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Human papillomavirus is a genus of papilloma vacuole virus A belonging to the Papillomavirus family. It is a spherical DNA virus that can cause squamous epithelial proliferation of human skin and mucous membranes. Presented as common warts, genital warts (condyloma acuminatum) and other symptoms. With the rapid increase of the incidence of genital warts in venereal diseases and the increase of cervical cancer and anal cancer, human papillomavirus (hpv) infection has attracted more and more attention.

Liu Yanchun

(Chief physician)

Department of Dermatology, Beijing Ditan Hospital

On October 27, 2017, the list of carcinogens published by the International Agency for Research on Cancer of the World Health Organization has initially compiled the reference. Carcinogen-like list. ^[1]

Western Medicine Name: Human papilloma virus
English name: Human papillomavirus (HPV)
Affiliated Department: Department of Physiology-Dermatology
Disease site: Skin mucous membrane
The main symptoms: Common warts, perinatal warts, papilloma-like, cauliflower-like, granular, chicken crown, etc.

Main cause: Prevalence
Contagious: Contagious
way for spreading: Sexually transmitted, close contact, indirect contact, iatrogenic infection, mother-to-child transmission

Human papillomavirus etiology

Human papillomavirus (HPV) is a genus of papilloma vacuolar virus belonging to the Papillomavirus family, a spherical DNA virus that can cause squamous epithelial proliferation of human skin and mucous membranes. At present, more than 130 species have been isolated. The type causes different clinical manifestations, which can be divided into:

(1) Low-risk skin type: including HPV1, 2, 3, 4, 7, 10, 12, 15 and other related to common warts, flat warts, plantar warts, etc .;

(2) High-risk skin types: HPV5,8,14,17,20,36,38 are related to wart epidermal dysplasia, and other malignant tumors related to possible HPV infection include: vulvar cancer, penile cancer, and anal cancer , Prostate cancer, bladder cancer;

(3) Low-risk types of mucous membranes such as HPV-6, 11, 13, 32, 34, 40, 42, 43, 44, 53, 53, 54 and other infections of the genital, anal, oropharyngeal, and esophageal mucosa;

(4) High-risk mucosal HPV-16, 18, 30, 31, 33, 35, 39 and cervical cancer, rectal cancer, oral cancer, tonsil cancer, etc.

Biological activity: HPV has strong resistance, can tolerate dryness and long-term storage, can be inactivated by heating or formalin treatment, so high temperature disinfection and 2% glutaraldehyde disinfection can inactivate. ^[2-3] ^[4]

Human papilloma virus epidemiology

Skin-type HPV infection rates are very common, such as the common warts, toe warts, and flat warts mentioned above, and specific infection rates cannot be obtained. The high-risk HPV infections and the low-risk HPV infections of the external genitals have been noticed. Genital warts and cervical cancer caused by HPV infection account for 15-20% of venereal diseases worldwide.

Regarding the prevalence of HPV in female genital tract infections, according to a survey result from the National Health and Nutrition Research Project from the United States in 2003-2004, the total HPV infection rate of 14-59 years old was 26.8%, so HPV infection caused by women The burden exceeds previous estimates. Epidemiological screening of HPV infection in China has not been reported in large samples, but the incidence of genital warts among sexually transmitted diseases caused by HPV infection is rapidly increasing. It is estimated that the incidence should be the most among sexually transmitted diseases, because there are a large number of leaks. Reported and not reported. There are about 131,500 newly discovered cervical cancers in China every year. The morbidity and mortality rate in the report are increasing, and the age of cervical cancer onset is younger. It can be predicted that Hpv infection will cause huge losses in China. ^[3] ^[5] ^[4] ^[6]

Human papillomavirus infection pathway

1. Sexual transmission channels;

2. Close contact;

3. Indirect contact: through contact with clothing, daily necessities, appliances, etc. of the infected person;

4. Iatrogenic infections: Medical staff's poor protection during treatment and care, causing their own infection or passing on to patients through medical staff;

5. Mother-to-child transmission: It is the close contact of the baby through the birth canal of the pregnant woman. ^[3]

Clinical manifestations of human papilloma virus

HPV Human papillomavirus low-risk HPV infection

1, benign skin manifestations

(1) Verruca vulgaris: papules the size of rice grains, obvious keratosis on the surface, rough, thorny top, hard texture, skin lesions can be single or multiple, can be inoculated and gradually increase. Occurs in hands, feet, etc.

(2) Diseases in specific parts:

Perianal warts: Occurs around the nails and toenails, manifesting as thickening and keratosis of the under nails.

Plantar warts: Occur in the plantar area, bleeding and black spots can be seen on the surface of the skin due to compression.

Filamentous warts: soft, filamentous warts that occur in the neck and eyelids

Flat wart: It usually occurs on the face and is also common on the trunk. It is usually a flat papule with a size of 2-5mm, skin color or hazel, smooth surface, round or round, occasionally scratching due to itching to form an inoculation, or Skin lesions are planted on the surface.

2. Benign manifestations of external genital diseases

(1) Genital warts (condyloma acuminatum): There are three states: typical manifestations, subclinical infections, and latent infections.

(a) Typical performance: typical skin lesions visible to the naked eye: morphologically papilloma-like, cauliflower-like, granular, chicken-crowned, etc .;

(b) The sub-clinical manifestations are not easily identifiable to the naked eye, and can only be observed with a magnifying glass and vinegar white test. Histological and cytological tests have typical HPV pathological changes;

(c) Latent infection is that HPV enters the cells of the skin and mucosa without causing any clinical manifestations and histological abnormalities. It can be detected in cells of the skin and mucous membrane by molecular biology methods and nucleic acid hybridization.

Vulnerable areas: female vulva, vagina, cervix and anus, anal canal, urethral opening; male vulva, penis, testicular surface, urethral opening, perianal area, anal canal, etc.

Rare parts: armpits, umbilical fossa, interphalangeal, under breasts, etc.

(2) Special parts: wart-like lesions on the surface of the oral mucosa, recurrent respiratory papillomatosis, etc.

HPV Human papillomavirus high-risk HPV infection

1. Skin performance

Some data indicate that epithelial tumors such as Bowen's disease, basal cell carcinoma, Patzell's disease, and squamous cell carcinoma of the skin are also related to this type of virus infection.

2. Mucosal manifestations

Cervical cancer, anal and anal cancer, tonsil cancer, oral cancer, laryngeal cancer, intranasal cancer, esophageal cancer, etc. ^[3]

Human papillomavirus diagnosis

Human papillomavirus

1. Vinegar white test;

2 histological examination;

3. Molecular biology: PCR, nucleic acid molecular hybridization technology, etc .;

4. Cytological pathology examination.

Differential diagnosis of human papilloma virus

External genital warts need to be distinguished from villous labia minora, pearl penis rash, sebaceous glands, flat genital warts, and pseudocondyloma. ^[3]

Human papilloma virus disease prevention

There are currently preventive tetravalent vaccines (HPV6, 11, 16, 18) in the world that can prevent the infection of these four virus types, because most cervical cancer infection types are 16, 18, so it can reduce most of the Cervical cancer, some scientific research has also shown that it has a certain degree of protection against other types. But it has no effect on people who are already infected. Male circumcision is an important measure to prevent cervical cancer in women, and it is also an important measure to prevent males from being infected with various sexually transmitted diseases. In some countries, circumcision of newborns and young children is very good for preventing HPV in adults. Ways to Infect and Spouse Cervical Cancer.

Human papilloma virus disease treatment

Human papilloma virus treatment

(1) Physical therapy: Objective to remove the tumor and subclinical infections that are visible to the naked eye

Methods include: laser, microwave, freezing, electrocautery, surgical resection (gynecological LEEP knife, etc.), photodynamic therapy, etc.

(2) Drug treatment: 0.5% podophyllotoxin tincture, 5% imiquimod, 50% trichloroacetic acid, fluorouracil ointment, etc.

(3) Immunotherapy is to reduce recurrence and speed up the removal of lesions. Drugs include: interferon, interleukin, thymosin, transfer factor, BCG, isotretinoin, autoimmune vaccine, etc.

(4) Therapeutic vaccine: There is currently no effective therapeutic vaccine.

^[3]

Human papillomavirus expert opinion

First, the advantages and disadvantages and choices of various commonly used methods

(1) Laser and electrocautery therapy: suitable for most clinical situations, with accurate positioning, small damage to surrounding normal tissues, disadvantages: the depth of treatment needs to be controlled by a skilled operator, deep wound healing is slow, especially in the external genital area, the wound is easy Bleeding and infection, easy to produce smoke cause air pollution and iatrogenic infection, so strict personal protection is required. Therefore, the distance between warts is relatively short and the number is very large, and giant warts are not applicable.

(2): Microwave treatment: also suitable for most clinical situations, with accurate positioning, small damage to surrounding normal tissues, low bleeding and recurrence rate, no smoke, no air pollution. Disadvantages: The depth of treatment needs to be controlled by a skilled operator, and the wound needs to be protected from infection. Giant warts are less suitable.

(3) Freezing: suitable for single, small lesions, flat clinical types, disadvantages: easy to relapse, sometimes autologous implants are formed around the lesion.

(4) Photodynamic therapy: It is more suitable for mucosa and thin skin tissues such as urethral opening, vaginal wall, vulva, etc. The advantages are safe, effective, low recurrence rate (can remove subclinical infections), no pain or mild patient resistance Acceptable.

(5) Drug therapy: Potophylla is corrosive and needs to protect the surrounding normal tissues, otherwise it is easy to form surrounding normal tissues for planting. Not very suitable for the application of mucosal warts. Genital warts are difficult to identify and should not be used by patients.

Imiquimod cream is an external immunomodulator. The advantage is that it is not very corrosive. It is convenient and convenient for patients to use the medicine. Disadvantages: It requires at least 4-16 weeks of medication. It is too time-consuming, has certain irritation, and can also appear on the skin. For shallow eroded surfaces, it is not recommended to rely on this medicine alone for large warts.

Second, comprehensive treatment can prevent recurrence and achieve clinical cure

(1) Remove the tumor as much as possible by physical methods.

(2) Application of immunological drugs: injection of immunological preparations and external use.

Effective combination of the above methods, various skin lesions caused by HPV infection can be clinically cured after 3-6 months of follow-up. However, the above method is only applicable to various benign lesions, so early detection of lesions caused by HPV infection is very important, but there are also some HPV infections and various warts that can be automatically removed, but doctors cannot tell which patients belong to people who automatically clear the virus and heal themselves .

(3) Treatment of special site infection: mainly refers to the treatment of high-risk cervical HPV infection

Current scientific research has shown that high-risk persistent HPV infection of the cervix can cause cervical cancer. Therefore, how to clear the infection of the cervix and prevent the occurrence of cervical cancer early is very important. The current methods for the prevention of cervical cancer are early detection of precancerous lesions, which include: macroscopic observation of vaginal speculum, cervical scraping (TCT), colposcopy (biopsy pathology if necessary), HPVDNA detection, etc. These methods only detect cervical precancerous lesions to facilitate early treatment. However, for high-risk cervical HPV and mild cervical lesions found in screening, especially for young women who have not given birth, there is currently no better way to remove the virus and cure the corresponding lesions.

It is gratifying that after years of scientific research and exploration, we have discovered some experiences that can cure the early lesions of the cervix and clear the virus, which is verified in further scientific research.