The human papillomavirus (HPV) is an extremely common sexually transmitted infection in 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 peculiar "subspecies" of a virus that differ from each other. Types are designated by numbers that were assigned to them as they were discovered.
The high oncogenic 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 located on the mucosa 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) may also be caused by these types of virus, or may have a different origin. In subsequent articles, we will discuss the types of HPV "high risk" and "low risk" separately.
Human papillomavirus infection
The 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 experience this infection during their lifetime.
But there is good news: the majority of those 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 completely get rid of the virus. In such a situation, HPV will not bring any harm to the body.That is, if HPV was detected some time ago, and now it is not, this is absolutely normal!
It must 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 they become sexually active, and many will never know 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 already been encountered, and with other types of the virus.
"High risk" HPV is dangerous because it can lead to the development of cervical cancer and some other types of cancer. "High risk" HPV does not cause other problems.
HPV does not cause inflammation of the vaginal/cervical mucosa, menstrual irregularities, or infertility.
HPV does not affect the ability to conceive and carry a pregnancy.
A "high-risk" HPV baby is not transmitted during pregnancy and childbirth.
Diagnosis of human papillomavirus
It is practically pointless to take an HPV test for high oncogenic risk before the age of 25 (except for those women who start sexual activity early (before 18 years)), since at this time it is very likely 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 a cytology analysis (PAP - test). If there are changes in the PAP test, and HPV "high risk", then this situation requires special attention;
- long-term persistence of "high-risk" HPV in the absence of cytological changes also requires attention. Recently, the sensitivity of HPV testing in the prevention of cervical cancer has been shown to be higher than the sensitivity of cytology, and therefore the determination of HPV alone (without cytology) is approved as a stand-alone study for the prevention of cervical cancer in the United States. However, in our country, an annual cytological examination is recommended, so a combination of these two studies seems reasonable;
- after treatment of dysplasia / precancer / cervical cancer (the 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 the material from the vagina, however, as part of the screening, it is recommended to obtain 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 given together with a cytological examination);
- 1 time in 5 years if the previous analysis was negative.
It is almost never necessary to take an analysis for HPV of low oncogenic risk. If there are no papillomas, then this analysis does not make sense in principle (carriage of the virus is possible, there is no treatment for the virus, so what to do next with the result of the analysis is unknown).
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 which specific types are included in the analysis. Some laboratories do research only on types 16 and 18, others - on all types together. It is also possible to take a test that will identify all 14 types of "high risk" virus in a quantitative format. Quantitative characteristics are important for 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. Analysis for HPV without cytology results (PAP test) most often does not allow drawing any conclusions about the patient's health status.
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 should be carried out using surgical methods (cryocoagulation, laser, radioknife).
No "immunostimulants" are related to the treatment of HPV and should not be used. None of the drugs widely known in our country have passed adequate tests that would show their effectiveness 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 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 procedures are needed.
It is only necessary to retake the analysis once a year and monitor the condition of the cervix (annually 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 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.