Papillomavirus infection – one of the most common and socially significant diseases in the world, since most of the sexually active population has contact with the human papillomavirus during their lifetime. According to modern studies, the frequency of infection with this virus in the age group of 16-29 years is 45-81%. The approach to managing patients with papillomavirus infection of the genitals and diseases of the cervix in the work of a gynecologist is of great importance, since the wrong tactics can contribute to the progression of the process, the appearance of various complications and a decrease in the patient's quality of life.
Currently, about 200 different genotypes of the human papillomavirus (HPV) are known, which are found in the tissues of various pathological formations of the human body, however, more than 40 varieties of HPV are detected mainly in the epithelium of the anogenital region.
It is known that most people infected with papillomavirus infection (PVI) are asymptomatic in a transient form. At the same time, HPV-induced changes in the epithelium are of a transient nature and in 70% of cases are resolved within 1 year, and 90% of cases – within 2 years due to the formation of virus-specific cellular and humoral immunity. However, in some cases, the virus is not eliminated, but remains in the tissue for a long time, and as a result, a pathological transformation of normal epithelium into dysplastic one may occur.
Dangers posed by human papillomavirus
HPV is capable of exerting a productive or transformative effect on target epithelial cells. The result of these processes are both benign papillomas and condylomas of the skin and mucous membranes, as well as dysplasia of various degrees of severity up to malignant neoplasms.
The incidence of cervical intraepithelial neoplasia is 10 times higher than the incidence of a similar pathology in the vagina or vulva. This is due to the fact that the transformation zone of the cervix has a specific risk of carcinogenicity in PVI, since HPV is tropic to cells in a state of metaplasia. It is important to note that HPV has evolved various ways to "bypass" immunological surveillance by the macroorganism, while in some cases there is a chronic relapsing course of infection with possible malignancy of the process. Long-term activation of the expression of viral oncogenes initiates a multi-stage process of genetic and epigenetic disorders that contribute to tumor progression. Human papillomavirus infection has been proven to be the leading cause of cervical cancer.
Studies show that for the development of cervical cancer, in addition to the persistence of HPV in an integrated form, the presence of cofactors is necessary:
- presence of an oncogenic genotype,
- combination of several virus genotypes,
- significant viral load,
- smoking,
- long-term use of hormonal drugs,
- comorbid urogenital infections,
- decrease in nonspecific resistance of the organism,
- the influence of genetic factors.
It is noteworthy that cervical cancer is the second most common oncological disease of the reproductive system in the world. According to the WHO, about 500,000 new cases of cervical cancer are diagnosed every year in the world, of which at least half are fatal. An important preventive measure in relation to cervical carcinoma is the timely diagnosis and adequate treatment of diseases of the cervix, primarily associated with HPV.
Human papillomavirus diagnostic methods
In the diagnosis of HPV infection, priority is given to the use of molecular biological methods to detect and identify HPV DNA. This allows not only to detect the infection, but also to find out how many genotypes are present at the same time, what is the viral load, and also in what form the virus is present – episomal or integrated. According to V.N. Prilepskaya et al. (2008, 2009), in 58% of cases of HPV detection in women with various genital pathologies, there are types of high oncogenic risk.
Currently, there is an opinion that diagnostics aimed at predicting cervical pathology should be based on cytological screening, supported by PCR diagnostics of the human papillomavirus and the introduction of specific molecular markers.
Treatment tactics for patients with papillomavirus infection
The approach to managing patients with PVI of the genitals and diseases of the cervix in the practical work of a gynecologist is of great importance, since the wrong tactics can contribute to the progression of the process, the appearance of various complications, the occurrence of iatrogenic conditions, significant material costs and a decrease in the patient's quality of life.
It is worth noting that there is still no single generally accepted standard for the treatment of patients with HPV-associated infection due to the presence of many controversial issues on this issue. A large number of methods have been proposed for the treatment of abnormally altered epithelium of the cervix, as well as the vagina and vulva, however, none of them is universal and without drawbacks, including the likelihood of recurrence, the formation of anatomical and functional disorders of the organ, as well as the adverse effects of smoke containing viral particles after the destruction of the infected focus, on the attending physician.
The choice of tactics for the treatment of HPV-associated diseases should be based on a correctly established diagnosis, morphological features, localization and size of lesions, the technical capabilities of the doctor, the patient's preferences and her reproductive plans, the presence of concomitant pathology, etc.
In recent years, significant progress has been made and the possibilities for the treatment of cervical pathology as the basis for the prevention of malignant lesions of this localization have significantly expanded. At the same time, it should be noted that, in general, the tactics of managing patients has become more gentle. Of the modern technologies for the destruction of pathological processes of the cervix, argon plasma coagulation (APC) is one of the most promising, effective and safe methods.
Unfortunately, it is not always possible to achieve a complete cure for PVI, in connection with this, the generally accepted goal of therapy is to remove the lesion, and not the complete elimination of the pathogen, or rather the cessation of its isolation from the lesion (given that the diagnostic methodology consists in the study scraping cells taken from these areas). This is due to the fact that the virus is located not only in the abnormal epithelium, but also in apparently healthy tissues along the periphery of the focus. In this regard, complex treatment should be considered optimal, including not only local effects on pathologically altered tissues, but also non-specific antiviral therapy.
In addition to various methods of destruction, the arsenal of medical treatments may include antiseptics, antibacterial and antiviral drugs to eliminate the inflammatory process of the cervix and vagina; hormonal preparations – with concomitant disorders of ovarian function, as well as immunomodulators.
It is known that any chronic infectious and inflammatory process is based on certain changes in the immune system, which are one of the reasons for the existence of this process, therefore, local and / or systemic use of immunopreparations in some cases can be used as an alternative treatment for extensive lesions and / or recurrent processes, both in the form of monotherapy and as part of a combined treatment.
According to O.A. Mynbaeva (2011), the optimal method of treating the clinical manifestation of HPV would be the use of therapeutic vaccines, the mechanism of action of which is based on blocking viral genes or proteins necessary for infection, persistence and reproduction of HPV virions in epithelial cells, while cellular immune response would be activated, which would eliminate infected epithelial cells.
Based on the materials of "RMJ, 2015"
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