HPV 16 in women: what to do and how to get rid of it.

Human papillomavirus, commonly abbreviated as HPV.

This is the causative agent of the most common infectious pathology of mucous membranes and skin throughout the world, the so-called. papillomavirus infection.

There are about 200 types of this virus.

About a fifth of which can be transmitted through sexual contact, damaging the organs of the urogenital system.

This pathogen is of particular concern due to the connection between infection and cancer pathologies.

Thus, 93% of episodes of cervical cancer in women are caused by this particular virus, of which 70% are HPV types 16 and 18.

That’s why, if a woman’s HPV 16 is detected in tests during an examination, the doctor strongly recommends additional studies.

So what is it: HPV 16 genotype in women?

All papillomaviruses are conventionally divided into three main groups depending on their oncogenic danger:

non-oncogenic, causing flat/plantar/vulgar warts (types 1, 3, 2, 4, 41, 10, etc.), not capable of causing malignant transformations
low risk, causing the development of anogenital warts (otherwise called genital warts), resembling characteristic cauliflower buds, epidermoplasia verrucous, laryngeal papillomatosis (types 5, 17, 12, 6, etc.), can extremely rarely, under very “favorable” conditions, cause malignant process
high risk, capable of causing neoplastic changes in women in the area of the uterine cervix, bowenoid papulosis (HPV types 16 and 18, 33, 31, 39, 35, 58, 56, 45, 68, 59, 52, 51), have been proven to provoke the overlap of various factors oncological processes

Thus, the answer to the question of whether HPV 16 infection is dangerous for a woman’s health has been determined: it is this type of virus that poses a serious threat.

However, the presence of a pathogen does not mean the presence of a disease.

In addition, HPV infection has an interesting feature: the ability to self-heal.

That is why in a situation where a certain amount of HPV type 16 DNA is detected in women during laboratory tests, it is important not to panic.

You just need to follow your doctor's recommendations and undergo regular examinations with a gynecologist.

Where does HPV type 16 come from in women?

According to WHO, up to 80% of the population is infected with HPV.

But only about 10% of those infected have clinical manifestations.

The answer to the question of how HPV 16 is transmitted to women is well known: the main route of infection is sexual contact.

Including anal-genital and oral-genital, with an infected partner.

HPV has a very high prevalence: almost 80% of women by the age of 50 have been infected at least once.

At the same time, the virus has a tendency to self-eliminate.

So it is not possible to establish the probability of infection after a single contact.

This is why it is so important not to neglect preventive measures during casual sexual acts.

Infection of a child by the mother at the time of birth is possible with viruses of types 6 and 11 - the cause of such a disease in children as respiratory papillomatosis.

No other types of virus, including HPV type 16, usually cause problems during pregnancy in either women or newborns.

There are only isolated cases of infection of newborns by mothers with bowenoid papulosis.

Therefore, routine HPV testing is not recommended by any international/national guidelines.

The incubation period varies from three months to several years.

It is possible to become infected with several types of viruses at the same time.

After entering the body, the virus infects the tissue covering the surface of the body and organs - the epithelium, namely its inner part (basal layer).

The virus inside the cell may not affect chromosomes or integrate into the genome.

The last option, the so-called. the malignant form is manifested by the appearance of cells with altered DNA, which multiply and form a tumor.

Thus, if a woman is a carrier of HPV type 16, 18, 6, 11 or others, the following conditions are possible:

latent course of infection, when the virus does not affect cellular DNA, women have no clinical manifestations, and infection is detected only by PCR
the appearance of such clinical manifestations as condylomas, warts, papillomas, the virus does not change the cellular genome, but provokes increased cell proliferation (the problem is detected by the presence of symptoms, PAP test, PCR method)
the development of neoplastic changes (dysplasia), when the virus made a change in the DNA of the cell and caused corresponding changes in the latter (such changes are called koilocytosis), the situation is confirmed by PCR, PAP test, histological and colposcopic examination
carcinoma, when the pathogen has changed the cellular genome and caused the formation of a large number of altered (“atypical”) cells – invasive cancer (the diagnosis is confirmed by PCR, Pap test, histological and colposcopic studies)

In most situations (up to 90%), the body heals from the virus within about 2 years.

The development of symptoms is observed only in 1-5% of infected people.

With regard to HPV 16, causes of severe clinical symptoms in women include:

early onset of sexual activity
having multiple sex partners

multiple pregnancies/births before age 20
smoking
chronic cervicitis
decreased immune defense, for example, due to concomitant HIV infection (with a normal functioning immune system, cancer in an infected woman can develop in 15-20 years, while in an HIV-infected woman - in 5-10 years, while HIV also increases the likelihood HPV infection)

Infection options

Human papillomavirus in patients is naturally associated with sexually transmitted diseases.

There is nothing surprising.

After all, the main way the virus spreads is sexually.

In sexual transmission, the pathogen is found in semen in men and in vaginal secretions in women.

Naturally, if you ignore basic recommendations for protected sex, it turns out to be quite easy to become infected.

A single sexual contact is enough.

Doctors emphasize that the pathogen can spread not only through classic sexual contact.

Infection can also occur if partners have unprotected anal or oral contact.

After all, the microorganism can infect not only the mucous membranes of the genital tract, but also the mucous membranes of the oropharynx and anus.

However, HPV can be transmitted from person to person not only through sexual contact.

A man can easily become infected through contact and household contact.

This happens if shared washcloths, towels, toothbrushes and other hygiene items are used, which normally should be exclusively individual.

The microorganism survives well in the environment, and therefore contact and household spread is not excluded.

HPV can also be passed from mother to child during childbirth.

The likelihood of virus penetration transplacentally is minimal.

But passing through an infected birth canal will inevitably introduce infection into the child’s body.

Moreover, not only a little girl, but also a boy can become infected.

Manifestations of HPV infection

In most situations, when infected with HPV in general and, in particular, HPV 16, women, as well as men, have no symptoms.

Sometimes a sign of infection can be warts and condylomas (in the case of the presence of a virus from the low-oncogenic/non-oncogenic group).

With HPV 16 infection, women may experience precancerous changes on the cervix.

This is revealed during a gynecological examination.

Or preventative, or when the patient consulted a doctor for another reason, for example, with complaints of unusual discharge.

The main diseases caused by HPV 16 are bowenoid papulosis and dysplasia of varying degrees.

With bowenoid papulosis, dense brownish, reddish or flesh-colored papules appear in the labia, pubis, inguinal and perianal areas.

They merge into large warty surfaces up to 2 cm in diameter.

The disease is characterized by a chronic, long-term course.

Malignancy develops in 3% of episodes (degenerates into squamous cell carcinoma), although self-healing is more often diagnosed.

Cervical dysplasia is a precancerous change and requires serious consideration.

Since this pathology may not be diagnosed in a timely manner due to its asymptomatic course, most countries in the world have adopted cervical cancer screening programs.

There are several classification approaches for dysplasia and cervical cancer.

They are based on the results of morphological/cytological studies (studies of cell changes).

According to the International Classification of Diseases, 10th revision, there are:

mild dysplasia - minor proliferation and changes in epithelial cells, often a similar condition is detected during inflammatory processes in the uterine cervix and is eliminated after appropriate anti-inflammatory therapy
moderate dysplasia - changes affect the entire lower layer of the epithelium
severe dysplasia - the entire length of the epithelium is affected, the cell structure is noticeably changed
cervical cancer (otherwise known as squamous cell carcinoma) – detected during colposcopic examination, confirmed cytologically and histologically

Moderate and severe dysplasia in most episodes is caused by exposure to the virus.

Signs of cervical cancer are detected only in the last stages and include:

bleeding between menstrual periods, irregular, after sexual intercourse
unpleasant smell of discharge
vaginal discomfort
pain in the pelvic area, back, legs
weight loss
fatigue, lack of appetite
unilateral swelling of the legs

As the disease progresses, the severity of symptoms may increase noticeably.

How does HPV infection manifest?

The main symptom of infection caused by the human papillomavirus is the formation of so-called genital warts.

Externally, genital warts are similar to ordinary warts. They can be small in size (from a few millimeters to a centimeter), pinkish or flesh-colored, and have a smooth or slightly bumpy surface.

Most often, genital warts form in the area of the external genitalia.

In women, genital warts can occur near the clitoris, on the labia minora and majora, in the vagina and on the cervix. In case of irritation of condylomas located close to the entrance to the vagina, itching and minor bleeding may occur during sexual intercourse.

In men, genital warts form on the penis and scrotum.

Condylomas can also form in the anus, in the urethra, or in any other place on the skin (skin of the neck, armpits). Several condylomas located nearby can merge into one large “wart”.

Generally, genital warts are painless. In some cases, mild itching and discomfort are felt in the area of condylomas.

Diagnosis of HPV infection

Anogenital warts, caused by viruses type 6 and 11, are easily detected during a gynecological examination.

Identification of such formations is an indication for additional examination of the uterine cervix, and, if necessary, the urethra (urethroscopy).

The main method for detecting neoplastic changes caused by HPV is the Pap test.

It is a cytological study of smears from the uterine cervix.

In general, oncocytology is a method for detecting cancer cells in the cervix and vagina.

Samples of material for study are taken during a gynecological examination using special cyto-brushes and are absolutely painless.

A distinction is made between simple oncocytology, when the cells under study are immediately applied to slides for microscopy.

And liquid, when the cells are pre-treated with a special solution and dye.

The latter type is the PAP test.

After processing the material with two types of dyes, changes in the cell nuclei and cytoplasm are easily detected in the sample using microscopy.

The type of pathological process is preliminarily determined: inflammatory, malignant, or other.

Then, based on the severity and nature of the changes, a differential diagnosis of possible conditions is carried out.

The PAP test is included in the screening system for detecting cervical cancer in all developed countries.

Its annual holding is recommended for all females who have reached the age of 20 years.

Cytological signs of HPV infection include:

koilocytosis - the appearance of characteristic koilocyte cells with voluminous uneven nuclei, vacuoles (absent normally) and clearing zones near the nuclei
dyskeratocytosis - the appearance of keracite cells with dark nucleoli and characteristically altered cytoplasm

If the PAP test reveals a change in cellular structures, the following is carried out:

colposcopic examination with acetic acid examination and test with Lugol's solution
histological examination – small fragments of tissue are studied under a microscope (the latter are obtained by targeted biopsy)

Colposcopic signs of infection:

lightening of areas treated with acetic acid
uneven staining with Lugol's solution
the presence of characteristic outgrowths (for low-oncogenic types of the virus)

According to international recommendations, diagnostic tactics for detecting disorders using the PAP test include:

The first option is to repeat the examination after three months, in case of normality, repeat after six months and a year, in case of abnormality - colposcopic examination
The second option is to immediately conduct a colposcopic examination; if no abnormal abnormalities are detected, cytology is repeated six months later (for oncogenic types of the virus). If necessary, a biopsy and canal curettage are performed. In a situation with insufficient reliability of colposcopic data, anti-inflammatory, estrogen therapy is recommended, followed by repeating the study
The third option is to determine the type of virus using the hybrid capture method (the so-called Daijin test, Digene) or PCR (polymerase chain reaction). Detection of HPV type 16 or another oncogenic virus in women (the norm is the complete absence of the pathogen) is an indication for colposcopy

Typing of papillomaviruses by PCR has a high diagnostic value in terms of determining the type of virus and its belonging to a high-risk group of oncology.

Also to predict the likelihood of developing cancer against the background of existing neoplastic changes in the cervical epithelium.

Qualitative analysis produces a result in the format “there is a virus of this type / not.”

The quantitative method (real-time PCR) allows you to detect viral DNA even in very low concentrations from 10 to 100 copies in a sample.

Can be used to track the dynamics of infection.

Due to the fact that young women have a high rate of self-healing from HPV, PCR is recommended to determine the type of virus only after the age of 30.

A blood test to determine antibodies to HPV has no diagnostic value and is carried out only for research purposes.

As for the problem of preferring the Digene test or PCR, it is important to consider that the first method determines the number of HPV type 16 and other types in women from 5000 copies.

Whereas PCR “senses” a significantly lower content.

This point is significant from the point of view that this is the number that is clinically significant.

Those. More than 5,000 copies were detected against the background of neoplastic conditions - a high risk of oncology.

And detection of a smaller amount does not allow predicting the risk of developing cancer against the background of dysplasia.

In general, the analysis data allows the doctor to decide whether to start treatment or limit himself to observation.

Rumyantseva, md.

Why do we even have to discuss these types of HPV? Because HPV is the cause of cervical cancer, and types 16/18 are the most “aggressive” of all.

Not all women with HPV 16/18 will develop cervical cancer, but among all cases of cervical cancer, one of these types is responsible for 70%. Let's figure out how to prevent this from happening.

1. If less than 10 years have passed since the beginning of sexual activity, getting tested for HPV is pointless. The virus can still easily “go away” from the body, but you will spend enough nerves. According to most recommendations, it makes sense to get tested for HPV starting at age 25-30.

2. If more than 10 years have passed since the beginning of sexual activity (or you are over 30 years old), an HPV test should be taken together with a PAP test (cytological examination of a smear from the cervix). If HPV type 16/18 is detected, it is worth doing a colposcopy.

3. If HPV 16/18 is detected, but there are no changes according to the PAP test and colposcopy, you need to repeat the study after 1 year, nothing more.

4. If changes are also detected in the Pap test, a biopsy will most likely be required. If there is no change in the PAP test, a biopsy may also be needed, but much less frequently.

5. Based on the results of the biopsy, you will receive a histological report. In the best case scenario (and this happens most often), the histology will indicate that the affected area is harmless (dysplasia) and has been removed entirely. In this case, there is every reason to hope that after 6 months the virus will no longer be in the body. In the worst case scenario, histology results will reveal a severe lesion (precancer/cancer) extending beyond the removed area. Then extended surgery will be required.

6. HPV does not cause inflammation of the cervix/vaginal discharge/itching/burning/pain during sexual intercourse. It is pointless to get tested for it with these complaints and manifestations.

7. There is no cure for HPV!!!

Neither injections, nor suppositories, nor pills will help get rid of HPV.

8. BUT! The body can get rid of the virus itself within 2 years from the moment of infection (which happens in 90% of cases).

9. The vaccine does not cure HPV! Vaccination is most reasonable before the onset of sexual activity, when infection has not yet occurred! I wrote in detail about HPV vaccination here.

Total:

If HPV type 16/18 is detected, a Pap test and colposcopy must be done, and further tactics depend on the results of these studies. There is no cure for HPV!!!

Take care of yourself!

More information about HPV in the articles:

HPV: general information
Low risk HPV
HPV and cervical cancer
Vaccination against HPV

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Treatment of HPV infection

Which doctor treats HPV 16 in women?

Treatment of HPV infection can be carried out by a gynecologist, oncologist, infectious disease specialist, or venereologist.

It is important to understand that accidental detection of the virus in the absence of clinical changes is not an indication for therapy.

Only if highly oncogenic viruses (HPV 16) are detected in women, the doctor decides what to do next.

Is it necessary to undergo diagnostic examinations and examinations more frequently or to prescribe additional studies?

Only a specialist can determine whether it is necessary to treat HPV 16 in women, taking into account the presence/absence of changes induced by the virus.

In a situation with HPV, it is important to trust your health only to highly professional specialists who are familiar with international protocols for managing the infection.

This is especially important when infected with HPV 16, which provokes malignant pathologies in women (reviews on the Internet or from friends will help you decide on an institution and a doctor).

Today, in women, treatment for HPV 16 is based on the removal of atypically changed epithelium.

It should be understood that if women have an infection, there are currently no drugs that destroy the virus itself.

Any international treatment regimen for HPV 16 does not include any antiviral agents.

At the same time, specific treatment for HPV 16 is carried out, in which it is recommended that women take drugs with immunomodulatory and antiviral activity.

It is believed that such drugs mobilize the immune system to fight the virus.

Such products have not been sufficiently tested for effectiveness in clinical trials.

Accordingly, there is no reliable data on the cure rate.

Despite this, many patients note a significant improvement in their well-being after using them.

Immunocorrective therapy for HPV 16 in women includes:

with human recombinant interferon or its inducers, suppositories (Viferon, Genferon), Isoprinosine, Cycloferon, etc.
with an immunostimulating effect - Lykopid, Polyoxidonium, etc.
B vitamins, omega acids and dietary supplements

Often, before prescribing a drug treatment regimen, an analysis of the immune status (immunogram) is recommended.

With determination of indicators of the activity of monocytes, neutrophils, lymphocyte function, levels of immunoglobulins, CD16+, CD8+, CD4+ and others.

Unfortunately, for many drugs, data on the safety of use, complications and relapses after use have not been obtained.

Therefore, it is recommended to refrain from using them for people with:

autoimmune diseases
malignant formations (for cervical cancer can be prescribed only after completion of surgical treatment)
allergic reactions
bronchial asthma, etc.

As for the generally accepted approach to the management of HPV infection in the international medical community, the following points are positioned here:

There is no medicine to remove the virus from the body, but the likelihood of self-healing is very high, especially at a young age
If there are no changes in cellular structures and a virus from a high oncogenic risk group is identified, more frequent and careful monitoring of the patient is carried out
If changes caused by the activity of the virus are detected, therapy is carried out aimed at eliminating pathological changes

For bowenoid papulosis caused by HPV type 16, tumors are removed using the following methods:

Mohs excision
laser therapy
cryodestruction
electrocoagulation
local application of ointments with cytostatics (5-fluorourocil, prospidin, fluorofur)
intralesional administration of interferon
oral administration of Neotigazon capsules

Precancerous conditions and the first stages of cervical cancer are highly treatable.

The changed cells are removed using cryotherapy.

For dysplasia, organ-preserving operations are performed: conization of the cervix with a scalpel, electrosurgically, laser with preliminary canal curettage.

For localized forms of the tumor, surgical treatment is carried out, for a widespread process - radiation and chemotherapy.

Taking into account the fact that eliminating the result of virus activity does not remove the infectious agent itself.

The risk of recurrence of pathological changes remains, which, in turn, requires further monitoring of the patient.

In addition, the possibility of HPV reinfection cannot be excluded.

After implementing any treatment option, follow-up tests are recommended.

Since there is a possibility of spontaneous elimination of the virus within 2 years from the moment of infection.

A separate problem is presented by persons with HPV against the background of HIV infection.

It has been proven that the risk of developing cancer in such women is higher, as is the risk of HPV infection itself.

Although primary HPV infection was detected more often, which is associated with the greater prevalence of this virus.

Moreover, the worse the patient’s immune status, the higher the likelihood of her developing HPV-induced cancer.

Therefore, people with HIV status are recommended to undergo HPV testing more frequently.

Treatment is carried out using the same methods as for those uninfected with HIV, with additional specific therapy aimed at suppressing the activity of the immunodeficiency virus.

Human papillomavirus - which HPV treatment is effective?

What is human papillomavirus?

The HPV group of viruses is part of the papillomavirus family, which includes 5 genera, about 43 varieties and almost 170 types, and it is HPV that causes the formation of warts. There is a direct connection between it and cervical cancer: this virus is detected in 92% of cancer cases.

What tests are done for human papillomavirus?

The main areas of research are determining the viral load, that is, a quantitative indicator and determining the type of virus using the PCR method.

Are papillomas dangerous?

In essence, papilloma is a benign tumor, but it is also fraught with danger. Firstly, damage to its integrity is possible, leading to the formation of scars and, rarely, blood poisoning. It is not recommended to remove papillomas mechanically on your own; this can lead to generalization of the process and the spread of papillomas throughout the body. The main danger of papillomas is that they are viral. Most types of HPV do not pose a threat to human health and life, but HPV types 16 and 18 can provoke the development of malignant tumors. Benign papillomas, as a rule, cause a lot of trouble to a person. They can grow to large sizes and can form in the genital area. Some types of HPV cause precancerous lesions.

Is human papillomavirus contagious?

HPV can be transmitted in various ways. With contact and household transmission, the virus is transmitted through the skin through handshakes and the use of personal hygiene products, after trying on someone else's clothes and underwear, and when visiting public swimming pools and saunas. Sexual transmission of the virus is considered especially dangerous, since there is a high risk of infection with oncogenic HPV. The likelihood of sexual transmission of the virus is much higher if the partner has genital warts. HPV can be passed from mother to child during childbirth, although it rarely occurs during pregnancy. In this case, most often children develop laryngeal papillomatosis, which can cause serious respiratory problems. It is possible for a child to become infected from the mother during breastfeeding.

How is human papillomavirus treated?

Drug treatment of the virus is carried out using drugs that act on the cause of the disease and also restore the function of the immune system. There are various schemes for intravenous drug administration; doctors, as a rule, prescribe treatment individually; there are no standard schemes. What drugs are usually prescribed? Cycloferon, Interferon alfa, Panavir, Ingaron. Tablet forms of antiviral drugs: Isoprinosine, Lykopid, Lavomax, Alpizarin. Candles: Genferon, Betadine, Viferon. Ointments: Oxolinic ointment, San Fen Zhong ointment, Stefalin, Salicylic ointment. Vitamins: Aevit, Alphabet.

Vaccination against HPV (Gardasil)

It is still impossible to completely get rid of HPV at the current level of the pharmaceutical industry, but it is possible to prevent infection and for this purpose vaccination is carried out with a drug such as Gardasil. In some countries, these vaccinations are already mandatory; in Russia, vaccination can be done voluntarily. When choosing this method of preventing HPV, it is necessary to undergo a preliminary examination to determine the presence of the virus in the body. Vaccines contain synthetically modified proteins similar to the structure of the virus. The introduction of these proteins into the body activates the immune system and leads to the production of antibodies that protect against the development of HPV after the pathogen enters the body. Vaccine developers advise giving the drug to girls and boys aged 10 to 12 years. This is due to the fact that at this age, in the vast majority of cases, there is no sexual intercourse, and the immune system works at full strength, which contributes to a good response to the drug.

Can human papillomavirus cause cancer?

The most dangerous type of HPV that causes malignant tumors is the following: HPV-16; HPV-18; HPV-31, 33, 45, 56, 58; HPV-51, 59, 68; HPV-35, 39, 52.

What types of cancer does HPV cause?

Most often, cervical cancer is caused by human papillomavirus types 16 and 18, which also cause genital cancer. HPV 16 is the cause of laryngeal cancer in 50% of cases.

Is HPV sexually transmitted?

HPV is transmitted sexually, and sexual contact itself becomes the main cause of infection with the papilloma virus. Let's talk about this in more detail.

Papillomas located on the penis are a sign of human papillomavirus infection, therefore sexually transmitted infection is quite logical. The incubation period for HPV lasts from 1 to 12 months. In this case, the papillomas themselves may not grow at all, and only with a decrease in the function of the immune system can their formation begin. Therefore, detection of HPV in the body in the early stages of disease development is possible only with the help of special tests. Currently, HPV is one of the most common diseases and the risk of infecting a partner during unprotected sexual intercourse is almost 100%.

Are papillomas a cancer?

All types of HPV, according to the degree of risk of malignant degeneration, can be divided into the following: low risk, medium risk and high oncogenic (carcinogenic) risk. Genital warts in the genital area, as a rule, are not caused by a highly oncogenic virus. Squamous cell papillomas are malignant neoplasms. Patients diagnosed with squamous cell papillomas are at increased risk and require immediate treatment.

If a patient is diagnosed with HPV of the oncogenic group, in order to prevent the appearance of oncological processes in the body, it is necessary to pay attention to the immune system, regularly undergo tests and be observed by a doctor.

Is it possible to give birth if you have the human papillomavirus?

If HPV is detected in a woman’s body, but there are no external manifestations in the form of papillomas, then you can give birth calmly and not worry. If there are genital warts in the genital area, then there is a very high risk of the child becoming infected with HPV while passing through the birth canal. The child’s first independent breath can occur right in the birth canal; the virus entering the baby’s throat leads to the growth of papillomas on his vocal folds. Therefore, in the presence of genital papillomas and an active form of HPV, a cesarean section is indicated.

Can human papillomavirus go away without treatment?

According to statistics, in 85% of cases, HPV after infection is eliminated by the body on its own, thanks to the good functioning of the immune system. This process can last from several months to several years. Sometimes the presence of the virus in the human body may not be detected even during a medical examination. The presence of HPV can be fully confirmed by the presence of formations on the skin - papillomas.

What to do if you are diagnosed with human papillomavirus?

Dermatologists recommend: