Papillomavirus infection

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

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

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Causes papillomavirus infection

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

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Risk factors

• Age over 35 years.
• Cervical pathology.
• History of STIs.
• Prostitution.

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Pathogenesis

Transmission routes - contact, including sexual. The virus can be transmitted from mother to child during childbirth.

Perinatal transmission of papillomavirus infection during childbirth is rare. Perinatal infection usually manifests clinically within 2 years. The presence of genital warts in children over 18 months, especially over 2 years, should indicate the possibility of sexual abuse. HPV is detected both in damaged tissues and in unchanged epithelium. In 80% of cases, with an unchanged cervix, HPV type 16 is detected. Among young women (average age 22.9 years), HPV is detected in 33%. Most often, this virus is detected in the cervical canal of the cervix and vulva (46%). In most cases, the cause of infection is HPV types 16 and 18. Not all women infected with oncogenic types of HPV, including types 16 and 18, develop a clinically pronounced disease that develops into cervical cancer.

The incubation period is 2–3 months for external warts, not precisely established (years) for precancerous and cancerous warts.

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Symptoms papillomavirus infection

• Development of exophytic growths on the skin and/or mucous membranes of the anogenital area, similar to cauliflower; keratinized nodules rising above the skin level. Sometimes they can cause bleeding, itching, discharge.
• In women, the most common localization is the cervix. Often, several areas are affected simultaneously (for example, the cervix, vagina, vulva, etc.).
• The size and number of warts varies.
• Warts may increase in size and number during pregnancy.
• External clinical manifestations rarely become malignant.
• Only certain types of HPV cause cervical and anorectal cancer, as well as cancer of the vulva and penis.

Complications and consequences

Cervical cancer.

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Diagnostics papillomavirus infection

Laboratory diagnostic methods

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

Taking clinical material

• In asymptomatic forms - scraping of the epithelium of the urethra and/or cervical canal to detect oncogenic types of human papillomavirus.
• When oncogenic types of human papillomavirus are detected, a cytological examination is mandatory to determine the degree of epithelial dysplasia.
• If warts are localized on the cervix, a colposcopy is performed, and if they are localized in the area of the external opening of the urethra, a urethroscopy is performed.
• If there are external genital warts, then HPV typing is not performed.
• Serological testing is not performed.
• 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 genitals or cervix, after 3-5 minutes subclinical damage can be detected in the form of whitened areas. This method is not performed on patients with clinically visible damage.

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Differential diagnosis

• Molluscum contagiosum.
• Micropapillomatosis of the labia.
• Pearly penile papules.
• Seborrheic keratosis.
• Intradermal nevus.
• Cancer in situ.

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

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Treatment papillomavirus infection

If complications develop, consultation with related specialists is required. If malignancy is suspected, consultation with an oncologist is required.

The doctor's procedure when a diagnosis of papillomavirus infection is established

1. Informing the patient about the diagnosis.
2. Providing information on the recommended regimen during treatment.
3. Collection of sexual anamnesis.
4. All sexual partners of the sick person are involved in the identification and examination.
5. Conducting epidemiological measures among contact persons:
   • examination and screening of contact persons;
   • laboratory data statement;
   • deciding on the need for treatment, its scope and observation period.
6. If high-risk human papillomavirus is detected in the cervical canal of women, it is necessary to undergo a colpocytological examination once a year, and if stage III cervical dysplasia or cervical cancer is detected, observation and treatment by an oncogynecologist is necessary.
7. If there are no results from treatment, it is recommended to consider the following possible reasons:
   • non-compliance with treatment regimen, inadequate therapy;
   • relapse of the disease.

Prevention

Prevention is common for all sexually transmitted infections.

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Forecast

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

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