Cervical Papilloma

Cervical Papilloma is a small single or multiple papillary tumor formed by a connective and epithelial tissue of a viral origin. The main "culprit" of the pathology is the sexually transmitted human papillomavirus( HPV), on the cervix after infection it triggers the processes of local pathological proliferation of the epithelium, and there appear small single or plural, papillae-like outgrowths. The external characteristics and structure of the papillomas of the cervix are diverse.

There are a lot of myths associated with human papillomavirus, their number has increased especially recently, due to the development of modern diagnostic and therapeutic techniques, the presence of papillomavirus is diagnosed quite often. It should be noted that this virus has a great variety( more than 120) of varieties( or types), and more than 30 of them are capable of affecting the genital tract. Therefore, the virus does not always uniquely affect the body. More often it is diagnosed in young, active persons of both sexes. Among young people who did not overcome the 23-year-old barrier of women, human papillomavirus is found in 33%.It can exist in the form of carriage, not manifesting clinically, or provoke structural disorders of varying severity.

We will try to refute the most common misconceptions about the human papilloma virus:

Myth one: the papillomavirus always provokes pathology.

It is reliably established that almost 80% of the world's population has this virus in the blood, but not every infected person has any symptoms. Often, the presence of the virus is found by chance in perfectly healthy women.

Myth two: the human papillomavirus is only sexually transmitted.

Indeed, in most young women, papillomavirus infection provokes the appearance of papillomas on the genitals after intimacy with a partner who has this virus in the blood. They can be either an infected carrier or a sick person. However, there are other ways of delivering the virus to the female body, namely, contact and intrauterine. The contact path of infection implies the possibility to get infected in tanning beds, saunas, baths and other public places, and also this is possible in medical institutions that do not comply with the necessary sanitary and hygienic standards. Human papillomavirus can penetrate the fetus during pregnancy through the common blood system of the mother and fetus, or in the process of childbirth with the direct contact of the child with the infected tissues of the genital tract of the mother.

Myth three: the human papillomavirus always causes cancerous tissue degeneration.

In infected cells, the virus can exist in two ways. Sometimes he "lives" in a cage, without damaging her chromosomal apparatus, so the cellular composition of infected tissues remains the same. In more rarely occurring adverse situations, human papillomavirus is integrated with the chromosomes( cellular genome) of the cell, changing its properties, which can trigger cancerous tissue degeneration.

As already noted, the papillomavirus has many varieties, most of which provoke benign changes in the superficial epithelium of the skin and mucous membranes. According to the degree of cancer, three groups of human papillomaviruses are isolated. A high degree of viruses are of type 16 and 18, medium - 31, 33, 3, 42, and to a low degree are viruses of the 6th and 11th type. However, even in the presence of "threatening" types of the virus in women with strong immune protection, the cervical papilloma does not always transform into a malignant process. The infection, provoked by the virus of low oncorrhiza, is distinguished by benign course and rapid recovery, which does not take more than one and a half years.

Myth Four: the human papilloma virus must always be eliminated from the body.

The question of the need for therapy and its methodology does not have a standard solution. It is well known that sometimes a healthy organism is able to eliminate the virus by itself. Treatment is necessary if the detected virus is classified as a "dangerous" type, has clinical manifestations in the form of papillomas, in other situations the decision is taken individually.

Myth Five: Cervical papilloma during pregnancy will certainly harm the fetus.

Indeed, HPV is able to penetrate from the mother to the developing fetus and provoke the papillomatosis of the respiratory system and the external genitalia. However, the probability of such a scenario is ambiguous and amounts to 5 - 80%.Until now, it has not been reliably established how the virus penetrates the fetus, and what factors contribute to further infection.

Cervical papilloma during pregnancy deservedly deserved the epithet "mysterious", since after birth, it most of the bereaved independently disappeared, and laboratory diagnostics confirms the absence of human papillomavirus in their body. Such situations do not concern those who gave birth, for whom the virus was identified before the onset of pregnancy, their probability of self-healing is low.

Cervical papilloma requires close attention, as sometimes it is caused by oncogenic types of viruses. Patients should understand that in women with human papillomavirus, the papilloma is not always formed on the cervix, and the presence of such does not mean cancer. From the appearance of the papilloma to the development of the oncological process on the cervix, it usually takes a very long time - from 10 to 40 years, very rarely this period is reduced to two years. Agree that for such a time period it is possible to diagnose and completely eliminate the pathological process in order to prevent possible negative consequences.

Diagnosis of cervical papilloma begins with the moment of visual inspection, when on the neck a site of mucosa of an unusual kind is determined. A feature of the papilloma of the cervix is ​​its flat shape, while the papillomas of another localization may look different. Flat papilloma of the cervix is ​​not always well visualized in the early stages of formation, so for a more detailed study of the mucous cervix uterus used colposcopic, cytological and histological methods.

To get rid of the papilloma is not enough mechanical removal appeared on the neck of the formation. If the human papilloma virus is not eliminated from the body, the disease will inevitably recur. Therefore, adequate antiviral therapy is one of the stages of adequate treatment.

Causes of papilloma of the cervix

Papilloma of the cervix has a single origin: it is formed due to the penetration of the papillomavirus into the mucous layer and its subsequent pathological effect on the cervical epithelium. The probability of infection by household means, of course, is possible, but it is extremely rare, and the most common way of infection remains sexual when the virus is transmitted from a partner. Partners - carriers of the human papilloma virus, despite the absence of signs of disease, can serve as a source of infection in 46% - 67% of cases.

After infection of the papillomavirus mucosa, events can develop according to several scenarios. Often the internal reserves of the immune system cope with the infection, and after a few months HPV is completely eliminated. It is also possible the asymptomatic presence of the human papillomavirus in the body( carriage), when its presence does not provoke pathological changes. But a virus that does not harm the carrier can be a source of the disease for the sexual partner.

A complete clinical picture of cervical papilloma develops with certain provoking factors, among which lead poor immunity, the presence of microtraumas and inflammatory changes on the cervix, as well as constant sexual contact with HPV partners.

Healthy mucous membranes endowed with good local immune defense are more likely to withstand various infectious agents, including HPV.It is much easier to infect the cervical epithelium against the background of cervicitis, including specific origin( gonorrhea, trichomoniasis), pseudo-erosions or colpitis. Long-term use of hormonal tableted contraceptives can also serve as a predisposing condition for the formation of the papilloma of the cervix.

Pregnancy in some situations can become a kind of natural, predisposing to infection with HPV factor. After all, during this period, the woman's immune system is under severe stress, and the hormonal background is completely reconstructed.

Symptoms and signs of cervical papilloma

Papillomas are classified as benign formations that form exclusively in the outer layers of the integumentary epithelium. With gynecological examination, they can be found on the skin of the anogenital zone and / or on the mucous external genitalia. Single papillomas are diagnosed more often. The shape of the papilloma and the size vary greatly. Sometimes the papillae have a well-defined thin base - the "leg".According to the method of growth, papillomas are conventionally divided into exophytic( pointed), growing outward( that is, in height), and endophytic( flat), which slightly rise above the surface of the surrounding epithelium.

The flat papilloma of the cervix has a wide base and is characterized by horizontal growth, therefore sometimes it looks like a rough mucosa, slightly different in color.

The structure of the papilloma corresponds to the structure of the epithelium from which it is formed. Papillomas can be covered with multilayered flat, cylindrical or transitional epithelium, contain a different number of connective tissue elements. The squamous papilloma of the cervix is ​​more often diagnosed, formed by a flat epithelium and connective tissue.

Like any infectious process, cervical papilloma has an incubation period - the time elapsed from the introduction of the virus into the epithelium before the appearance of structural changes in the tissues. Its duration varies greatly from one to nine months, as it depends on many factors: the state of the immune defense, the presence of pathological changes in the mucous membranes of the vagina and cervix. More often, the first symptoms of the disease manifest themselves three months after infection with HPV.

Cervical papilloma often does not cause unpleasant symptoms, so it is diagnosed for the first time in a visual examination. Squamous papilloma of the cervix due to horizontal( endophytic) growth is not always clearly visible, it is often accompanied by cervical erosion and / or chronic cervicitis. Usually on the neck you can see a section with a finely hilly( rough) surface. In later stages, this area becomes more noticeable, as it rises in height.

Colposcopy is carried out by all having "suspicious" changes on the cervix to patients. As a rule, with colposcopy, an experienced specialist can only suspect the presence of papillomavirus in mucous membranes, since its external manifestations do not have characteristic distinctive features. Of great importance for the final identification of pathology are cytological and histological studies of mutated tissues.

It is possible to determine the presence of the human papillomavirus by means of a PCR method. It allows you to detect the DNA of the papillomavirus, and also to typify it.

It should be noted that the positive result of PCR diagnosis on HPV is of clinical importance only in women with manifestations of the disease, when it is necessary to establish the true cause of the appearance of papillomas. At the age of 30 years of healthy patients, the presence of HPV does not always require attention, as in this age category there are short-term episodes of infection, resulting in complete elimination of the virus.

Once again, it should be recalled that the presence of HPV does not always mean disease, and the identification of its oncogenic types does not imply the mandatory development of cervical cancer.

Treatment of papilloma of the cervix

Papilloma, regardless of type, is always removed due to unpredictable behavior of papillomavirus infection. The method of treatment is quite a lot, so the decision is made by the attending physician according to the results of the survey.

Treatment of cervical papilloma is always complex. It includes measures to eliminate local infectious inflammation( if any), correction of immune disorders and elimination of hormonal dysfunction.

Recovery will never be successful if the treatment of papillomavirus infection is isolated from the sexual partner, and if the patient neglects medical recommendations regarding the need to regulate intimate life and to refrain from casual relationships with unfamiliar partners.

The most effective treatment method is the removal of cervical papilloma by one of the destructive surgical methods. However, some situations do not allow to destroy the papilloma in this way, therefore other, no less effective methods are used:

- Influence on the papilloma of cytostatic drugs that suppress growth and destroy it. Use an alcohol solution of Podofillin or Condilin, ointment, gel or cream of 5-fluorouracil. Medicinal products "bring" to the papilloma with the help of appliques. The duration of therapy is determined according to the visual changes in the tissues, and complete the treatment after the complete destruction of the neoplasm.

- Chemical degradation with the help of aggressive acids( trichloroacetic, nitric salicylic and lactic), Feresol or Solkoderma. In fact, the papilloma is "burned out" chemically.

It should be noted that the drug destruction of the papilloma of the cervix is ​​not always accompanied by a complete elimination of the human papillomavirus from the body, but it can prevent the negative consequences of the disease. Often after treatment, the patient becomes a HPV carrier, and a repeated episode of papilloma can never happen again.

Unfortunately, absolutely effective methods of curing papillomavirus infection do not exist, therefore the disease sometimes recurs. With the recurrence of papilloma it is necessary to restore the normal functioning of the immune system so that it can "help" cope with the virus. Immunological and restorative treatment is selected individually.

Cervical papilloma during pregnancy requires a special relationship. The cervix during the pregnancy undergoes certain structural changes and becomes very vulnerable. After contact with aggressive chemical compounds, the tissue of the "pregnant" cervix may suffer, leading to birth trauma, bleeding, or secondary infection. If the papilloma is small in size, and its good quality is confirmed in the laboratory, a dynamic observation is carried out, and the formation is deleted only after the birth.

Cervical papilloma removal

Surgical destruction of the cervix papilloma involves several methods. Since they imply the destruction of a pathologically altered mucosa, in fact, they repeat the treatment techniques for many cervical diseases, for example, pseudo-erosion. More often the papilloma is eliminated by the following methods:

- cryodestruction. The method is based on the ability of nitrous oxide to "freeze" the pathological region of the cervical epithelium. Under the influence of low temperatures, the papilloma cells are destroyed.

- Diathermocoagulation( "moxibustion").The cells of the papilloma of the cervix are exposed to an electric shock, after which they die.

- Laser destruction. After exposure to the neck with a high-energy laser, the papilloma cells are literally evaporated with minimal damage to the surrounding structures.

- Radio wave method. In recent years, begins to acquire the greatest popularity, because it is characterized by the least traumatism and a reduction in the timing of regeneration of damaged tissues. The uniqueness of the technique for treating the papilloma of the cervix by radio waves is that the electrode that emits radio waves does not touch the neck, that is, it acts non-contact. Under the influence of radio waves, the cells damaged by the virus heat up, boil from within and collapse.

In recent years, the number of infected HPV has increased significantly, so the issue of disease prevention has become of paramount importance. Like any other pathology, the papilloma of the cervix is ​​better prevented than treated. All measures to prevent HPV infection can be divided into primary and secondary. In fact, both groups are aimed at preventing the development of cervical cancer.

The most popular measure of primary prevention in our day is vaccination in three stages. The serum administered to patients does not contain viable viruses, so it can not "infect" the human papillomavirus. The vaccine is unable to cure the already existing papilloma of the cervix, it is used only to prevent its appearance. It is also not performed by infected HPV patients. Pregnant vaccination is contraindicated. The most suitable for vaccination against HPV is 9 to 12 years of age or up to 26 years, since it is believed that the effectiveness of vaccination after this age boundary is low enough.

Secondary prevention implies the prevention of recurrent cervical papilloma. It is also performed by persons infected with HPV to prevent the appearance of clinical manifestations of infection. Antiviral drugs and immunomodulators are used.