Treatment and prevention of progression of cervical diseases associated with human papillomavirus

Papillomas on the cervix: causes and treatment

Speaking about the reason for the appearance of papillomas, we are entering one of the most mysterious areas of medical knowledge - the nature of viruses.
These microscopic formations have a non-cellular structure, unlike most organisms living on Earth. They exist exclusively by parasitizing living cells. The papillomavirus we are interested in (HPV or HPV) penetrates skin cells, integrates into chromosomes and changes the tissue growth program. Cells begin to rapidly divide, growing to form papillomas. More than a hundred strains of HPV have already been identified, but not all of them are well studied.

How does HPV manifest?

• genital condylomas are multiple papillary formations on the mucous membranes of the genital organs. Many people do not pay attention to them, since these irregularities have existed since childhood, and people consider this their anatomical norm. In fact, the genital mucosa should be absolutely smooth;
• papillomas (warts) on the skin. Viral papillomas can disappear and appear on their own, as this is a manifestation of a viral infection;
• confluent genital warts. They have the appearance of cauliflower due to the fusion of genital warts into a single whole; they can be distinguished from other skin formations using a special apparatus (colposcope) using a vinegar test.

Why do papillomas appear?

There is only one reason for papillomas on the cervix – the entry of a virus into the body. But there are several ways through which he can penetrate. We list them in order of increasing likelihood of infection:

• Sexual contact with an HPV carrier. At the same time, the use of condoms, according to experts, is not able to protect against infection.
• Everyday route: when visiting public institutions (baths, swimming pools, etc.), through the use of hygiene items shared with the carrier.
• A child can become infected during childbirth if the mother has an acute form of the disease.

The immune system of a healthy person is so strong that it is able to overcome the papilloma virus. If immune cells control the virus, external forms of the disease do not develop immediately after infection. However, when the defenses are weakened (severe stress, fatigue, excessive alcohol consumption, smoking), the virus can become more active and cause the formation of papillomas, as well as associated pathologies.

How are papillomas diagnosed?

Exophytic papillomas (genital warts) of the cervix are quite simply diagnosed visually during a routine gynecological examination.
To improve visualization, the formations are treated with a 5% acetic acid solution.

As a result, a characteristic whitish-gray color appears and the vascular pattern intensifies.

Also, uneven staining with Lugol's solution is typical for papillomas.

Endophytic condylomas are difficult to distinguish by simple examination.

They can be seen only with the simultaneous presence of genital warts or with significant keratinization.

That is why, if such formations are suspected, the results of cytology and colposcopy become very important.

When making a diagnosis, a differentiation is made between flat condylomas and Naboth cysts (cysts of the cervix formed due to blockage of the gland ducts).

The disease is finally confirmed after histological examination.

Cytological examination (study of cellular structures) is also carried out for simple pointed papillomas on the uterine cervix.

Such tests can exclude cancer.

Molecular biological methods (PCR - polymerase chain reaction) are also used to assess the viral load and determine the type of virus.

Additionally, especially in preparation for surgical removal of papillomas, tests for HIV, syphilis, hepatitis B and C, and other urogenital infections may be prescribed.

The need for the latest tests is also determined by the fact that 90% of episodes of HPV infection are accompanied by the presence of other infections.

Diagnostic and therapeutic procedures are prescribed by a gynecologist, dermatologist, and venereologist.

If necessary, consultations are provided:

• obstetrician-gynecologist, if pathology is detected in a pregnant woman
• urologist, if you suspect the presence of formations in the urethra
• an immunologist if the disease developed against the background of immunodeficiency conditions and/or is characterized by persistent recurrence

Dysplasia and papillomas

If left untreated, highly oncogenic papillomavirus (mainly types 16 and 18) can lead to dysplasia. This is a precancerous condition in which a violation of the structure of the cervical epithelium and the replacement of normal cells with atypical ones are detected. This process is not yet malignant, but over time it can lead to cancer. The time of this transition is individual for each woman and depends on many factors: the strength of the immune system, heredity and others.

According to the observations of practicing doctors, the time for the degeneration of dysplasia into an oncological process varies from 10 to 20 years. If you get rid of the cause of cervical dysplasia - the papilloma virus - as early as possible, this will eliminate the unfavorable prognosis of the disease.

The best way to prevent cancer is regular examinations with a gynecologist and taking a control smear for oncocytology. You should visit a gynecologist every six months. Women who are HPV carriers should especially strictly follow these recommendations.

What kind of virus is it and where does it come from?

The human papillomavirus (HPV) lives in the blood, appears on the skin and mucous membranes and is transmitted from these areas by contact - by touch, i.e. it is not an infection transmitted exclusively through sexual contact. Moreover, the human papillomavirus can live in the body for a long time, even from birth, and appear for the first time in the middle of life due to a decrease in immunity.

You cannot associate the first manifestation of the virus with a recent infection - it could have happened a long time ago, although you did not know it.

According to official statistics, the prevalence of HPV is quite high - up to 70%, although doctors in their practice encounter it in 90% of cases. Fortunately, not all types of the virus are oncogenic.

Treatment of cervical papillomatosis

Modern schemes for getting rid of this disease are based on three main points:

• direct removal of formations;
• carrying out antiviral therapy;
• subsequent correction of immunity.

The optimal method for removing papillomas is determined taking into account the size, type, and presence of complications after consultation with a gynecologist. To date, many techniques have been successfully used:

• laser;
• radio wave;
• electrocoagulation;
• cryotherapy with liquid nitrogen;
• exposure to chemical solutions;
• surgical excision.

The question of whether a definitive cure for the papilloma virus is possible remains open. Most doctors agree that, outside of an exacerbation, HPV is not detected by modern diagnostic tools. An alternative point of view is that complex treatment allows you to forget about this disease forever, provided that re-infection is excluded.

Prices for services

Initial appointment with a gynecologist + ultrasound (assessment of complaints, medical history, examination in a gynecological chair, pelvic ultrasound, consultation)

Primary appointment – ​​visiting a doctor of a specific specialty for the first time. Make an appointment

1400 ₽ 1800 ₽

Repeated appointment with the gynecologist

With the exception of repeated appointments with doctors: Blatsios N.D., Dzhashiashvili M.D. Make an appointment

940 ₽ 1200 ₽

Ultrasound of the pelvis in women (uterine cavity, ovaries)

Make an appointment

1170 ₽ 1500 ₽

Why get tested for HPV

Cervical cancer is a disease with a proven viral etiology. Its causative agent is the human papillomavirus (HPV), an infection transmitted primarily through sexual contact. However, the more specialists accumulate knowledge about the nature of this disease, the more myths and misconceptions accumulate among the population. Today we’ll try to figure out what to believe and what not – and at the same time answer the most frequently asked questions about HPV.

Human papillomavirus - what is it?

First of all, it's a virus. Like all other viruses, it penetrates the cell, declares itself the local ruler and sets up a factory from the cell to produce its beloved self. These viral copies penetrate neighboring cells and take control of them in the same way.

Researchers have now identified more than 150 different types of HPV. Some of them cause small, harmless papillomas on the skin, and about 40 varieties prefer the tissue of the genital organs.

HPV is a highly contagious virus, easily jumping from person to person during any form of sexual contact, including petting. Due to its high contagiousness, almost every sexually active woman will be diagnosed with HPV at least once in her life.

What will happen to me if I am diagnosed with HPV?

Since HPV prefers to “settle” in the cells of stratified squamous epithelium, which is constantly renewed and exfoliated, in most cases no disease develops.

But if something goes wrong, HPV manages to integrate into the genome of the host cell and says: “I’m in the house.” From this moment on, the immune system ceases to recognize HPV, and the development of the disease begins. Which one depends on the specific type of HPV.

Some viruses are considered low-oncogenic and cause the development of genital warts (anogenital warts) in the genital area. These growths can appear on the skin and mucous membranes of the genital organs in men and women, around the anus, on the rectal mucosa or on the cervix in women. The most common low-oncogenic types are HPV-6 and HPV-11.

Genital warts can look very ugly, sometimes even scary, but they are easy to remove with the help of medications (not on your own! There may be such a chemical burn that it doesn’t seem like much) or surgical methods (cryotreatment, radio waves, laser or electrosurgery).

Highly oncogenic types of HPV (at least 14 different types) slowly but surely “enslave” all layers of the epithelium and penetrate deeper. This process does not manifest any symptoms at all, develops very slowly, but almost inevitably leads to the development of cancer of the cervix, anus and rectum, vagina, penis, mouth and throat. The most dangerous and “evil” types are HPV-16 and HPV-18.

How is HPV infection treated?

Whether you like it or not, attempts to treat HPV infection with all sorts of magical immunotropic drugs, extracts of potatoes, broccoli and some kind of flies are a waste of money.

You can find hundreds of domestic publications and studies telling how amazingly these medicines “work”. The problem is one thing - no one can claim that the virus is defeated by the pill, and not by the body’s own work. In women under 30 years of age, spontaneous clearance of HPV occurs in most cases.

If the virus has entered the integrative phase (into the “house”) and the development of an HPV-associated disease has begun, treatment can only be surgical. If these are genital warts, they must be excised; if this is a precancerous lesion of the cervix (CIN - cervical epithelial neoplasia) - the entire area of ​​the lesion (the doctor sees this place through a colposcope) must be removed.

What can I do to prevent the disease?

The principles of protection are the same as for other infections transmitted primarily through sexual contact. However, even constant and correct use of condoms does not exclude infection (HPV is highly contagious), although it significantly reduces the risk.

The onset of the disease caused by HPV is possible within 8–10 years from the onset of sexual activity, but in order to identify the initial signs of the disease, it is necessary not only to go to the gynecologist, but to undergo cervical screening: a cytological smear from the cervix from the age of 21 (not less than once every 3 years) and analysis for HPV of high carcinogenic risk from the age of 30 (at least every 5 years)1.

Debate has been going on for many years about at what age it is advisable to start HPV testing. In our country, they decided to add an HPV test to cytological screening from the age of 30, and in some countries, including the USA2, from the age of 25. But experts are unanimous on one thing: in young patients, HPV is detected in 90% of cases and leaves the body as quickly and easily as it is colonized. Therefore, there is no need to start testing too early - there will be a lot of unnecessary movements, tears and pointless attempts at treatment.

Does correct diagnosis guarantee protection against cancer?

It is important to understand: screening is good, but not ideal. Of course, the opportunity to catch cervical cancer in its pre-stages is a magical chance given to humanity by Georgios Papanicolaou, but there are many different “buts”.

The analysis must be taken well, transported carefully, colored correctly, viewed correctly - and at each of these stages, errors can, unfortunately, occur. In any case, the task of screening is to “catch” an already started disease at the stage of early, still precancerous, changes in order to cure it as quickly as possible.

But there is a second strategy - vaccine prevention, the task of which is to prevent infection at all. And we’ll talk about the possibilities of preventing HPV-associated diseases through vaccination next time.

Oksana Bogdashevskaya

Photo istockphoto.com

1 Benign and precancerous diseases of the cervix from the perspective of cancer prevention. Clinical recommendations (treatment protocol). Letter from the Ministry of Health of the Russian Federation dated November 2, 2017.

2 Society of Gynecologic Oncology (SGO) and the American Society for Colposcopy and Cervical Pathology (ASCCP): Interim clinical guidance for primary hrHPV testing 2015

When should you sound the alarm?

You should definitely visit a doctor if you have:

Painful sensations, the intensity of which often increases as menstruation approaches or during menstruation, as well as during sexual intercourse.

Intermenstrual bleeding. If they become bleeding, you should seek help immediately.

It is necessary to visit a doctor if you cannot conceive a child for a long time, since infertility, when the affected ovaries cease to function fully, can be a complication of endometriosis. The most common concomitant pathology of internal endometriosis (in more than 80% of cases) is uterine fibroids. The diseases are similar in their pronounced dependence on hormonal levels and excessive proliferation - tissue growth.

Pathological tissue in endometriosis can be localized outside the cervix: in the area of ​​the ovaries, pelvic peritoneum, fallopian tubes, and vagina. In the case of deep invasive endometriosis, the intestines, bladder, urethra, etc. may be involved in the process.

Against the background of endometriosis, there is a high risk of hypoxia and underdevelopment of the fetus, and subsequently, inhibition of its development.

Cervical papilloma has an equally dangerous complication - it increases the risk of developing cancer. Therefore, you should visit a gynecologist even in the absence of complaints, for the timely detection of asymptomatic pathologies.

This is why early diagnosis is so important in clinical practice. Ineffective treatment of these conditions can lead to serious consequences for women:

• formation of pain;
• psycho-emotional disorders;
• decreased quality of life.