The mode of transmission of HPV infection
Sexually transmitted infections are mainly transmitted sexually. The infection indicates the presence of potential pathogens in the body, and the possibility of transmitting the infection to sexual partners. Great mobility of today's population contributes to the prevalence of pathogens. The causes of these infections can be bacteria (Chlamydia trachomatis, Neisseria gonorrhoeae, Treponema pallidum, Ureaplasma urealyticum, Mycoplasma hominis), parasites (scabies, pubic lice), protozoa (Trichominas vaginalis) and viruses like human papillomavirus, hepatitis B virus, herpes simplex, HIV (Human Immunodeficiency Virus) which, of all these pathogens, carries the most serious consequences.
Infection with human papillomavirus (HPV) is the most common sexually transmitted infection caused by a virus. This virus has a high affinity for squamous epithelium and reproduces in terminally differentiated epithelial cells. Today we know about 150 types of HPV, from which 40 species cause infections in the genital region, and only some genotypes have malignant potential.
Due to the microtraumas of skin and mucous membranes during genital contact, this easily leads to infection of the basal layer of stratified squamous epithelium of the genital tract, where the virus reproduces and disrupts the normal cell cycle. Most people are unaware that they are carriers of HPV and that the virus can be transmitted to their sexual partner, therefore, this is usually a transient infection. It is believed that almost every sexually active person, men and women, sometimes in life gets a HPV infection. The immune response of the body recognizes foreign agents and fight against them, and 90% of HPV infections our body overcome within two years and the person never have any clinically visible symptoms. But in some people, HPV infection can cause anogenital warts or other changes. There is no diagnostic method that can determine with certainty that a person will develop clinically visible changes.
The consequences of infection
The most serious consequence of persistent infection with oncogenic types of human papillomavirus is cervical cancer which is preceded by premalignant lesions of a certain degree (CIN cervical intraepithelial neoplasia). A person usually has no symptoms until the cancer is advanced. The basic method of detecting changes in the throat of the cervix is a regular Pap test screening (for women), as recommended by gynecologists. Cervical cancer can develop for years and decades after the HPV infection. Although much less common, HPV is the cause and respiratory papillomatosis, and cancer of the vulva, vagina, penis and anus.
A large number of patients have no clear symptoms, but today we have available diagnostic methods mainly based on methods of molecular biology that allow us to identify the pathogen quickly and easily, followed by appropriate treatment. Anogenital warts on the skin and mucous membranes of anogenital region usually occur in a few weeks or months after the infection. They do not cause any problems, except depending on the size and localization, rarely can cause itching or pain. They are diagnosed by clinical examination anogenital region (pointed or flat condyloma, etc.). If left untreated, warts can grow in number and size, stay the same or go away. In 10-20% of cases pointed warts can determine the presence and type of HPV with high risk, and flat condyloma are usually caused by viruses of high malignant potential type. For now there is no specific antiviral treatment of genital infections caused by the human papilloma virus, which also means an increased possibility of recurrence (relapse). Recurrences are particularly common in the first three months after the completion of treatment.
What are the treatment methods?
Treatment methods that we use can be destructive methods (excohleation, cryotherapy, electrocautery) which precedes the application of a local anesthetic or use of immunomodulatory agents. Deciding which method will be implemented depends on the extent of the disease, the clinical picture and agreement between therapist and patient. These methods of treatment are often combined. The treatment procedure is repeated several times, emphasizing that the use of destructive methods is often one and leads to prompt and effective treatment of visible lesions. The treatment removes visible changes in the skin and mucous membranes, thus trying to reduce the spreading of changes and significantly reducing the chance of passing infection to a partner. Good cooperation of patient and the implementation of treatment according to the instructions leads to better treatment success.
In addition to the visible changes, with the help of Peniscopy or colposcopy methods it is possible to determine the presence of subclinical HPV infection. For now, according to statistical data there are no uniform recommendations and opinions for the treatment of this phase of the disease. A latent infection however implies the absence of visible changes in the skin and mucous membranes, but the presence of the virus in the tissues, and the diagnosis is made after evidence of HPV DNA in tissue. If a woman has detected HPV infection, in 40-60 % of her male partner, it is possible to identify the signs of the same infection.
Tests for the diagnosis of HPV infection give us information on the genotypes HPV infection of high risk for cervical malignancy (16,18,31,33,35,39,45,51,52,56,58,59,68), or low-risk (6,11,42,43,44) which cause anogenital warts. One person is often infected with multiple HPV types.
Prevention of HPV infection
Prevention of HPV infection is responsible sexual behavior of all ages, especially adolescents and vaccination program by applying a vaccine against HPV types 6,11,16, and 18. Specifically, HPV type 6 and 11 are responsible for 90% of anogenital warts in both men and women, and HPV types 16 and 18 for more than 70% of cervical cancer cases. The vaccine has only a preventive, not therapeutic role, therefore, is not intended to treat. Vaccination significantly reduces the risk of anogenital warts caused by human papillomavirus in both sexes, cervical dysplasia and dysplasion lesions on the vulva and vagina, and most importantly, reduces the risk of cervical cancer.
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