How does non-sexually acquired HPV differ from sexually transmitted HPV. What are the common types of warts associated with non-sexual HPV transmission. How can non-sexually acquired HPV be diagnosed and treated effectively.

What is Non-Sexually Acquired Human Papillomavirus (HPV)?

Human Papillomavirus (HPV) is a diverse group of DNA viruses with over 200 identified types. While HPV is often associated with sexual transmission, it’s crucial to understand that non-sexual transmission is also possible and relatively common. Non-sexually acquired HPV infection occurs when the virus comes into contact with broken or macerated skin, typically through direct contact with infected skin or skin squames.

The primary types of HPV associated with non-sexual transmission include:

• HPV types 1, 2, 3, 4, 7, and 10
• These types are commonly linked to cutaneous warts
• They can affect various parts of the body, including hands, feet, and occasionally the anogenital region

Who is at Risk for Non-Sexually Acquired HPV Infections?

Non-sexually acquired HPV infections can affect individuals of all ages, but certain groups are at higher risk:

• Children and young adults
• Workers in meat, poultry, and fish industries (known as ‘butcher warts’ caused by HPV 7)
• Individuals with compromised immune systems, such as those with HIV/AIDS or organ transplant recipients on immunosuppressive drugs
• People with atopic dermatitis

How does immunosuppression affect the risk of non-sexually acquired HPV? Immunocompromised individuals are more susceptible to extensive and persistent HPV infections due to their weakened immune response, making it harder for their bodies to fight off the virus effectively.

Transmission Routes of Non-Sexually Acquired HPV

Understanding the various ways non-sexually acquired HPV can spread is crucial for prevention. Some common transmission routes include:

1. Autoinoculation: Spreading the virus from one part of the body to another, often from a wart on the hand to other areas
2. Caregiver transmission: A caregiver with HPV on their hands can inadvertently spread the virus during activities like diaper changes
3. Vertical transmission: From mother to baby during vaginal delivery
4. Direct contact with contaminated surfaces or objects
5. Shared personal items like towels or razors

Can non-sexually acquired HPV affect the anogenital region? While less common, it is possible for non-sexually acquired HPV to affect the anogenital area, particularly in children. This can occur through autoinoculation or during caregiving activities.

Clinical Manifestations of Non-Sexually Acquired HPV

Non-sexually acquired HPV infections can present in various forms, depending on the specific virus type and the area of the body affected. The most common manifestations are different types of warts:

1. Common Warts (Verruca Vulgaris)

These warts typically appear on keratinized skin, such as hands, feet, and knees. They present as dome-shaped, circumscribed, hyperkeratotic, and verrucous papules or nodules. While often asymptomatic, they can become painful if traumatized.

2. Plantar Warts (Verruca Plantaris)

Found on the soles of the feet, plantar warts appear as thickened areas with lost surface skin lines. They are distinguishable from corns by the presence of tiny black dots (thrombosed capillaries) and their tenderness to lateral pressure.

3. Flat Warts (Verruca Plana)

These are small, flat-topped, skin-colored papules, commonly found on the face. They can spread easily through shaving or other forms of minor skin trauma.

4. Filiform Warts

Characterized by their narrow base and fine, elevated keratotic fronds, filiform warts are typically found on the face.

5. Periungual and Subungual Warts

These warts affect the area around and under the nails, often resulting from picking or scratching warts elsewhere on the body.

How long is the incubation period for non-sexually acquired HPV? The incubation period can vary significantly, sometimes lasting up to 12 months. This extended period is evidenced by the appearance of warts in organ transplant recipients up to a year after their procedure.

Diagnosis of Non-Sexually Acquired HPV Infections

Diagnosing non-sexually acquired HPV infections typically involves a combination of clinical examination and, in some cases, additional tests:

• Visual inspection: Many warts can be diagnosed through careful visual examination by a healthcare professional
• Dermatoscopy: This non-invasive technique can help distinguish warts from other skin lesions
• Biopsy: In uncertain cases, a skin biopsy may be performed to confirm the diagnosis
• PCR testing: While not routinely used, polymerase chain reaction (PCR) can identify specific HPV types in research settings

Is it necessary to determine the specific HPV type for non-sexually acquired infections? In most cases, identifying the exact HPV type is not clinically necessary for treatment. However, it may be useful in research settings or in cases of persistent or unusual presentations.

Treatment Options for Non-Sexually Acquired HPV Infections

The treatment of non-sexually acquired HPV infections aims to remove the warts and stimulate the immune system to fight the virus. Several treatment options are available:

1. Topical Treatments

• Salicylic acid: Available over-the-counter, this treatment gradually removes the wart
• Imiquimod: An immune response modifier that stimulates the body’s defenses against the virus
• 5-Fluorouracil: A chemotherapy agent that can be applied topically to treat warts

2. Cryotherapy

This involves freezing the wart with liquid nitrogen, causing it to blister and eventually fall off.

3. Electrocautery and Curettage

These procedures involve physically removing the wart through burning or scraping.

4. Laser Therapy

For persistent or extensive warts, laser treatment may be used to destroy the affected tissue.

5. Immunotherapy

In some cases, treatments that stimulate the immune system, such as intralesional injections or oral medications, may be used.

How effective are these treatments for non-sexually acquired HPV infections? The effectiveness of treatments can vary depending on the type of wart, its location, and the individual’s immune response. Many warts will eventually clear on their own, but treatment can speed up this process and prevent spread.

Prevention Strategies for Non-Sexually Acquired HPV

Preventing the spread of non-sexually acquired HPV involves a combination of personal hygiene practices and awareness:

• Regular hand washing, especially after touching warts
• Avoiding direct contact with warts, both on oneself and others
• Not sharing personal items like towels, razors, or nail clippers
• Wearing protective footwear in public areas like swimming pools and locker rooms
• Keeping skin healthy and intact to reduce the risk of infection
• Promptly treating any warts to prevent spread

Can the HPV vaccine prevent non-sexually acquired HPV infections? The current HPV vaccines primarily target HPV types associated with genital warts and cancers. They do not provide protection against the HPV types commonly causing cutaneous warts from non-sexual transmission.

Long-Term Management and Follow-Up

Managing non-sexually acquired HPV infections often requires a long-term approach:

1. Regular follow-up appointments to monitor treatment progress
2. Adjusting treatment strategies if initial approaches are ineffective
3. Addressing any underlying conditions that may increase susceptibility to HPV infections
4. Patient education on self-examination and early recognition of new warts
5. Psychological support, especially for visible or persistent warts

How long should patients be monitored after successful treatment of non-sexually acquired HPV? While there’s no standard follow-up period, patients should be advised to monitor for recurrence and seek medical attention if new warts appear. Immunocompromised individuals may require more frequent follow-ups.

Research and Future Directions

The field of non-sexually acquired HPV research is continuously evolving, with several areas of focus:

• Development of more effective topical treatments
• Exploration of immunotherapies to enhance the body’s natural defense against HPV
• Investigation into the potential for broader-spectrum HPV vaccines
• Studies on the long-term impact of persistent HPV infections
• Research into the relationship between HPV and other skin conditions

What are the most promising new treatments for non-sexually acquired HPV on the horizon? Emerging research is focusing on targeted immunotherapies and novel topical agents that can more effectively stimulate the immune response against HPV. Additionally, there’s growing interest in combination therapies that may offer improved efficacy over single-modality treatments.

In conclusion, non-sexually acquired HPV infections represent a significant aspect of HPV epidemiology that is often overlooked. Understanding the transmission routes, clinical manifestations, and treatment options for these infections is crucial for effective management and prevention. As research continues to advance, we can expect more targeted and efficacious treatments to emerge, improving outcomes for those affected by non-sexually acquired HPV infections.

Non-sexually acquired human papillomavirus infection

Author: Umaima Khatoon, 5^th Year Medical Student, University of Auckland, Auckland, New Zealand. Medical Editor: Dr Helen Gordon, Auckland, New Zealand. DermNet NZ Editor in Chief: Adjunct A/Prof Amanda Oakley, Dermatologist, Hamilton, New Zealand. 2019. Revised September 2020. Copy edited by Gus Mitchell.

What is a non-sexually acquired human papillomavirus infection?

Human papillomavirus (HPV) is a small double-stranded DNA virus which has been classified into over 200 types based on genome sequencing. Each type is associated with infection at a particular anatomic site and clinical morphology.

HPV infections can be sexually transmitted or non-sexually acquired; this review focuses on the latter.

Transmission of non-sexually acquired HPV occurs when infected skin or skin squames are in direct contact with broken or macerated skin.

Who gets non-sexually acquired human papillomavirus infections?

Non-sexually acquired human papillomavirus infection is common in:

• Children and young adults
• Workers who handle meat, poultry, and fish — the so-called ‘butcher warts’ due to HPV 7.

Extensive and persistent HPV infection is seen in association with:

• Immunosuppression, such as acquired immunodeficiency virus (HIV) infection with acquired immune deficiency syndrome (AIDS), and organ transplant recipients on long-term immunosuppressive drugs.
• Atopic dermatitis.

What causes a non-sexually acquired human papillomavirus infection?

Cutaneous infection is mostly associated with HPV types 1, 2, 3, 4, 7, and 10, which cause common, flat, and plantar warts.

Non-sexually acquired HPV with the HPV types above can occasionally affect the skin of the anogenital region. Examples of transmission include:

• Autoinoculation from a viral wart elsewhere on the body, typically from a child’s hand
• Inoculation from the hand of a caregiver during a nappy change
• Vertical transmission from mother to baby during vaginal delivery.

What are the clinical features of non-sexually acquired human papillomavirus infection?

HPV infection of the skin can present with a clinical lesion ie, wart.  Subclinical infection or latent infection is normal-appearing HPV-infected skin. The incubation period can be as long as 12 months, as demonstrated by the eruption of viral warts a year after an organ transplant, or in early experiments injecting wart tissue to demonstrate infectivity.

The clinical manifestations of non-sexually acquired HPV are classified according to the anatomical site and lesion morphology. Warts may be solitary or multiple, and when multiple are often clustered or in lines due to autoinoculation.

Warts from non-sexually acquired human papillomavirus infection

Verruca vulgaris on a thumb

Plantar warts

Verruca plana in the beard area spread by shaving

Warts

• Common viral warts (verruca vulgaris) affect keratinised skin, especially hands, feet, and knees. They are dome-shaped, circumscribed, hyperkeratotic and verrucous papules and nodules. The majority of common warts are asymptomatic, but are easily traumatised causing pain.
• Plantar warts (verruca plantaris) affect the soles of the feet. A plantar wart presents as a thickening with loss of surface skin lines (dermatoglyphics) in contrast to accentuated dermatoglyphics through a corn. On paring down, multiple pinpoint bleeding spots of patent papillary capillaries or black dots of thrombosed capillaries are encountered. Capillaries are not seen on paring corns. Plantar warts are especially tender with lateral pressure rather than with direct pressure typical of corns. Plantar warts can occur anywhere on the sole; corns occur only at pressure sites.
• Mosaic warts are a field of warts, especially seen on the soles of sweaty feet.
• Flat warts (verruca plana) are small < 5 mm flat-topped skin-coloured papules seen particularly on the face where they are spread by shaving.
• Subungual and periungual warts can affect the nail plate. Warts under the free edge of a nail probably result from picking or scratching a wart elsewhere.
• Filiform warts have a narrow base and fine elevated keratotic fronds. They are typically seen on the face.

Types of warts

Ungual wart

Subungual wart

Filiform wart

Epidermodysplasia verruciformis

Epidermodysplasia verruciformis is a rare autosomal recessive disorder with an increased susceptibility to specific HPV types, most commonly types 5 and 8. It results in the early onset of disseminated flat polymorphic lesions resembling pityriasis versicolor or plane warts.

Epidermodysplasia verruciformis carries an increased risk of HPV-related cutaneous squamous cell carcinoma (SCC). Immunosuppressed patients with HIV infection or are post-transplant may very rarely present with multiple HPV lesions resembling epidermodysplasia verruciformis.

What are the complications of non-sexually acquired human papillomavirus infection?

Non-sexually acquired HPV may cause:

• Cosmetic concern
• Discomfort, especially from plantar warts on pressure sites
• Social consequences such as teasing at school or exclusion from sport
• Spread to other body sites, particularly with immunosuppression or atopic dermatitis
• Malignant transformation in epidermodysplasia verruciformis.

How is a non-sexually acquired human papillomavirus infection diagnosed?

HPV-related warts are usually diagnosed on examination.

• Dermoscopy may reveal rounded keratinous structures with patent or thrombosed capillaries appearing as red or black dots respectively.
• A skin biopsy may be required, such as in an organ transplant recipient with a keratotic lesion suspicious for SCC. Warts show characteristic features on histology. See verruca vulgaris pathology and verruca plana pathology.

What is the differential diagnosis for non-sexually acquired human papillomavirus infections?

Non-sexually acquired human papillomavirus lesions may appear similar to:

• Skin tag (acrochordon)
• Seborrhoeic keratosis
• Corns and calluses.

What is the treatment for non-sexually acquired human papillomavirus infection?

Treatment of the cutaneous manifestations of HPV infections can be challenging. A wait and see approach can be appropriate in children who are likely to see warts resolve spontaneously.

Many treatments have been suggested for cutaneous warts, and most lack adequate clinical trials demonstrating efficacy.

First line treatments are various over-the-counter wart paints and pastes containing salicylic acid, podophyllin, and other ingredients. Higher concentrations of paints may be applied by a dermatologist.

Cryotherapy with liquid nitrogen is the most commonly used treatment by doctors. This needs to be applied multiple times at frequent intervals soon after the surface layer has peeled off and before the wart has a chance to regrow. However, to be effective, cryotherapy is painful and should induce a blister. Cryotherapy with carbon dioxide snow was mostly ineffective for warts and ‘spray cans’ wart treatments only achieve a similar temperature.

Other treatments used off-label include:

• Imiquimod cream
• Contact immunotherapy
• Intralesional bleomycin.

Treatment should include a rim of normal-looking skin where the virus has probably already spread. Horseshoe-shaped and ring-shaped recurrences around treatment sites are common.

HPV is infectious, so common-sense measures are required to minimise spread.

• Avoid deliberate unnecessary handling of warts on self or others.
• Do not share a tool used on a wart such as nail file.
• Avoid shaving hair-bearing skin where there are warts especially on the beard area.
• Wear footwear in communal places such as public showers.

What is the outcome for non-sexually acquired human papillomavirus infection?

Cutaneous warts due to non-sexually acquired HPV resolve spontaneously in the majority of children within two years. Warts are slower to resolve in adults and may take several years. Recurrence after treatment in adjacent skin is common due to subclinical or latent infection. However, once immunity has developed to a specific HPV type, reinfection with that type is unlikely.

HPV Vaccine Information For Young Women

A vaccine is available to prevent the human papillomavirus (HPV) types that cause most cervical cancers as well as some cancers of the anus, vulva (area around the opening of the vagina), vagina, and oropharynx (back of throat including base of tongue and tonsils).

The vaccine also prevents HPV types that cause most genital warts.

Why is the HPV vaccine important?

Genital HPV is a common virus that is passed from one person to another through direct skin-to-skin contact during sexual activity. Most sexually active people will get HPV at some time in their lives, though most will never even know it. HPV infection is most common in people in their late teens and early 20s. There are about 40 types of HPV that can infect the genital areas of men and women. Most HPV types cause no symptoms and go away on their own. But some types can cause cervical cancer in women and other less common cancers — like cancers of the anus, penis, vagina, and vulva and oropharynx. Other types of HPV can cause warts in the genital areas of men and women, called genital warts. Genital warts are not life-threatening. But they can cause emotional stress and their treatment can be very uncomfortable. Every year, about 12,000 women are diagnosed with cervical cancer and 4,000 women die from this disease in the U. S. About 1% of sexually active adults in the U.S. have visible genital warts at any point in time.

Which girls/women should receive HPV vaccination?

HPV vaccination is recommended for 11 and 12 year-old girls. It is also recommended for girls and women age 13 through 26 years of age who have not yet been vaccinated or completed the vaccine series; HPV vaccine can also be given to girls beginning at age 9 years. CDC recommends 11 to 12 year olds get two doses of HPV vaccine to protect against cancers caused by HPV. For more information on the recommendations, please see: https://www.cdc.gov/hpv/parents/index.html

Will sexually active females benefit from the vaccine?

Ideally females should get the vaccine before they become sexually active and exposed to HPV. Females who are sexually active may also benefit from vaccination, but they may get less benefit. This is because they may have already been exposed to one or more of the HPV types targeted by the vaccines. However, few sexually active young women are infected with all HPV types prevented by the vaccines, so most young women could still get protection by getting vaccinated.

Can pregnant women get the vaccine?

The vaccine is not recommended for pregnant women. Studies show that the HPV vaccine does not cause problems for babies born to women who were vaccinated while pregnant, but more research is still needed. A pregnant woman should not get any doses of the HPV vaccine until her pregnancy is completed.

Getting the HPV vaccine when pregnant is not a reason to consider ending a pregnancy. If a woman realizes that she got one or more shots of an HPV vaccine while pregnant, she should do two things:

• Wait until after her pregnancy to finish any remaining HPV vaccine doses.
• Call the pregnancy registry [800-986-8999 for Gardasil and Gardasil 9, or  888-825-5249 for Cervarix].

Should girls and women be screened for cervical cancer before getting vaccinated?

Girls and women do not need to get an HPV test or Pap test to find out if they should get the vaccine. However it is important that women continue to be screened for cervical cancer, even after getting all recommended shots of the HPV vaccine. This is because the vaccine does not protect against ALL types of cervical cancer.

How effective is the HPV Vaccine?

The HPV vaccine targets the HPV types that most commonly cause cervical cancer and can cause some cancers of the vulva, vagina, anus, and oropharynx. It also protects against the HPV types that cause most genital warts. The HPV vaccine is highly effective in preventing the targeted HPV types, as well as the most common health problems caused by them.

The vaccine is less effective in preventing HPV-related disease in young women who have already been exposed to one or more HPV types. That is because the vaccine prevents HPV before a person is exposed to it. The HPV vaccine does not treat existing HPV infections or HPV-associated diseases.

How long does vaccine protection last?

Research suggests that vaccine protection is long-lasting. Current studies have followed vaccinated individuals for ten years, and show that there is no evidence of weakened protection over time.

What does the vaccine

not protect against?

The vaccine does not protect against all HPV types— so they will not prevent all cases of cervical cancer. Since some cervical cancers will not be prevented by the vaccine, it will be important for women to continue getting screened for cervical cancer. Also, the vaccine does not prevent other sexually transmitted infections (STIs). So it will still be important for sexually active persons to lower their risk for other STIs.

How safe is the HPV vaccine?

The HPV vaccine has been licensed by the Food and Drug Administration (FDA). The CDC has approved this vaccine as safe and effective. The vaccine was studied in thousands of people around the world, and these studies showed no serious safety concerns. Side effects reported in these studies were mild, including pain where the shot was given, fever, dizziness, and nausea. Vaccine safety continues to be monitored by CDC and the FDA. More than 60 million doses of HPV vaccine have been distributed in the United States as of March 2014.

Fainting, which can occur after any medical procedure, has also been noted after HPV vaccination. Fainting after any vaccination is more common in adolescents. Because fainting can cause falls and injuries, adolescents and adults should be seated or lying down during HPV vaccination. Sitting or lying down for about 15 minutes after a vaccination can help prevent fainting and injuries.

Why is HPV vaccination only recommended for women through age 26?

HPV vaccination is not currently recommended for women over age 26 years. Clinical trials showed that, overall, HPV vaccination offered women limited or no protection against HPV-related diseases. For women over age 26 years, the best way to prevent cervical cancer is to get routine cervical cancer screening, as recommended.

What about vaccinating boys and men?

HPV vaccine is licensed for use in boys and men. It has been found to be safe and effective for males 9 -26 years. ACIP recommends routine vaccination of boys aged 11 or 12 years with with a series of doses. The vaccination series can be started beginning at age 9 years. Vaccination is recommended for males aged 13 through 21 years who have not already been vaccinated or who have not received all recommended doses. The vaccine is most effective when given at younger ages; males aged 22 through 26 years may be vaccinated. CDC recommends 11 to 12 year olds get two doses of HPV vaccine to protect against cancers caused by HPV. For more information on the recommendations, please see: https://www.cdc.gov/hpv/parents/index.html

Is HPV vaccine covered by insurance plans?

Health insurance plans cover the cost of HPV vaccines. If you don’t have insurance, the Vaccines for Children (VFC) program may be able to help.

How can I get help paying for HPV vaccine?

The Vaccines for Children (VFC) program helps families of eligible children who might not otherwise have access to vaccines. The program provides vaccines at no cost to doctors who serve eligible children. Children younger than 19 years of age are eligible for VFC vaccines if they are Medicaid-eligible, American Indian, or Alaska Native or have no health insurance. “Underinsured” children who have health insurance that does not cover vaccination can receive VFC vaccines through Federally Qualified Health Centers or Rural Health Centers. Parents of uninsured or underinsured children who receive vaccines at no cost through the VFC Program should check with their healthcare providers about possible administration fees that might apply. These fees help providers cover the costs that result from important services like storing the vaccines and paying staff members to give vaccines to patients. However, VFC vaccines cannot be denied to an eligible child if a family can’t afford the fee.

What vaccinated girls/women need to know: will girls/women who have been vaccinated still need cervical cancer screening?

Yes, vaccinated women will still need regular cervical cancer screening because the vaccine protects against most but not all HPV types that cause cervical cancer. Also, women who got the vaccine after becoming sexually active may not get the full benefit of the vaccine if they had already been exposed to HPV.

Are there other ways to prevent cervical cancer?

Regular cervical cancer screening (Pap and HPV tests) and follow-up can prevent most cases of cervical cancer. The Pap test can detect cell changes in the cervix before they turn into cancer. The HPV test looks for the virus that can cause these cell changes. Screening can detect most, but not all, cervical cancers at an early, treatable stage. Most women diagnosed with cervical cancer in the U.S. have either never been screened, or have not been screened in the last 5 years.

Are there other ways to prevent HPV?

For those who are sexually active, condoms may lower the chances of getting HPV, if used with every sex act, from start to finish. Condoms may also lower the risk of developing HPV-related diseases (genital warts and cervical cancer). But HPV can infect areas that are not covered by a condom—so condoms may not fully protect against HPV.

People can also lower their chances of getting HPV by being in a faithful relationship with one partner; limiting their number of sex partners; and choosing a partner who has had no or few prior sex partners. But even people with only one lifetime sex partner can get HPV. And it may not be possible to determine if a partner who has been sexually active in the past is currently infected. That’s why the only sure way to prevent HPV is to avoid all sexual activity.

Human papillomavirus (HPV)

Human papillomavirus (HPV) is one of the most common sexually transmitted infections and skin-to-skin contact. There are no exact statistics on how many people in the world are infected with HPV, because in most of those infected, the virus does not manifest itself in any way.

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Biologists believe that about 80% of the world’s population are carriers of HPV.

The danger of the virus is that some of its types can lead to oncology. 98% of cervical cancer (according to US scientists – 100%) are associated with HPV. The virus provokes cancer of the vagina, vulva, anal canal, male genital organs, throat, mouth. Moreover, a deadly disease can develop years, decades after infection, if favorable conditions arise for this.

In total, the HPV group includes more than 170 viruses and strains, of which approximately 40 are sexually transmitted, and 13 can cause cancer.

Infection with certain types of HPV – in the presence of high immunity – goes unnoticed, without a trace for the body. Other strains cause skin cells to divide intensively, resulting in warts, papillomas, condylomas (“venereal warts”). The third types, integrating into human DNA, act as oncogenes and promote malignant cell transformation and tumor growth.

This is important! HPV is not a sufficient factor for the development of cancer. But he is one of the most important oncofators, a “provoker” of malignant cells.

In order to begin the degeneration of healthy tissue into cancerous tissue, a combination of several conditions is necessary, including malfunctions of the immune system. It is immunity that is the main defender, including against an increase in the HPV viral load. It is very important to periodically take an HPV test to prevent the danger caused by the virus. So, you can cure the precancerous condition of the cervix. Other HPV-associated cancers respond best to treatment if started early in the disease and monitored by periodic viral load reduction/increase studies.

HPV: methods of infection, symptoms, oncogenic types of the virus

Main methods of infection:

• vaginal, oral, anal sex with a person infected with HPV;
• upon skin-to-skin contact with a person infected with papillomavirus, or contact with surfaces that an infected person has touched – household infection is possible if there are cuts, abrasions, or other damage on the skin;
• during childbirth – from mother to child.

Recent studies by American and European scientists have shown that there is a high probability of HPV infection in medical institutions – through blood transfusion, the use of medical equipment, inhalation of viral particles, for example – during laser ablation or electrocoagulation of genital warts.

The complexity of the fight against non-sexual forms of infection is that the virus is extremely resistant to most disinfectants. HPV is the first virus to be insensitive to inactivation (treatment) with glutaraldehyde (an agent for sterilizing surgical instruments that require absolute cleanliness). Doctors and technologists faced the problem of decontaminating devices that cannot be autoclaved and exposed to aggressive chemical compounds.

Symptoms and types of human papillomavirus

Symptoms of infection vary depending on the type of HPV. Some types, such as HPV5, remain in the human body without clinical symptoms and can only be detected by special studies. HPV1, 2, 4, 7, 22, 63 strains cause the formation of warts on the hands, feet, and soles.

Types 6, 11, 42, 44 can cause the development of genital warts, laryngeal papillomatosis; 6, 16, 18, 31 and others – anal dysplasia; 60 – viral cysts.

Strains 26, 53, 66 can lead to cancer of the genital organs. Strains with a high oncor risk – 33, 35, 39, 51, 52, 56, 58, 59. Types 16, 18, 31, 45 have the highest risk of cell transformation into malignant .

HPV testing for women and men. When are they appointed?

Every adult needs to undergo HPV tests on their own, without an appointment, because the probability that you are infected is 8 out of 10. A referral for analysis is usually issued by a dermatologist, urologist, gynecologist in the presence of characteristic external signs or diseases that can be caused by a virus .

HPV tests are taken when planning a pregnancy, when identifying the causes and treating infertility, pathologies of pregnancy and gestation. In this case, both partners are tested.

Risk factors and reasons for testing in women are also:

• early sexual life;
• relationships with different, sometimes several sexual partners at once;
• general chronic, gynecological diseases, pathologies;
• weak immunity.

Risk factors and reasons for testing in men are also:

• multiple sexual contacts;
• sexual contact with women infected with HPV;
• poor hygiene;
• narrowing of the foreskin;
• weak immunity.

HPV diagnostic methods

Colposcopy

Colposcopy – examination with a colposcope of the vaginal part of the cervix, the entrance and walls of the vagina. This is a simple, inexpensive, but highly informative method for diagnosing diseases of the cervix. Of clinical importance is extended colposcopy using several tests – with 3% acetic acid, Lugol’s iodine solution. Tests reveal different types of epithelium, allow assessing the size and quality of pathological formations (if any), vascular pattern, quality of the cervical glands.

During colposcopy, a targeted biopsy is performed from the most atypically altered areas.

Cytology

The task of cytological examination of cervical smears (Papanicolaou test, pap test) is to identify cells specific for HPV infection – koilocytes and dyskeratocytes.

Confirmation of papillomavirus infection is the detection of koilocytes, transepithelial lymphocytic infiltration, basal cell hyperplasia in a biopsy specimen (a biomaterial taken for research).

Pap test required for:

• women after 30 years;
• women who have previously been diagnosed with HPV;
• women who, during colposcopy, found areas with altered epithelium.

According to the results of the pap test, a class of danger to a woman’s health is determined: class 1-2 – no suspicion of cancer, class 3 – suspicion of oncology, class 4-5 – the presence of cancer cells in small or large numbers.

The disadvantages of cytological examination include the complexity of execution, high qualification requirements for a cytologist. Therefore, it is necessary to undergo a study in diagnostic centers and laboratories, whose staff constantly confirms their professionalism.

Histological examination

The histological method for detecting HPV could be considered the gold standard for diagnosing the virus, but its high cost, the impossibility of frequent conduction, and not always accurate targeted biopsy sampling from the cervix prevent it. Histological diagnosis also requires highly qualified specialists.

Therefore, the histological examination of the biopsy often serves as an addition to the Pap analysis. It allows you to assess the condition of the cells, the degree of damage, to determine what the neoplasm is – a tumor or condyloma.

PCR diagnostics of papillomavirus

Polymerase chain reaction (PCR) is a high-resolution technology for the detection of nucleic acids. Modern PCR test systems are highly sensitive and are used not only to detect HPV, but also the viral load on the body (a quantitative indicator of infection) of the main clinically significant genotypes (16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59), which are responsible for almost 94% of cases of severe cervical dysplasia and cervical cancer. PCR test systems are also used to detect HPV 6 and 11 strains.

Such capabilities of the test system make it possible to predict the course of HPV infection and evaluate the effectiveness of therapy. It has been established that human papillomavirus infection has a dose-dependent effect: the higher the concentration of virus DNA in the test material, the higher the risk of developing neoplasia and cancer.

The test results indicate the concentration of HPV:

• Lg < 3 — papillomavirus detected in a clinically insignificant amount;
• Lg 3–5 — papillomavirus detected in a clinically significant amount;
• Lg > 5 – papillomavirus is found in high concentration, the viral load on the body is high.

Types of test material, sampling rules:

• for pap test – cervical smear;
• for cytological examination – a biopsy specimen taken aimingly from atypically altered areas of the mucosa.
• for the PCR test – scraping cells of the mucous membranes of the genital tract.

A swab in women is taken from the cervical canal, in men – from the urethra. For a smear, use a soft brush or cotton swab. They are carefully inserted into the canal, then carefully removed by rotating. On the surface of the brush / swab remain epithelial cells needed for research.

How do I prepare for an HPV test?

The biomaterial is not taken during menstruation, 5 days before it starts and within 5 days after the end. You can not undergo a study if there are inflammatory processes.

2 days before biomaterial sampling, women and men should refrain from sexual contact. Women should not use vaginal creams, medicines, suppositories, douches, tampons for 48 hours, instead of taking a bath, they need to take a shower. A smear is taken before any gynecological manipulations or 2 days after them.

If the biomaterial is taken from the urethra, then at least 90 minutes must pass from the last urination to the sampling of the biomaterial.

When taking a biopsy for histological examination, the same rules are followed as in preparing for taking a smear.

After a biopsy within 2-3 weeks it is impossible:

have sexual intercourse

• experience significant physical exertion,
• overheat (bath, sauna, hot weather),
• swim in open water or pool,
• take blood thinners;
• use vaginal products.

If bleeding occurs, use only pads (not tampons!)

The accuracy of the result can be affected by antibiotics, probiotics, local antiseptics that you took / used even 2 months ago. Before collecting the material, you need to tell the doctor about all the medicines that you have used or are using.

The cost of testing for the presence of papillomavirus infection in JSC “SZDTSM”

The cost of testing for HPV infection depends on the type of testing, coverage of virus strains, type determination / no detection, calculation of viral load.

Prices for types of studies in the medical divisions of JSC “SZDTSM” are a variety of combinations of coverage, detail, predictive value.

Which method of research to choose, you will be prompted by a doctor – a gynecologist, dermatologist, venereologist. If you are taking tests on your own initiative, select a study for the presence of oncogenic HPV strains.

Where can I get tested for HPV?

You can take HPV tests at the medical divisions of SZDCM JSC located in St. Petersburg, the Leningrad Region, Veliky Novgorod, Staraya Russa and other cities.

To find the point closest to you, use the interactive map or the list of medical institutions of JSC “SZDTSM”.

In all our branches – terminals and centers – you will be met by attentive, experienced and highly qualified specialists. Medical institutions of JSC “SZDTSM” are equipped with modern equipment, laboratory materials, disposable instruments and consumables.

We guarantee you the accuracy of research, caring attitude, complete confidentiality of your personal data and examination results.

Be healthy! And for this, pass important examinations at JSC “SZDTSM” on time and regularly.

We will help you maintain and restore health!

STDs: forewarned is forearmed

The topic of sexually transmitted diseases is very relevant even in our enlightened time. But, despite the fact that we are aware of the significance and importance of this problem, our theoretical knowledge does not always find a practical response.

What is an STD? Sexually transmitted diseases, quite a lot is known today. The unifying moment of various infectious agents (bacteria, viruses, protozoa) is the predominantly sexual route of transmission of the pathogen from person to person. Actually, true venereal diseases are syphilis, gonorrhea. But, in addition to the “classic” sexually transmitted diseases, the development of microbiology and the study of new pathogens and the lesions caused by them made it possible to significantly expand the group of STDs, which also included chlamydia, ureaplasmosis, mycoplasmosis, trichomoniasis, genital herpes, molluscum contagiosum, HIV, HPV (human papillomavirus ) and others. Here are some figures for the incidence in the Cherikovsky district for 2017: trichomoniasis – 22, chlamydia – 8, mycoplasmosis – 3, ureaplasmosis – 13, gardnerellosis – 44, papillomavirus infection – 7, syphilis – 1, gonorrhea – 2. Of course, most STDs are curable, But not all. For example, it will never be possible to part with genital herpes – treatment only softens the course of the disease and reduces the frequency and severity of relapses. Only those under 25 have a chance to permanently get rid of the human papillomavirus (HPV). By the way, it is believed that the human papillomavirus can cause cancer of the cervix, vagina, vulva and penis. The genital herpes virus also affects sperm, and if a woman becomes infected with it during pregnancy, it can cause severe congenital diseases of the fetus. Statistics say that every 10 people on our planet suffer from STDs, not excluding children and the elderly.

STD risk factors. Obviously, the main risk factor for the development of STDs is active promiscuous sex life with frequent changes of sexual partners. Important points are also the neglect of barrier contraception, a decrease in the protective properties of local immunity, and hormonal disorders. But the main reason that significantly increases the risk of contracting STDs is excessive sexual activity.

STD symptoms. It is difficult to talk about the initial signs of STDs due to the variety of pathogens included in this group. But it is obvious that the first changes appear at the site of the first contact with the infectious agent, as a rule, in the area of ​​the external genital organs and they are associated with a change in the nature of the discharge from the genital tract. But the severity, intensity, time of appearance of these symptoms varies. In any case, a change in the nature of secretions from the genital tract against the background of existing risk factors, various outgrowths of the mucous membrane of the external genital organs, itching, wounds and sores, skin rash, pain and burning during urination. – This is an occasion for a visit to the doctor and an examination.

Let’s get to know each other better. Chlamydia. 1-4 weeks after infection with it, patients develop purulent discharge, painful urination, as well as pain in the lower abdomen, in the lower back, bleeding between menstruation in women, in men – pain in the scrotum, perineum. What is dangerous? In women, it can lead to inflammation of the fallopian tubes, cervix, pathologies of pregnancy and childbirth, diseases of the liver, spleen; in men – to inflammation of the epididymis, prostate, bladder, impaired potency. Newborns may develop conjunctivitis, nasopharyngeal lesions, pneumonia.

Trichomonas. Symptoms of may appear 4 to 21 days after infection, sometimes later. Women have abundant foamy discharge of white or yellowish-green color with a pungent odor, causing severe itching and irritation of the genital organs, as well as pain, burning during urination, pain during intercourse. In men, there is a burning sensation during urination, mucopurulent discharge from the urethra. However, this disease is often asymptomatic. What is dangerous? In women, the cervix and inner layer of the uterus, fallopian tubes, ovaries, and urinary tract are affected. The infection can even cause peritonitis! In men, the prostate gland, testicles and their appendages, and urinary tract are affected.

Mycoplasmosis (ureaplasmosis). May reveal itself 3 days after infection, and maybe even a month later, manifested by itching and discomfort in the genital area, scanty clear discharge, painful urination. What is dangerous? A common complication of trichomoniasis in women is inflammation of the genital organs, in men – a violation of spermatogenesis.

Gonorrhea. 3-7 days after infection, women develop a yellowish-greenish vaginal discharge, frequent, painful, urination, pain in the lower abdomen, and sometimes bloody discharge. However, in most of the fairer sex, the disease goes unnoticed for a long time. Men have pain and burning sensation during urination, yellowish-greenish purulent discharge from the urethra. What is dangerous? In women, the urethra, vagina, anus, uterus, ovaries, fallopian tubes are affected. In men – internal genital organs, chronic inflammation of the epididymis, seminal vesicles, prostate develops, which threatens impotence, infertility.

Syphilis. The incubation period of the disease is from 3 to 6 weeks. The first sign is a rounded sore (hard chancre). In women, it lives on the labia or vaginal mucosa (sometimes in the anus, in the mouth, on the lips), in men, on the penis or scrotum. By itself, it is painless, but a week or two after its appearance, the nearest lymph nodes increase. This is the time to start treatment! This is the first stage of the disease, when it is still reversible. 2–4 months after infection, the second stage develops – a rash “spreads” all over the body, high fever, headache appear, almost all lymph nodes increase. In some patients, hair falls out on the head, wide condylomas grow on the genitals and in the anus. What is dangerous? This disease is called slow death: if not fully cured in time, serious problems arise with the musculoskeletal system, irreversible changes occur in the internal organs, the nervous system – the third stage of the disease begins, in which about a quarter of patients die.

Diagnostics. At the disposal of the doctor today there are a number of successful diagnostic tests to identify a particular pathogen. But, as a rule, the examination begins with a general smear on the flora. The method allows in the acute process to identify pathogens of trichomoniasis and gonorrhea. Sowing on the microflora and determining sensitivity to antibiotics can be considered as the “gold standard” in the diagnosis of STDs, especially gonococci, chlamydia, mycoplasmas. PCR diagnostics is the most popular today. The method is sensitive and specific, and can be used to detect almost all STD pathogens.

When should I be tested for STDs? Of course, the annual scheduled examination by a gynecologist should also include infectious screening in order to timely detect and treat STDs. But questions about the timing of the survey often arise when there is a history of casual sexual intercourse and fear of infection as a result of this. Unfortunately, there are no universal terms. Identification of possible pathogens will depend on the pathogen itself, or rather on the incubation period. And if, when infected with Trichomonas, the first clinical signs, and, accordingly, the possibility for diagnosis, appear after 3-7 days, then about 6 months may pass before the serological detection of antibodies to HIV. In any case, the identification of the pathogen in one of the partners dictates the need to examine the other partner.

STD treatment. It is impossible to consider treatment within the framework of general positions, because everything will depend on the pathogen, infectious load, history of the disease. I would just like to dwell on the main points of the treatment of STDs. Treatment will be successful only if it is started without delay and completed.

1. Self-treatment when the first signs appear can only worsen the prognosis of the disease and lead to a chronic process.
2. Treatment of STDs requires laboratory monitoring of the effectiveness of therapy.
3. At the time of treatment and until a positive control test result, sexual activity is possible only with barrier contraception.
4. Treatment is recommended for both partners at the same time.

Prevention of STDs. Given the mechanism of transmission of the pathogen, methods of prevention are obvious. First of all, it is responsibility in choosing sexual partners and the exclusion of casual intimate contacts.