medical examination of HPV

HPV symptoms treat disease

The abbreviation HPV stands for human papillomavirus. The pathogen causes sexually transmitted diseases and can be manifested by warts on the skin and in the genital area. Most HPV infections go unnoticed, but malignant tumors can also occur long after infection. Men and women can get HPV equally. Read more about HPV here.

Brief information about HPV

Infection: mainly by direct contact with the skin or mucous membranes (sexual intercourse); It is possible to transmit the virus through infected objects (sex toys, towels, etc.) and during birth (from an infected mother to a child)

Possible secondary diseases: Depending on the type of HPV, mainly skin warts, genital warts, tissue changes (potential precancerous stages), and cancer (such as cervical cancer, mouth and throat cancer, anal cancer)

Common symptoms: depending on the clinical picture; e.g., in genital warts, reddish, brownish, or whitish papules in the genital and anal area, possibly with a feeling of moisture and itching; in cervical cancer, vaginal discharge, and unexplained vaginal bleeding

Tests: physical examination, cell swab, colposcopy (in women), HPV test, biopsy (tissue sample analysis)

Treatment: Depending on the clinical picture, ice therapy, laser therapy, electrocautery, drugs, surgical interventions, natural treatment by strengthening the immunity.

HPV: causes and risk factors

Human papillomaviruses (HPV) belong to DNA viruses. Your genetic information is stored in the DNA chain, the human genome. HPV viruses need human cells to multiply. The infection works like this:

HPV viruses smuggle their genetic material into a human host cell (skin or mucous membrane cell) and force it to produce new viruses constantly. At some point, the host cell opens (and dies in the process), releasing many new viruses. Then they can attack new human cells.

At the same time, HPV infection can alter the human genome in such a way as to develop uncontrolled growths of skin or mucous membranes (tumors). These growths can become cancer. The risk of cancer depends on the type of HPV.

HPV transmission

Many HPV viruses are transmitted by skin contact. This is especially true for those pathogens that cause harmless skin warts (papillomas).

HPV types, which infect the genitals and cause genital warts or cervical cancer, are mostly transmitted through sexual intercourse. Genital HPV infections are therefore classified as sexually transmitted diseases (STDs). Transmission of the HPV virus is also possible through oral sex if the oral mucosa comes in contact with areas of the skin infected with HPV (such as the lips or penis). The same applies to contact with the body during bathing together, but this is a much rarer way of infection.

In theory, it is also possible for the HPV virus to become infected through infected objects such as sex toys, towels, or toilets.

Another possibility is the transmission of pathogens from mother to child during birth.

According to the current knowledge, there is no risk of infection through breastfeeding, normal kissing, or giving blood.

If genital warts can be found in the genital anus in children, special care is needed. Each case must be investigated, and sexual abuse must be ruled out as a possibility.

Risk factors

hpv in word

The most important risk factor for genital infection arises from the mechanism of HPV transmission: frequent and, above all, unprotected sexual intercourse. Other risk factors for HPV infection are:

First sexual contact before 16. years: This risk factor is especially true for girls.

Smoking: Cigarettes & Co. increase the risk of HPV infection and cells’ risk of degenerating and developing cancer cells.

Birth of several children at an early age: During pregnancy, the cervical mucosa changes and becomes more susceptible to infections. Tissue changes can last for several years after pregnancy.

Uncoordinated use of condoms: Condoms cannot 100% prevent HPV infection. However, if used continuously during sexual contact, the risk of infection is reduced.

Weak immune system: If the immune system is damaged in its function due to a disease (such as HIV) or medication (immunosuppressants), the risk of HPV infection increases.

Other genital infections such as chlamydia or genital herpes appear to promote HPV transmission.

Also, some factors increase the risk of HPV-infected cells turning into cancer cells. These include smoking, many pregnancies, HIV infection, and taking birth control pills for five or more years.

HPV: secondary diseases

To date, over 200 different types of HPV are known. Most of them do not cause symptoms or only cause harmless warts on the skin. About 40 types of HPV infect the genital mucosa. They are divided into groups based on how likely they are to cause cancer:

Low-risk types (low-risk HPV) rarely cause dangerous genital warts. Although there is a risk of cancer here, it is shallow. The most common types of low risk are HPV 6 and 11. Further known representatives of this group are HPV 40, 42, 43, 44, 54, 61, 62, 70, 71, 72, 74, 81 and 83.

High-risk types (high-risk HPV) trigger tissue changes (dysplasia, neoplasia) from which a malignant tumor can develop over the years, especially cervical cancer. However, HPV infection can also increase the risk of other cancers such as penile cancer or throat cancer. The two most important types of high-risk HPV are HPV 16 and 18. They also include HPV viruses 31, 33, 35, 39, 45, 51, 52, 56, 58, 59 (and possibly more).

Some papillomaviruses, such as HPV 26, 53, and 66, are more likely to be detected in the precancerous stages. Some authors talk about moderate HPV here. The risk of cancer for these types of HPV is between low and high. HPV viruses 5 and 8 are also classified as intermediate HPV. They are actually really dangerous only if the immune system is weak or epidermodysplasia verruciformis. This is an inherited skin condition.

Genital warts (Condilomata acuminata)

Genital warts (pointed warts) are benign tissues in the genital area and the anus. They are transmitted through unprotected sexual intercourse and are mainly caused by low-risk HPV types 6 and 11, but sometimes by other representatives of HPV. Both men and women can get them.

It can take up to eight months from HPV infection to the appearance of genital warts (incubation period). Condyloma is the most common benign tumor of the external genital and anal area. They can disappear spontaneously, but they can survive for months and years.

Condyloma plan

Planar condylomata are flat types of genital warts on the external and internal genitals. The main culprits are HPV viruses 16, 18, 31, and 33. They can lead to changes in cells known as intraepithelial neoplasms. These changes in cells are considered potential precursors of cancer and are classified according to where they occur:

  • Cervical intraepithelial neoplasia (CIN): on the cervix (cervix = cervix)
  • Vulvar intraepithelial neoplasia (VIN): on the vulva (= lips, clitoris and mons)
  • Vaginal intraepithelial neoplasia (VAIN): in the vagina
  • Intraepithelial penile neoplasia (PIN): on the penis
  • Perianal intraepithelial neoplasia (BOL): in the area of the anus
  • Anal intraepithelial neoplasia (AIN): in the anus

Cervical cancer (cervical cancer)

If the mucous membrane cells on the cervix are chronically infected with high-risk HPV types, they can degenerate over time and form a malignant tumor. This does not happen with every infection, but relatively rarely: according to statistics, less than one in 100 women infected with the high-risk HPV type will develop cervical cancer – on average 15 years after the HPV infection.

Thus, it takes a long time for a malignant tumor to develop. Therefore, women should go to the gynecologist regularly once a year: the so-called Pap test from the cervix can reveal suspicious changes in the cells at an early stage.

You can read more about the development, symptoms, treatment, and prognosis of cervical cancer in the text Cervical cancer.

Other cancers

In cervical cancer, the connection with the HPV virus has been clearly proven. But the development of cancer through HPV in some other parts of the body has not yet been fully explored. Oral intercourse, for example, can increase the risk of malignant growths in the throat (such as throat cancer). Cancer development in the genital and anal area, such as vaginal cancer, vulvar cancer, penis cancer, and anal cancer, can also favor infections with high-risk HPV types. All of these cancers are much rarer than cervical cancer.

Skin warts

Some HPV viruses cause common skin warts called verrucae vulgares. They are the most common type of warts. There are various special forms, such as the butcher’s nipple. It occurs when working with raw meat in a humid and cold environment (especially in butchers) and is associated with the HPV type 7 virus.

If HPV infection causes warts on the soles, it is usually plantar warts (verrucae plants). The trigger is usually HPV 1. If plantar warts appear in large numbers in the form of warty fields, dermatologists say that they are mosaic warts.

Flat warts that often occur in children cause HPV 3 or 10. Their technical name is Verrucae plane juveniles.

Warts in the mouth

Sometimes warts form in the mouth. They are called oral papillomas. Some of them are associated with HPV infection.

If warts or wart-like structures appear in the mouth, it could also be Hack’s disease (Hack’s disease or focal epithelial hyperplasia). These benign growths on the skin always appear in groups and not individually. Their development is associated with HPV 13 or 32. Hack’s disease is rare among the European population, but it is more common in other populations, for example, among the indigenous peoples of Central and South America.

Pidermodisplasia verruciformis

This rare disease is a chronic HPV skin infection. It is also known as Lewandowski-Lutz syndrome after its inventor. It occurs in families and is one of the inherited skin diseases. Due to a genetic defect, HPV viruses can spread more easily among relatives. Various types of HPV play a role in developing epidermodysplasia verruciformis, including HPV 3, 5, 8, and 10.

HPV: signs (symptoms)

The human immune system, in many cases it can fight the HPV virus quite well so that almost no symptoms of HPV occur. In the case of latent HPV infection, the human papillomavirus can only be detected in the laboratory. In the case of subclinical HPV infection, skin / mucosal changes associated with the virus can only be made visible by special techniques.

If, on the other hand, the symptoms of HPV are visible to the naked eye, doctors then talk about a clinical HPV infection. The symptoms caused by HPV viruses depend on the type of virus and disease type.

Symptoms of genital warts (condilomata acuminata)

Genital warts or pointed warts can develop in three to eight weeks (incubation period) after infection with certain HPV viruses. They are reddish, gray-brown, or whitish papules of the skin or mucous membranes of the genital and anal region. Their size varies between the needle head and even a few centimeters. Often, individual condylomata are close to each other and form so-called papillomas.

In women, such HPV signs are mostly found in the lips, at the posterior junction of the two labia majora (posterior commissure), and in the anal region. Genital warts can also develop in the vagina and cervix. Code men, these signs of HPV infection affect the penis and anal region.

Genital warts hardly cause symptoms. However, sometimes dampness and itching, tingling, and bleeding after intercourse are possible symptoms of genital warts caused by HPV. On the other hand, pain is manifested only occasionally.

In rare cases, genital warts that exist for years develop into Buschke-Lovenstein giant condylomata (Condylomata gigantea). These cauliflower-like deformities displace and destroy the surrounding tissue. Cells can degenerate and become cancer cells (verrucous cancer).

Articles on HPV

Symptoms of intraepithelial neoplasms

Intraepithelial neoplasms do not cause symptoms in many people. This applies, for example, to cervical intraepithelial neoplasia (CIN). In other cases, more or less obvious discomfort may occur. For example, intraepithelial neoplasia of the vulva (VIN) may be accompanied by itching, burning, and pain during sexual intercourse (dyspareunia) but may be asymptomatic. Anal or perianal intraepithelial neoplasia (AIN and BOL) causes itching in the area of the anus, as well as discrete bleeding from the anus and pain during bowel movements. Changes in the cells on the penis (PIN) can cause a velvety, irregular, shiny redness in the area of the head or foreskin.

The most common cancer associated with the HPV virus is cervical cancer. Most women who become ill do not show symptoms in the early stages of the disease. In other women, vaginal discharge and bleeding after intercourse, between menstrual bleeding, or after menopause indicate a possible tumor disease. However, these symptoms can have other causes.

In advanced cervical cancer stages, women often report pain in the lower back or pelvis when urinating or emptying the bowel. Lymph congestion in the legs can also occur.

Sometimes other cancers are associated with HPV. Symptoms depend on the tumor’s location and the stage of the disease. In penile cancer, skin changes such as swelling or hardening of the head or foreskin, lightly bleeding skin on the penis, and sometimes an unpleasant odor can occur. Vaginal cancer becomes noticeable only in an advanced stage with bloody discharge or vaginal bleeding (for example, after sex).

Symptoms of skin warts

Skin warts can usually be recognized without any problems. As a rule, they do not cause any symptoms except occasional itching, pressure, or tension. Warts on the feet can also cause pain. Sometimes warts (like plantar warts) have tiny black spots. It is clotted blood from tiny capillaries of the skin.

Common verrucas are a pea’s size and have a rough, scaly surface. They tend to form on the back of the hand, on the toes and edges of the nails, and the feet.

Plantar warts on the feet are pressed against the nails by the body’s weight when walking or standing. This pressure can cause such pain that those affected can barely walk.

The mosaic warts are about the size of a white pinhead. They grow especially on the feet or under the toes. Some patients also cover the entire lower side of the foot. Because they are flatter than plantar warts, they usually do not cause pain while walking or standing.

Juveniles verrucae planae, mainly in children, are flat skin-colored warts. They especially develop on the hands below the elbows’ face and back.

Symptoms of warts in the mouth

Oral papillomas are individual wart-like structures of a small cauliflower. They are mostly found on the hard or soft palate or the uvula.

Several oral or oval papules develop on the oral mucosa with Heck’s disease. Children and young people are particularly affected by these changes.

Symptoms of Epidermodisplasia Verruciformis

In this disease, an abnormally large number of generalized skin lesions resembling flat, irregular warts (verrucous) form throughout the body. Papules or plaques are slightly scaly reddish to brownish in color. Adolescents are particularly affected by these changes and less often older adults. The risk of developing skin cancer is significantly increased, especially on exposed skin exposed to the sun.

HPV: diagnosis and examination

In most cases, HPV symptoms cannot be found in the infection itself. The infection usually goes unnoticed. However, if HPV viruses cause signs of the disease, they are usually typical skin or mucous membranes. However, some manifestations are so inconspicuous that they can be visible only through special procedures. Necessary examinations are usually performed by specialists, whether dermatologists, gynecologists, urologists, or specialists in ears, nose, and throat, depending on the clinical picture.

Medical examination

A doctor usually examines the whole body. Most of the symptoms of HPV, namely warts on the skin, are easily spotted. Further examinations are then usually not required. If the skin’s wart seems suspicious, the doctor removes it and sends it to the laboratory for further examination.

Changes in the female genital area are usually detected during preventive examinations. The vagina is scanned and then examined with a speculum (“mirror”). Palpation is important because speckles sometimes cover deep-seated growths such as those caused by HPV viruses.

Suspicious HPV manifestations in the male genital area are usually recognizable and unambiguous to the naked eye. A specialist for this part of the body, a urologist, examines the head of the penis, the urethra (Meatus urethrae external), and its extension, which is located there (Fossa navicularis). Under certain circumstances, they will expand this area to examine the last two centimeters of the urethra.

HPV can also be found in the anal area. Because tumors caused by HPV can reach the anal canal, some doctors perform anal canal imaging (proctoscopy).

PAPA test

For women older than 20, gynecologists regularly take a swab from the cervix to detect cervical cancer. The cervix’s surface is first wiped with a kind of brush in a circular motion. The doctor takes another swab from the cervical canal. The smears are then fixed on a glass plate with the help of a high-percentage alcohol solution, then stained and examined. This is not a special HPV swab to detect the virus but an examination of suspicious changes in the cells that may result from an HPV infection (or for other reasons).

The scale developed by the Greek doctor Georges Papanicolaou is used to assess possible changes in the cells. This is why this test is also called the Pap test.

Colposcopy

Colposcopy should be understood as an enlarged reflection of the vagina. During this examination, the gynecologist also uses a so-called colposcope (Kolpo = vagina; scopie = observation), a type of microscope. With a magnification of up to 40 times, the doctor can see the slightest changes or bleed on the cervix, the walls of the vagina, and the vulva. The doctor drowns two to three percent of acetic acid on the mucosa with an extended colposcopy. The altered upper covering layers swell and whitishly separate from the mucosa’s rest.

The next step is the so-called Schiller iodine test. The vaginal mucosa is soaked with iodine solution (four percent Lugol’s iodine solution). The healthy mucosa then becomes brownish-red due to the starch (glycogen). In contrast, altered cell layers, such as HPV remain unstained.

Biopsy

If the doctor detects abnormalities during the PAPA test or colposcopy, he can specifically remove the tissue from the female genital area and examine it (biopsy). Depending on the diseased mucosa’s location, the tissue sample is scraped with a sharp spoon (curettage), or the cone is cut from the vaginal tissue (conization).

HPV test

This test is used to detect HPV infection and identify the virus type. Its application on the cervix is the most precise: the test result helps diagnose a malignant tumor or its preliminary stages. The test is much less suitable for detecting HPV infection in other parts of the body.

The HPV test is available in different versions. It is currently recommended for early detection of cervical cancer only for women aged 30 and over, together with the Pap test. If you have an abnormal Pap test at a young age, a human papillomavirus test may also be helpful. It can also help monitor therapy’s success after treating precancerous lesions on the cervix.

HPV: treatment

HPV infections usually heal spontaneously because immune cells kill HPV viruses. Sometimes, however, existing diseases weaken the immune system and fight against HPV. Therefore, they need to be addressed.

In general, the choice of HPV therapy depends on the type and extent of HPV symptoms. Symptoms such as warts or warts can be treated in different ways. The HPV virus itself is rarely completely eradicated. As a result, relapses are common.

Cryotherapy

This HPV treatment option is used for superficial warts and warts on the skin. The doctor applies the liquid nitrogen to the skin’s affected area using a spray or stick (cotton wool, metal), whereby the tissue dies. Sometimes a small bubble will form. The application is usually repeated for one to two weeks. However, the HPV virus survives this process. In many cases, new warts appear as a result.

Electrocautery

A doctor also performs this treatment. Like icing, electrocautery can be used for warts and warts. HPV-altered tissue is destroyed by electric current. However, here too, the HPV virus remains in the body and can trigger new skin changes at any time.

Electrocautery is also used after surgical removal of warts: directly adjacent layers of skin and their vessels are charred. Although this reduces the risk of recurrence, there is a high probability that a scar will form.

Operating procedures

Any symptom of HPV can be treated surgically. Various instruments can be used for this. First, the affected area of the body is anesthetized locally. The growths can then be excised with a sharp spoon (curettage), an electric loop (electrosurgical loop excision procedure, LEEP), or surgical scissors (scissors).

In case of suspicious new changes (intraepithelial neoplasia, especially of the cervix) of the genital mucosa, the entire cone (conization) is often cut. Before that, however, you usually perform several follow-up examinations: a doctor checks every six months to determine how the clinical picture is changing. If the abnormal area is enlarged and if high-risk HPV is also detected, the tissue must be removed. If the tumor is already recognized as malignant, it is performed as soon as possible. However, if the patient is pregnant, attempts are made to delay surgery until after delivery. Depending on the cancer stage, the surgeon will extend the procedure accordingly. For example, in advanced cervical cancer, the entire uterus is removed (radical hysterectomy).

Some cancer patients receive radiation therapy and/or chemotherapy as an alternative or adjunct to surgery.

Laser therapy

This option of treating HPV disease is also one of the surgical procedures. A laser (e.g., CO2 or Nd: IAG laser) is used for all types of HPV warts. The growths were burned under local anesthesia. However, caution is advised: HPV viruses can easily spread with the development of smoke. Therefore, it is essential to provide adequate protection with a suction device and filter.

HPV: course and prognosis of the disease

There is no classic HPV infection. Often the infection goes unnoticed and without any consequences. If symptoms of HPV appear, spontaneous healing is possible. Generally, most HPV infections go away within a few months. After two years, about 90 percent of all HPV infections have been cured.

Certain HPV viruses last longer and even lead to cancer. This can happen years or decades after the HPV infection.

HPV: prevention

There is a lot of discussion about protecting yourself from HPV infection. Prevention is not easy because HPV viruses are widespread, and therefore the risk of infection is very high.

In general, it makes sense to ensure thorough hygiene and strengthen the immune system. To reduce the risk of infection with normal skin warts, you do not need to walk barefoot in swimming pools, saunas, public locker rooms, and hotel rooms. If someone around you has warts, you should not share a towel, cloth, or socks with them (if you have warts on your feet).

To prevent HPV infections in the genital and anal area, you should always use a condom, especially if you change sexual partners often. Safer sex does not offer reliable protection against HPV because the HPV virus can be transmitted by smear infection. However, condoms can reduce the risk of infection.

The risk of HPV is lower in circumcised men than in non-circumcised men.

HPV: vaccination

Standing Commission for Vaccination (STIKO) Robert Koch Institute recommends that all girls and boys between the ages of nine and fourteen be vaccinated against HPV (preferably before the first sexual intercourse). Those who have not been vaccinated at the age of 15 should be vaccinated by 18 at the latest. Birthdays.

The main purpose of HPV vaccination is to reduce cervical cancer risk. It can also reduce the risk of some other types of cancer (vaginal cancer, penis cancer, etc.) and prevent the development of genital warts (genital warts) in both sexes.

It is unknown exactly how long the protection against the vaccine lasts. The study results show that vaccinated girls/women are still effectively protected from HPV infection 12 years after vaccination.

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