Human papillomavirus is a benign tumor–like formation of the skin and mucous membranes of viral etiology. It has the appearance of a papilla on a narrow base (leg), soft or dense consistency, from light to dark brown. Localization on the skin leads to the formation of a cosmetic defect, in the larynx – impaired breathing, voice, on the mucous membrane of internal organs – ulceration and bleeding. Relapses of the disease are possible, the most formidable complication is malignant degeneration. Removal can be carried out by electrocoagulation, cryodestruction, surgical excision, radio wave method or laser exposure.
Human papillomavirus are a disease affecting epithelial cells and the skin. Viruses with high and low oncogenic risk are distinguished among HPV. The oncogenicity is explained by the ability of the virus to integrate its DNA into the genome of human cells.
Getting into the human body, at the initial stage HPV affects the basal epithelial cells. Microtrauma, scuffs, cracks and other skin damage contribute to the penetration into the body. For a long time, the virus can primarily multiply without appearing clinically (chronic carrier). If the virus multiplies in the surface layers of the skin, then over time, even with the chronic carrier of the papilloma virus, cell hyperplasia is observed.
Since the human papillomavirus is unstable in the external environment, infection occurs through direct contact. Promiscuous sexual relations lead to infection; smoking, pregnancy, endometriosis, vitamin deficiency, immunodeficiency are predisposing factors for infection to occur when interacting with the virus. The risk of infection increases with frequent contact with naked human skin, for example, during massage.
Human papillomavirus is a neoplasm of the skin or mucous membranes and looks outwardly like a papillary overgrowth that protrudes above the surrounding tissue. Disease are localized on the skin, mucous membranes, in the inguinal region and on the genitals, in some cases human papillomavirus are found in the renal pelvis and on the mucous membrane of the ureters.
Since the human papillomavirus consists of connective tissue covered with skin and contains blood vessels, bleeding is possible when it is traumatized. The neoplasm grows upward outward in the form of scattered papillae in various directions and looks like cauliflower.
The skin color may not change, but in most cases, human papillomavirus have a color from white to dirty brown. A favorite localization is the skin of the hands and hands. In patients with immunodeficiency, HPV becomes widespread. Primary changes on the skin begin to manifest 1-6 months after infection. The concentration of the virus in the affected areas reaches a maximum by the 6th month from the moment of infection, this period is the most contagious.
Depending on the type of virus, the clinical manifestations are variable. So, vulgar form look like a solid lump with a diameter of 1 mm with a rough keratinizing surface. Vulgar are prone to fusion, and therefore often affect significant areas of the skin. Simple (vulgar) HPV are localized everywhere, but more often they affect the skin of the fingers and the back of the palms. In children, especially younger children, the knees are affected by papillomas, this is due to physiological characteristics, since children crawl without clothes. Usually vulgar HPV are located in groups, but it is possible for a single element to exist for several years for a long time. Immunodeficiency conditions and general diseases contribute to the spread of the process, in isolated cases, vulgar form is malignified.
The causative agents of plantar human papillomavirus are HPV 1,2,4. A few months after infection, a small shiny bump appears on the skin of the sole, which has all the signs of a normal human papillomavirus and is surrounded by a protruding rim. In some cases, daughter neoplasms of small sizes appear around one papilloma, which outwardly resemble bubbles. Then mosaic human papillomavirus is diagnosed.
Human papillomavirus on the soles are often painful, especially when walking. In about 30% of cases, they resolve themselves, self-recovery is more often observed in young children. They are often confused with calluses that appear between the fingers during prolonged squeezing. However, calluses, unlike papillomas, have a smooth surface and retain a skin pattern.
The causative agents of flat papillomas are HPV 3,10. These human papillomavirus are of unchanged skin color and look like smooth flat bumps, sometimes they can be yellowish or slightly pink in hue, more often rounded in outline. There are also polygonal plantar human papillomavirus. Neoplasms cause pain, itch, the affected area is hyperemic.
Filamentous papillomas are diagnosed in half of the applicants over the age of 50 for neoplasms on the skin, they are also called acrochords. They are localized on the skin around the eyes, in the groin area, in the armpits and on the neck. First, small cones of a yellowish hue appear, which later increase and gradually transform into dense elongated elastic formations up to 5-6mm in size. If the acrochords are localized in places where injury is possible, then they become inflamed and cause pain. Filamentous form are not prone to spontaneous disappearance. Patients with diagnosed filamentous HPV often have polyps of the rectum.
HPV 13, 32 cause local epithelial hyperplasia, which is characterized by the appearance of small papillary neoplasms on the mucous membrane of the mouth and on the red border of the lips, which slightly rise above the skin and tend to merge.
One of the rare HPV are Lewandowski-Lutz HPV (warty epidermodysplasia). Mostly children and teenagers get sick. Sometimes warty epidermodysplasia is familial in nature. Clinically, it looks like multiple red-brownish spotted on the hands and feet. If disease are located on the areas of the skin that are most susceptible to ultraviolet radiation, then in 30% of cases they are malignified and degenerate into malignant tumors with germination into neighboring tissues.
HPV, which are the causative agents of genital warts, can be at low, medium and high risk of oncological degeneration, therefore, when diagnosing genital warts, it is always necessary to undergo a PCR examination. The incubation period is from several weeks to several months. Since in some cases the changes are minimal, these human papillomavirus remain unnoticed. The main way of transmission is sexual. The risk group includes people with immunodeficiency and who often change sexual partners. Externally, they look like pink or pale gray pigmented pointed growths on the stem.
In most cases, there is pain, burning, itching, irritation when touching and rubbing underwear, often injured and bleeding. They are localized in the vestibule of the vagina, on the labia minora, less often genital warts are found in the vagina and on the cervix. In men, the opening of the urethra is affected. The affected area depends on sexual behavior. For example, in persons practicing anal contacts, genital warts occur in the perineum and in the perianal zone. In some cases, genital warts are diagnosed on the oral mucosa and on the red border of the lips, which is again associated with the peculiarities of sexual life.
Juvenile laryngeal HPV are rarely registered, they are caused by HPV 6,11; mostly children under five years old are ill. Infection occurs during childbirth, when a woman in labor has HPV in the vagina and the baby, while passing through the birth canal, takes a premature breath. The disease is characterized by HPV growths on the vocal cords, which leads to difficulty in air circulation and speech disorders.
Diagnosis of HPV is carried out by a dermatologist or venereologist. Due to the large number of virus types, it has its own characteristics. It is possible to make an accurate diagnosis based on a visual examination only in the classic case of genital warts, but this does not provide accurate information about the type of virus and its oncogenicity. Therefore, if the papillomatous nature of neoplasms is suspected, they resort to PCR diagnostics of the DNA of the virus.
PCR diagnostics allows not only to confirm the presence of human papillomavirus in the body and determine its type, but also to diagnose how many viruses are present in the body at the time of the analysis. This is of diagnostic importance, since knowing the percentage of the virus and its type, it is possible to determine the approximate timing of infection and identify contact persons for the purpose of examination and prescribing preventive therapy. PCR diagnostics also provides information on whether HPV have a chronic course or they are the result of a simultaneous decrease in immunity. Thanks to such data, adequate therapy can be prescribed.
If the only method of treatment is the removal, then in parallel with the surgical intervention, a biopsy is performed for cytological examination. Histological examination gives more accurate results, since both cells are subject to examination, as well as the correctness of the arrangement of their layers and the features of the structure of the tissue. This gives reliable results about the degree of changes in the body and the likelihood of malignancy, since long-term and untreated HPV more often lead to oncological diseases than HPV detected in time with a high degree of oncorisk.
As a rule, PCR diagnostics is screening in nature and, if the analysis confirms the presence of the virus, an additional study is carried out.
The treatment regimen is selected individually in each case. If HPV is detected during diagnosis, but there are no clinical manifestations yet, then preventive therapy with cytostatics is prescribed. It is quite effective and allows you to “put to sleep” the virus for several years. Patients who are carriers of HPV are recommended to periodically conduct a PCR examination and use barrier contraceptives in order not to endanger their partner’s infection with the human papillomavirus.
Inosine pranobex is a drug for the treatment of HPV from the group of antiviral agents that suppresses the reproduction of viruses. It is one of the most preferred, as it has immunomodulatory properties. Indications for use are diagnosed HPV with a combination of other viral infections, such as cytomegalovirus infections, measles and mumps viruses. The presence of herpes virus, chronic viral hepatitis and immunodeficiency also requires the inclusion of Isoprinosine in the treatment regimen. Since HPV therapy is long-term, inosine pranobex should be taken only under the supervision of a doctor, since laboratory monitoring is necessary. The use of immunomodulators and vitamin courses are indicated for all patients with HPV.
If there are manifestations of HPV on the skin and mucous membranes, then depending on the localization and symptoms, cryodestruction of papillomas, electrocoagulation or removal of papillomas by laser is resorted to. It is possible to use another modern method of surgical treatment – removal of papillomas by radio waves. If the papilloma has signs of malignancy, then excision of the affected area with a scalpel is performed with the capture of healthy tissues.
It should be borne in mind that the removal of papillomas does not lead to a complete recovery, since there are currently no drugs that have a detrimental effect on HPV. Therefore, patients with previously diagnosed papillomas need to be periodically examined and undergo courses of antiviral therapy.
Since HPV is mainly transmitted sexually, the only prevention of HPV is a barrier method of contraception. When planning a pregnancy, it is necessary to diagnose and, if necessary, treat the virus in order to reduce the likelihood of infection of the child during childbirth and in the first years of life.