Today, HPV infection is one of the most common and important STIs (infections that are predominantly sexually transmitted), which infects most of the sexually active population of the planet. The peak of HPV infection occurs at the age of 18-25 years and decreases after 30 years, when the frequency of dysplasias and cervical cancer increases significantly, the peak of which occurs at 45 years.
The clinic conducts diagnostics of infection with the human papillomavirus, as well as procedures for the prevention of infection with sexually transmitted infections after casual sexual intercourse.
At least 50% of the sexually active adult population is infected with one or more types of HPV, and in most cases, genital HPV infection in them is unrecognized, subclinical or asymptomatic. Genital HPV infection is highly contagious and is acquired during the first few sexual contacts; infection with a single sexual contact occurs in about 60% of cases.
Risk Factors for Infection with Human Papillomavirus
Recent studies have established that HPV is a necessary but insufficient factor in cervical neoplasia. Risk cofactors for the development of the disease can be:
- disorders of cellular and humoral immunity
- unfavorable socio-economic status;
- sexual behavior;
- concomitant sexually transmitted diseases (herpes, chlamydia, trichomoniasis, gonorrhea, syphilis, etc. );
- hypo- and avitaminosis;
- young age;
- smoking;
- pregnancy;
- vaginal dysbiosis.
The virus is also sometimes transmitted from mother to child both in utero and during childbirth. In addition, pregnancy is a provoking factor for the manifestation and growth of neoplasms, as well as their transition to cancer. This is due to a decrease in immune defenses and changes in hormonal levels.
Quite often, one has to deal with a situation when a patient is diagnosed with human papillomavirus (HPV) of high oncogenic risk. As a rule, doctors immediately report that there is a risk of developing cervical cancer. Often, a rather aggressive treatment is immediately prescribed, a biopsy is performed, however, in general, it is not clearly explained what actually happens, and what is the future prognosis. So, if you have a high oncogenic risk of human papillomavirus (HPV) detected by PCR, this does not mean at all that you need to panic. There is nothing serious in this find, it is just an excuse to undergo an appropriate examination.
Cervical screening, aimed at identifying cancer-threatening human papillomavirus infection and associated lesions of the cervix, continues to be a necessary component of health care and every woman should remember about the need to "pass" it.
How often and when to start screening?
It is important to note that the greatest number of cervical lesions, including severe ones, occurs at an early reproductive age. Therefore, it is more advisable to start screening for cervical pathology as early as possible after the onset of sexual activity. Cervical cytological screening should be performed from the age of 18 or from the age of onset of sexual activity. Only thanks to this approach, the number of women in whom the disease is detected late is reduced.
What should be done to prevent the development of cervical cancer?
- Once a year, it is imperative to undergo an examination by a gynecologist with a mandatory examination of the cervix - colposcopy.
- A simple examination of the cervix is not enough - certain tests must be done. That is, to answer two questions: do you have human papillomavirus, and whether there are changes in the cells of the cervix that can potentially lead to the development of cervical cancer.
Most often, in ordinary clinics and laboratories, a simple cytological smear and a smear by PCR are taken to determine the virus (that is, an analysis that simply answers the question - is there this virus or not). These analyzes have several disadvantages that can significantly affect their accuracy.
Disadvantages of conventional cytology and PCR smear:
A smear from the cervix is taken with a flat brush and the material is "smeared" on the glass. Wherein:
- the doctor may not pick up cells from the entire surface of the cervix;
- when applied to glass, a smear is obtained with an unevenly applied material (somewhere thicker, somewhere thinner), which does not allow the cytologist to fully examine it and correctly evaluate all the cells obtained;
- the glass with the applied smear can "clog", which also affects the quality of the evaluation of the obtained cells.
A PCR smear will then show whether the human papillomavirus is present or not. It cannot be used to judge the amount of this virus, and that matters.
Therefore, at present, the most accurate diagnostic method ismethod of liquid cytology.
The essence of the method is that the material is taken from the cervix using a special brush, which, due to its design, allows you to capture cells from the entire surface of the cervix and from the cervical canal. Next, the brush is immersed in a special container with a solution. This solution "preserves" the cellular material collected by the doctor, prevents cell damage, allows one to overcome bacterial "contamination" and makes it possible to transport the collected cells to the laboratory under optimal conditions.
For both the doctor and his patients, the advantages of using the liquid are its resistance to temperature fluctuations, the ability to store cellular material for several years and the ability to conduct additional or necessary tests for the full range of genital infections, including genetic testing for human papillomavirus. . .
Another important analysis can be made from the resulting solution with cells — the determination of a specific protein. The determination of this protein makes it possible to clarify the situation in identifying altered cells of the cervix, which have indirect signs of transformation. The detection of this protein indicates that the cell is seriously damaged, and there is a high probability of its malignant transformation. The absence of this protein indicates that the defect in the cells is not dangerous and the likelihood of malignant transformation is minimal.
All studies can be carried out from one vial with liquid cytological material; the patient does not require additional visits to the doctor, which means that the implementation of simultaneous or sequential cytology and genetic detection of the virus, and, therefore, full screening of cervical lesions in this case is maximally facilitated.
The use of a liquid method of collecting material for examining women for infectious pathology of the cervix is the most logical and economically feasible approach. But the most important thing is that this new technology makes it possible to increase the effectiveness of cervical screening and not "miss" those women whose lesions on the cervix have already acquired the status of "precancerous".
In the course of studying the new research technique, a comparative analysis of the traditional technique and liquid cytology was carried out. As a result of the analysis of more than 100 traditional cervical smears, "suspicious" or so-called "atypical" cervical cells were found in only every fifth woman, and as a result of a new liquid cytological study - in every second woman.
Such a triple test allows you to analyze the cells of the cervix with the highest possible accuracy and decide what to do next.
Such a test is important not only for women who have already had changes in the cervix or diagnosed with the presence of human papillomavirus oncogenic types. This test must be performed prophylactically once a year, in which case you can be sure not to miss possible changes in the cervix.