillomas, then:
- most often they are caused by HPV;
- they must be deleted regardless of whether we find 6/11 types 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 periodically get tested for HPV, pay attention to what specific types are included in the analysis. Some labs research only types 16 and 18, others research all types together. It is also possible to do a test that will identify all 14 "high risk" virus types in a quantitative format. Quantitative characteristics are important in predicting the likelihood of developing precancer and cervical cancer. These tests should be used in the context of cervical cancer prevention and not as a standalone test. HPV analysis without cytological results (PAP test) most often does not allow to draw conclusions about the patient's state of health.
There is no such analysis that will determine whether the virus in a particular patient will "leave" 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 carried out using surgical methods (crycoagulation, laser, radio knife).
No "immunostimulants" are related to HPV treatment and should not be used. None of the drugs widely known in our country has passed adequate tests that demonstrate 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 non-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 procedures are needed.
It is necessary to repeat the analysis only 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 for it to lead to the development of cervical cancer, but control is needed.
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 protection against them is so important. 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. In no way am I campaigning for him, I'm just giving food for thought.