Papillomavirus infection( PVI) - Causes, symptoms and treatment. MF.

Papillomavirus infection( PID) is one of the most common urogenital viral infections transmitted sexually. The most frequent manifestation of papillomavirus infection is "genital warts" or genital warts. Already in the late 60s of the XIX century, when the methodical possibilities of studying a viral infection appeared, viruses were isolated from genital warts, the structure of which had much in common with viral particles of vulgar skin warts, which indicated the relatedness of these viruses. And indeed, both of them belong to human papillomaviruses, only to different types of them. But a papillomavirus infection is usually called a disease precisely when the papillomas are located on the genital organs.

How is transmitted papillomavirus infection

Transmission of PVI occurs only through sexual contact. The infection affects mainly young women who have an active sex life with different partners, and the spread of papillomavirus infection has recently increased dramatically.

Symptoms of papillomavirus infection

The incubation period for papillomavirus infection varies from 1 to 9 months depending on the state of immunity of the infected person, averaging 3 months. During this period, the papillomavirus infection does not manifest itself.

Symptoms depend on the type of PVI that caused the disease. Distinguish papillomavirus infection in the form of genital warts, flat and inverting( intra-epithelial) condylomas.

Genital warts basically look like single or multiple small( sometimes large or giant) papillary forms of pale pink formation on a short stem and resemble a wart, raspberry, cauliflower or a cock's comb. Depending on the location( on the external genitalia, vagina, cervix), genital warts can be bodily or intensely red, while maceration - whitish. Being exposed to ulceration, condylomas produce a liquid with an unpleasant odor. Giant condylomas can symmetrically be located on the large and small labia, grab the entire sexual gap, go to the femoral-inguinal folds. Occasionally they are located on the perineum, between the buttocks, and also isolated around the anus with the transition to the mucosa of his sphincter. Extensive condylomas can be localized around the urethra, forming a clutch.

As the growth of genital warts occurs painlessly, those infected with papillomavirus infection often do not notice them, and only with intensive growth of genital warts are they turned for help to a doctor. The appearance of significant secretions causes maceration, ulceration of the warts and skin, which leads to the appearance of itching and burning. With condylomata large and gigantic, patients have difficulty moving.

Papillomavirus infection of the cervix is ​​often asymptomatic and can only be detected with gynecological examination. These papillomas are very dangerous and have been proven to be involved in the occurrence of cervical cancer.

Diagnosis of papillomavirus infection

The diagnosis of genital warts is made on the basis of characteristic symptoms and usually does not cause difficulties due to the characteristic appearance of condylomas. Genital warts should be distinguished from wide condylomas, which are a manifestation of secondary syphilis. Unlike genital warts, they have a wide base, dense, do not bleed. In doubtful cases, it is necessary to examine the discharge to identify pale treponema and carry out serological reactions to the presence of syphilis.

The diagnosis of flat and endophytic genital warts on the basis of external examination is very difficult to put. In this regard, it is necessary to use additional research methods. Thus, papilloma virus infections of the vagina and cervix can be examined by colposcopy. A typical colposcopic picture is also of classic pointed condylomas. The lesion is a whitish epithelial formation with a finger-like outgrowth that imparts an irregular shape to the formation. The most important diagnostic criterion is the presence of a proper capillary network in these outgrowths, which is revealed after treatment of the lesion site with a 3% solution of acetic acid.

Diagnostic difficulties occur in the early stages of the disease, when the lesion has a small or rough surface. In this case, the capillary network is not observed, only the dilated vessels in the form of dots are visible. A similar colposcopic pattern resembles that of dysplasia and preinvasive carcinoma( in the foreign literature, the term "cervical intraepithelial neoplasia" is used for the latter lesions), but the surface roughness allows one to suspect early stages of development of genital warts.

Characteristic colposcopic signs, which allow to diagnose flat and inverted condylomas, are absent.

With certain experience of colposcopic examination, it is possible to isolate areas suspected of papillomavirus infection, severe dysplasia and malignancy, which is necessary for targeted biopsy. Nevertheless, additional methods should be used in setting the final diagnosis.

For the diagnosis of papillomavirus infection, particularly flat condyloma, cytological and histological examination of tissue removed by targeted biopsy is of great importance.

There is a number of data suggesting a link between papillomovirus infection and the development of squamous cell carcinoma, which obliges oncologic alertness to the papillomavirus lesions.

Treatment of papillomavirus infection

In connection with the foregoing, condylomas are always removed regardless of their type, location and size, especially since spontaneous cure for papillomavirus infection never occurs, and benign condyloma occurs in rare cases and can degenerate into carcinoma. Removed condylomas must be subjected to histological examination to exclude the combination with precancerous lesions and the possibility of malignant transformation.

Depending on the location and size of the condyloma, there are several ways to treat.

When genital warts are located on the external genitalia and in the vagina, they are removed using scissors or a scalpel under local anesthesia, after removing the condylomas, apply a pressure bandage to the wound surface for 5-6 days. However, surgical methods, including radical ones, sometimes do not lead to the desired effect, there are often observed relapses.

Treatment of cervical warts with the use of diathermocoagulation and cryosurgical method is possible.

Treatment with interferon( antiviral, antiproliferative and immunomodulating substance) of genital warts is very modest, although it is very effective in the treatment of PVI of other localization.

With the impossibility of surgical treatment of genital warts, podophyllin( cytostatic drug) is used: a napkin moistened with alcoholic solution of podophylline( podophylline - 20 g, ethyl alcohol 70% - 70 ml, collodion - 10 g), apply to condylomas at first for 3 hours, thenthe time of its application is increased to 24 hours. The treatment is repeated 1-2 times a week, until the condylomas disappear. It should be borne in mind that podophylline is a highly toxic drug and when it is overdosed, death may occur. You should not prescribe podophyllin to pregnant women, as the preparation dies of the fetus. Thus, both local and general side effects of podophylline limit its use.

For the treatment of patients with papillomovirus infection of the lower parts of the reproductive system, a CO2 laser is used( with high therapeutic effect).Pre-prophylactically appointed metronidazole, doxycycline, nystatin, immunomodulators. In women with a regular menstrual cycle, the CO2 laser exposure to the affected areas is carried out immediately after the end of menstruation. The advantages of this method are the rapid and complete healing of the wound surface without scar formation, safety during application during pregnancy.