Human papillomavirus infection is one of the sexually transmitted diseases associated with human papillomavirus (HPV).
HPV is considered a predisposing factor for cervical cancer, as well as other types of cancer: penis, oropharynx, rectum. There are about 1. 5 million cases worldwide each year.
The overall prevalence of human papillomavirus in the general population is 10% among women and 20% among men.
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HPV infection is more common among sexually active young women and men between the ages of 16 and 25.
About 50% of gay men who engage in anal sex are at risk of squamous cell carcinoma, which was previously anorectal warts.
For heterosexual men and women, this risk is 20%.
The most important predictor of HPV infection in men or women is the number of sexual partners.
About 189 HPV genotypes are classified according to their biological niche and carcinogenic potential. Among them, about 40 can affect the genitourinary tract.
| Risk category | HPV type |
| high risk | 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68, 73, 82 |
| low risk | 6, 11, 40, 42, 43, 44, 54, 61, 70, 72, 81, 83, 89 |
| Uncertain risk | 26, 53, 66 |
Women with invasive cervical cancer are more likely to be diagnosed with HPV type
16, 18, 33, 45, 31 and 58, but the clinical results may be different.
Recently, vaccination against HPV infection has become more and more popular, but according to experts, vaccination does not avoid regular visits to a doctor. There is evidence that the effect diminishes after 15-20 years. In addition, it is worth considering the effect of other unexplored viral genotypes for which vaccines have no effect.
Methods of diagnosing HPV infection
Please note that the diagnosis can be suspected by visual inspection, during which the lesion location and clinical manifestations of human papillomavirus infection can be determined.
There are many ways to diagnose HPV:
- Cytological methods (PAP test);
- Liquid cytology
- Extend the colposcopy;
- Urethral cystoscopy;
- PCR (polymerase chain reaction to confirm the presence of human papillomavirus DNA);
- Determine the viral load (HPV-Digene test), real-time PCR-a method to detect the copy number of DNA cancer-causing viruses;
- Morphological research;
- Determination of tumor markers and oncoproteins p16, ki67, mcm2, mcm7, etc.
PCR diagnosis of HPV
PCR diagnosis can be qualitative and quantitative (real-time PCR, HPV-Digene test).
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At present, cervical cancer screening and early detection of infection are recognized as the most effective measures to control cervical cancer.
The previous screenings for women were cytology and histology, but due to their low specificity, they need to be repeated in a short time. A PCR diagnosis with a negative result can reduce the frequency of examinations by a gynecologist (1 time/5-6 years).
It should be noted that the qualitative definition of HPV is not very informative because it only allows confirmation of infection. Therefore, in order to solve the problem that both men and women with clinical manifestations need treatment, it is best to perform the HPV-Digene test, which will reveal the virus. concentration.
When performing polymerase chain reaction, type and species-specific primers are used to quantify the risk of malignancy (malignant tumor). Viral load determination is the main purpose of these tests.
If the HPV DNA level is higher than 5000 genomes-the possibility of cancer is high, treatments designed to suppress the activity of HPV are needed. Less than 3000 genomes-low risk.
PCR diagnosis can detect all cancer-causing viruses in men and women.
In addition to detecting HPV, STD and HIV must also be diagnosed. These diseases are considered to be cofactors of human papillomavirus infection.
Since the relationship between HPV and cervical cancer, penile cancer, and rectal cancer has been confirmed, the molecular method of detecting HPV DNA in biological materials is reasonable. Use the following:
- Vaginal secretions and exudates from the cervix of women;
- Male urethral scraping;
- sperm;
- Anal secretions;
- Pharynx mucus;
A study conducted by Italian scientists showed that PCR diagnosis (88-100%) is more effective than cytology (34-86%) in preventing invasive cervical cancer.
The specificity of HPV detection (82-97%) is considered to be higher than the specificity of cytology (78-99%).
In most people, human papillomavirus infection resolves on its own without medication. However, in women over 30 years of age, HPV is rarely eliminated spontaneously. Therefore, within the framework of cancer vigilance, regular inspections are recommended. In the Russian Federation, according to current regulations, it is carried out once a year.
In some foreign countries, the results of PCR analysis and cytological examination of papilloma virus on women were negative, once every three years, the cytology was negative, but the polymerase chain reaction was positive. For highly carcinogenic types of HPV, colposcopy is performed once a year.
Men are checked by a urologist every year and found to be suspicious of papillomavirus infection. It is reasonable to consult a dermatologist.
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According to the indications, a biopsy can be performed especially when it is suspected of degeneration into a malignant tumor.
Female colposcopy
Colposcopy is the most accessible diagnostic method for women, and the results can be used to draw conclusions about whether to continue the examination.
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Studies have shown that 99-100% of cervical cancers are related to the highly carcinogenic type of human papillomavirus.
During prolonged colposcopy, the cervix is treated with solution or acetic acid. When interacting with it, the following conditions will occur:
- Whitening of the epithelium;
- Mosaic;
- Find out;
- Atypical transformation zone.
After dyeing with the solution, the modified area under the HPV background takes the form of "semolina".
In a cytology study, the main signs of infection were the appearance of keratocytosis and dyskeratosis in the cells, which was evidence in support of CIN.
Cytological diagnosis of HPV
This material was photographed with a special brush. Women-scrape from the suspicious area of the cervix, men-from the urethra, determine the type, number and changes of mucosal cells.
Pap smear, Pap test and liquid cytology
Pap smear-a non-invasive study used in gynecological practice that allows you to diagnose cervical cancer and endometrial cancer at an early stage before the development of clinical manifestations. The goal is to detect atypical cells in suspicious tumor processes. In the standard Pap test, the material obtained with the cell brush is stained and examined under a microscope.
In 1940, G. Papanikolaou developed a screening study to detect cancer to verify exfoliated cells suspected of being cancer or precancerous.
Liquid cytology analysis is a Pap test, a more modern and effective method of diagnosing HPV. When conducting research, biological materials are not placed on glass slides, but in a special liquid preservative.
Biopsy
Perform cervical targeted biopsy and cervical mucosal curettage and subsequent histological examination in the following cases:
- Detect atypical cells based on cytology results,
- Has a highly carcinogenic HPV type and changes found through colposcopy,
- There are obvious signs of pathology, regardless of the results of HPV testing.
For men, if you suspect HPV tumors, you can get a biopsy. If the wart is deep in the urethra, take biopsy material during the urethroscopy.
Histological examination
The histology of HPV is a diagnostic method that examines specially treated papilloma tissue under a microscope. This study provides 100% information for confirming malignant tumors.
Histological performance:
- Exogenous flat warts are accompanied by dyskeratosis and acanthosis,
- Cytoplasmic changes in squamous epithelium,
- СIN,
- Cervical cancer,
- Penile cancer
- Anorectal cancer.
Several options have been proposed for the control of human papillomavirus infection. In the first case, cytological studies are used, and in the second case, PCR diagnosis is used to determine whether HPV is transient. For this reason, it is necessary to perform PCR analysis again after 6 months.
Who needs to be tested for HPV
Qualitative tests are more commonly used for large-scale inspections for prevention. When clinical manifestations suspect HPV infection, quantitative tests are prescribed.
In addition, the indications for HPV testing are as follows:
- Unprotected "casual" sexual intercourse;
- Monitor the effect of treatment;
- Sexually transmitted infection testing;
- Overburdened gynecological history;
- HIV infection;
- Planning to become pregnant
- Have more than one sexual partner.
It is recommended that women of childbearing age undergo HPV testing every 3-5 years.
What kind of diagnosis is needed-the doctor will tell you.
Men are tested for HPV only when clinical manifestations are present, and sometimes the diagnosis is made when the partner has a heavy obstetric and gynecological history.