Modern approaches to the treatment of human papillomavirus infection of the urogenital tract

Papillomas are a widespread phenomenon in modern society. According to medical statistics, they are observed in one form or another in 80% of people and are benign small tumor-like formations on the skin and mucous membranes of different parts of the body. They are only one of the manifestations of infection with the human papillomavirus (HPV), of which there are more than 190 types. Among them, viruses with high, medium and low oncogenic risk are distinguished. Therefore, in addition to an aesthetic drawback, papillomas can pose a serious danger to human life and health, since some of them can transform into malignant tumors.

What is HPV

The human papillomavirus affects only humans, and its main mode of transmission is sexual. Therefore, HPV is most common among sexually active people. This explains the fact that most often infection occurs at a young age at the beginning of sexual activity and at its peak, i.e. 15-25 years. Moreover, several strains (types) of HPV can be present in the human body at the same time, provoking the appearance of different types of tumor-like formations on the skin and mucous membranes.

The disease caused by HPV is called papillomatosis.

Infection with the virus occurs when it comes into contact with the skin or mucous membranes with particles of exfoliated skin or mucous membrane of an infected person. They attach to the membranes of immature epithelial cells, from where they penetrate into the cytoplasm of the cell, and subsequently into the nucleus. It is the cell nucleus that contains DNA, which is damaged by HPV. As a result, when the affected cell divides, the consequence will be the formation of not healthy new cells, but those that already have altered genetic information, which leads to failures in the mechanism of their reproduction and differentiation. This causes the appearance of tumors on the skin and mucous membranes.

HPV infection can lead not only to the formation of papillomas, but also warts, as well as flat and genital warts. However, it can also be asymptomatic. In this case, the patient will not show external signs of human papillomavirus infection, but he will act as a carrier and can infect others through unprotected sexual intercourse or at home.

Thus, HPV infection does not always lead to the formation of papillomas. This depends on the strength of the person’s immunity, but more often the first small papillomas appear 1-6 months after infection.

The human papillomavirus is intracellular. Therefore, with sufficient strength of the immune system, the body successfully suppresses its activity and does not allow it to provoke cell proliferation. But when the immune system is weakened as a result of certain factors, the body’s defenses fall, the virus becomes more active, which leads to the formation of papillomas.

All strains or types of HPV can be divided into 4 groups:

• non-oncogenic – strains 1-5, 63;
• low oncogenic risk – strains 6, 11, 40, 42-44, 54, 61, 70, 72, 81;
• medium oncogenic risk – strains 26, 31, 33, 35, 51-53, 58, 66;
• high oncogenic risk - strains 16, 18, 39, 45, 56, 59, 68, 73, 82 (types 16 and 18 are considered the most dangerous).

HPV strains of high oncogenic risk have special genes in their DNA that are responsible for the synthesis of specific oncoproteins (E6 and E7). Therefore, when it is integrated into the DNA of a human cell, its anticancer protection decreases. Oncoproteins destabilize the genome of skin cells, provoke their active reproduction and suppress the ability to differentiate. Therefore, this is fraught with a high risk of developing cancer when infected with strains of the human papillomavirus of high oncogenic risk.

The magnitude of the danger that papillomas pose directly depends on the type of HPV. Infection with strains with a high oncogenic risk is dangerous due to the development of:

• cervical cancer;
• malignant tumors of the anus, vulva, penis;
• oropharyngeal cancer, etc.

70% of cases of cervical cancer are caused by infection with types 16 and 18 of HPV.

But even when infected with strains of low oncogenic risk and the formation of papillomas, they should be treated carefully. Convex neoplasms are often injured by items of clothing, bleed and tend to become inflamed. At the same time, perhaps the greatest discomfort is caused by formations on the genital organs, which cause severe discomfort and complicate the conduct of an intimate life. In such cases, a secondary infection may occur, which can cause the development of purulent-septic complications. In addition, papillomas can form on the mucous membranes of almost any internal organ, which leads to disruption of their functioning. Thus, papillomatosis of the upper respiratory tract often occurs, which causes difficulty breathing.

Important numbers: the statistics are scary

• In the last 10 years, the number of people infected with hpv
  has increased 12-fold.
• HPV ranks second after genital herpes among all female infections and is found in 70% of adult women.
• Papillomavirus is the cause of all cases of cervical cancer.
• HPV is associated with 50% of anogenital cancers.
• The greatest risk of infection is between the ages of 18 and 25. The peak age for development of cervical dysplasia is 30 years, and cervical cancer is 45 years.

Causes of papillomas formation and risk factors

HPV can be transmitted sexually, as well as from an infected mother to a child during childbirth. The contact and household route of transmission of the virus cannot be ruled out, i.e. by sharing towels, clothes, etc. This explains the high prevalence of HPV in the world. Self-infection is also possible. In this case, if one papilloma is injured, the virus can be transferred to healthy areas of the skin and infect them.

The main causes of HPV infection are frequent changes of sexual partners and unprotected sexual contacts.

But infection with a virus does not always lead to the formation of papillomas, condylomas, etc. The likelihood of developing papillomatosis depends on various factors:

• immunodeficiency of any origin, including taking drugs that suppress the immune system (immunosuppressants, cytostatics, etc.), the presence of HIV infection, radiation injury;
• a decrease in the body’s defenses against the background of physiological changes during pregnancy;
• early onset of sexual activity, when the immune system is not yet fully formed and strengthened;
• microtraumas of the skin and mucous membranes;
• infection with highly oncogenic strains of HPV;
• the presence of several types of HPV in the body at the same time;
• the presence of other sexually transmitted diseases (STDs), in particular gonorrhea, trichomoniasis, herpes, cytomegalovirus infection, Epstein-Barr virus, hepatitis B and C, etc.;
• hormonal imbalances;
• exhaustion of the body, hypovitaminosis, chronic fatigue and severe stress;
• multiple births and abortions;
• the presence of severe chronic diseases, in particular diabetes;
• maintaining an unhealthy lifestyle, having bad habits;
• poor living conditions.

Older and overweight people are more prone to the formation of papillomas. At the same time, their tumors often form in the folds of the skin, which contributes to their injury and inflammation.

Types and symptoms

Neoplasms caused by HPV infection can form on the skin and mucous membranes of various parts of the body, including the face, neck and décolleté. They can also form on the arms, legs, back, genitals, including the perineum, labia minora and majora, vulva, vagina, cervix, penis, especially along the coronary sulcus and frenulum. Damage to the mucous membrane of the oral cavity, tongue, nasopharynx, esophagus, bladder, conjunctiva of the eye, trachea and other internal organs is possible.

The human papillomavirus can lead to the appearance of neoplasms of various types. In general, they can be divided into 3 groups, although in all cases the cause of their appearance is the same - infection with the human papillomavirus.

• Papillomas are benign neoplasms of pink, white, pearl or light brown color, most often forming on the eyelids, lips, chest, armpits, and neck. They are located singly and usually do not tend to merge even with multiple lesions. Papillomas are usually round or lumpy, resemble the head of a cauliflower, and often have a stalk.
• Condylomas are benign formations of a dirty brown or paler color in the form of a cock's comb or many villi united by a common base. They are most often found in the genital area, anus and near the mouth. They tend to merge with each other and, as a result, cover large areas of the body. Their appearance is caused by infection with HPV types 6 and 11. There are pointed, flat and intraepithelial condylomas.
• Warts are uneven, light, benign tumor-like formations in the form of a plaque or small nodule on the surface of the skin of the hands, near the nails, feet, face, and front of the body. Warts can be similar to papillomas, but differ from them in that they have a wide base. They usually occur when infected with HPV types 1-5, 7-10, 12, 14, 15, 17, 19-24.

Such tumor-like formations can vary in size from a few millimeters to large growths covering large areas of the skin or mucous membranes.

Also, neoplasms may differ in appearance, which directly depends on the type of HPV that entered the body. The most common ones are:

• Vulgar or ordinary - protrusions of dense consistency with a diameter of more than 1 mm. They tend to merge and be located in groups.
• Plantar warts are protruding above the surface of the skin, often painful bumps with a shiny surface and rim. A characteristic feature is the absence of a skin pattern. They provoke the formation of HPV types 1, 2, 4.
• Flat papillomas are soft, smooth, flat, usually round growths that have a normal skin color or slightly yellowish, pinkish. They can provoke itching, so they are often injured, painful and inflamed. The reason for their formation is HPV strains 3 and 10.
• Filiform (acrochordas) are one of the most common papillomas, especially among elderly patients. Most often they are found on the face, around the eyes, in the groin, armpits, and neck. They are yellowish in color and tend to gradually enlarge, turning into bumps with a dense but elastic consistency.
• Genital warts in the perineal area, genitals.

Papillomas can be visible to the naked eye or located deep in the skin or mucous membranes. In the latter case, they are called endophytic and one of their manifestations is cervical dysplasia. Damage to the female internal genital organs by papillomatosis may be indicated by:

• itching, burning, weeping in the perineal area;
• profuse leucorrhoea;
• spotting, particularly after sexual intercourse;
• discomfort during intimacy.

Sometimes papillomatosis can provoke pain in the back and pelvis, weakness, swelling of the legs and causeless weight loss. Such signs are among the most alarming, as they may indicate the development of complications of HPV infection.

Diagnostics

If papillomas form on the body, face or genitals, you should consult a dermatologist. This will allow not only to diagnose human papillomavirus infection at an early stage, but also to take measures to prevent the formation of new elements, as well as monitor changes in existing ones.

It is especially important not to delay visiting a doctor if there are signs of growth, change in color of the papilloma, unpleasant odor or pain in the area where it is located.

First of all, the doctor will perform a dermatoscopy, i.e., an examination of the tumors using a special magnifying device. This will make it possible to determine their nature, as well as to notice dangerous signs indicating a high probability of degeneration of a benign tumor into a malignant one, not to mention the formation of a cancerous tumor. When detected at an early stage of development, they can be successfully treated and have a favorable prognosis in the future.

Patients are recommended to be tested for the presence of STDs, especially if condylomas are detected in the genital area. Also in such situations, women are advised to consult a gynecologist, and men - a urologist. This is important for diagnosing the presence of human papillomavirus infection of the cervix, urethra, etc. and, if necessary, prescribing appropriate treatment.

To confirm papillomatous infection, patients are usually prescribed a PCR test. With its help, it is possible not only to confirm or refute infection with the human papillomavirus, but also to accurately determine the strains.

Folk remedies

On the Internet you can find many recipes and techniques for removing papillomas and condylomas. However, you should not self-medicate. Only a doctor can safely and effectively get rid of the problem. Any attempts to bandage the formation with thread, cauterize it with celandine juice and other popular folk methods can provoke complications.

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Treatment and removal of papillomas

Treatment of human papillomavirus infection is always complex. Of course, you can simply remove the disturbing papilloma, but in this case there is a high risk that a new one or even several will soon form in its place. Since the main reason for the formation of papillomas is a decrease in the body’s own defenses, which allows HPV dormant in the body to become more active, patients with papillomatosis are first prescribed drug therapy. It includes taking immunomodulators and antiviral drugs. For extensive lesions of the skin and mucous membranes by papillomas, cytotoxic drugs can also be prescribed. But their use is carried out under the supervision of a doctor, since they can provoke serious side effects.

If a patient is diagnosed with concomitant infections or diseases, he must be prescribed treatment appropriate to the situation, and sometimes it is additionally necessary to obtain advice from a specialized specialist and undergo therapy under his supervision.

Condylomas of all types are subject to mandatory removal, as well as papillomas, which are often injured and inflamed. In other cases, removal is carried out at the request of the patient. But it is possible to begin eliminating visible manifestations of HPV infection only after completing treatment for concomitant diseases, if any have been identified, and while antiviral therapy is continued.

In general, all modern methods of destruction or removal of papillomas can be divided into 2 large groups:

• chemical - involve the use of various chemical compounds to remove papillomas, including trichloroacetic acid, Solcoderm, Ferezol, Collomak, etc.;
• physical - involve the removal of papillomas surgically, using electrocoagulation, cryodestruction, laser, radio wave or plasma coagulation.

After removing the papilloma by one method or another, it is important to use topical products prescribed by your doctor to speed up healing and eliminate the risk of infection.

The success of treatment and especially the removal of papillomas depends on the strength of the immune system. In its normal state, in 90% of cases, within 2 years from the moment of infection, HPV is suppressed or even completely destroyed. But this does not guarantee that there is no risk of re-infection or the formation of new papillomas. If immunity is reduced due to certain factors, papillomatosis becomes chronic, periodically relapses and can lead to serious complications.

In order to prevent infection with dangerous strains of HPV and the development of severe complications, it is recommended, especially for girls, to be vaccinated with Gardasil or Cervarix vaccines between the ages of 9 and 25.

Surgical removal of papillomas

The essence of the method is to remove the tumor using a scalpel, which is associated with the formation of scars and an increase in healing time. Therefore, it is used only when it is necessary to remove a large papilloma or in cases where it is necessary to conduct a histological examination, since the formation of malignant cells is expected in it.

The procedure is performed under local anesthesia, which ensures its painlessness. The doctor uses a scalpel to remove the tumor itself, including surrounding healthy tissue. This is necessary to eliminate the risk of re-formation of papilloma in the same place. If it has a pedicle, it is cut with surgical scissors, and the blood vessel that fed the neoplasm is “sealed” using an electrocoagulator. The remaining wound is sutured, treated with an antiseptic and covered with a sterile bandage.

Today, surgical removal of papillomas is mainly carried out if there is suspicion of the formation of cancer cells.

Cryodestruction

The method involves the use of low temperatures to destroy papilloma cells. This is achieved through the use of liquid nitrogen, the temperature of which is -196° C. The essence of the procedure is to use a special attachment or touch the papilloma with a cotton swab dipped in liquid nitrogen. Under its action, the water contained in the cells instantly turns into ice crystals, which destroy them from the inside. The procedure is performed under local anesthesia or without it, since the exposure time to liquid nitrogen does not exceed 5-20 seconds.

The complexity of the method lies in choosing the correct duration of exposure in order to remove the papilloma to its full depth and not harm healthy tissues, which will lead to scar formation.

Immediately after treatment with liquid nitrogen, a white spot forms at the site of the papilloma. Subsequently, a small blister with clear or pinkish liquid contents forms on it, and the surrounding skin turns red and may swell slightly. This may be accompanied by minor discomfort such as a burning or tingling sensation.

After 3-4 days, the blister bursts, and in its place a crust forms, which itself falls off after a few days, revealing healthy young skin. Under no circumstances should you pierce the bubble yourself or injure it or the crust in any other way.

Cauterization of papillomas with liquid nitrogen is possible only in cases where the possibility of the formation of malignant cells in it is completely excluded. This method is most often used to remove papillomas and condylomas on:

• centuries;
• face;
• small joints;
• genitals.

Laser removal of papillomas

The use of a laser to remove papillomas is also possible only in cases where their malignancy is completely excluded. The procedure is carried out under local anesthesia and consists of evaporating moisture in papilloma cells using thermal laser energy. Thus, a focused laser beam is directed at the tumor. The duration of exposure does not exceed 1 minute.

As a result, a crust forms at the site of the papilloma, and the surrounding skin turns red and swells. The crust will come off on its own within a week. It should not be wetted and steamed for 3 days, nor should it be torn off or injured, as this can lead to the formation of scars. In addition, for 2 weeks after removal of the papilloma, you should protect the treatment area from sunlight. Otherwise, there is a high probability of hyperpigmentation of this area.

When removing papillomas on the face with a laser, decorative cosmetics should not be applied to the affected area until complete healing.

After the crust falls off, healthy pink skin is exposed, which gradually acquires a normal shade. This is the main advantage of laser removal of papillomas, since it is not associated with the formation of scars. They can only form when large tumors are removed and the rules of care in the postoperative period are violated. Also, laser removal completely eliminates the risk of wound infection and is an absolutely bloodless method, since under the influence of thermal energy, instant coagulation of small blood vessels occurs.

Using a laser, papillomas are mainly removed on:

• hands;
• legs and feet;
• face;
• centuries;
• neck;
• genitals.

Laser is the only reliable way to remove plantar warts, as their roots can go 1 cm or more deep into the tissue.

Electrocoagulation of papillomas

The essence of the method is to use electric current to remove papillomas. Using a special device called an electrocoagulator, the doctor captures the papilloma and cuts it off within healthy tissue. In this case, bleeding is completely absent, since the thermal energy of the current is enough to coagulate small blood vessels. But the procedure can be painful, especially if it is necessary to remove a tumor in areas of the body with delicate skin.

After electrocoagulation, a crust also forms. And the entire recovery period takes 7-10 days. After the crust falls off, the skin underneath should be protected from damage and exposure to ultraviolet radiation.

The method is used to remove papillomas in different parts of the body. Moreover, electrocoagulation can also be used in cases where it is necessary to conduct a histological examination of the neoplasm and accurately determine its nature. But the result of the procedure completely depends on the qualifications and experience of the doctor, however, as in other cases, since if the removal is not deep enough, the papilloma can form again in the same area.

Radio wave surgery

This method is one of the most advanced in removing papillomas of any kind. It involves the use of a special Surgitron device. But at the same time, it has much in common with laser removal of papillomas. The procedure is carried out under local anesthesia, and the actual removal occurs due to the effect of radio waves on the tumor. Thanks to them, it is possible to completely cut off papilloma of any size and location, and also avoid the formation of scars.

Cryodestruction

This removal method is only used for skin tags. It consists of a short-term effect on the formation of liquid nitrogen. Pathological tissues are destroyed by flash freezing.

Cryodestruction

The advantages of cryodestruction include easy tolerance by the patient, no need for anesthesia and no risk of scar formation. Disadvantages are difficulty in controlling the depth of impact and a longer rehabilitation period.