How papilloma virus affects pregnancy. Papillomas appeared during pregnancy - what to do
Nearly ninety percent of people have papillomavirus in their blood. For most, it does not manifest itself in any way, with the exception of people with severely weakened immunity. To date, there are approximately one hundred different types papillomavirus, a third of which is transmitted through sexual intercourse. In a woman's body, the virus can manifest itself in the form of papillomas and warts on the cervix and in the vagina.
Papillomavirus, entering the body of a pregnant woman, does not have a clear negative effect on either the expectant mother or the fetus. So far, it has not been proven that human papillomavirus infection has any effect on the course of pregnancy. However, the papilloma virus can threaten the baby if the mother has genital warts (anogenital warts)
papillomavirus symptoms
The bulk of human papillomaviruses without pronounced symptoms. If at the time of conception the virus was in a "sleeping" state, then during pregnancy it can manifest itself in the form of papillomas - soft warts or skin outgrowths. If papillomas were present before, then they can change and increase in size. During pregnancy, it is undesirable to get rid of papillomas, since any burn is stressful for the skin, which can affect the condition of the fetus. During pregnancy, any methods of treating papilloma are possible only at the twenty-ninth week. By this time, the child has formed all the organs and systems.
The impact of the papilloma virus on the fetus
Sometimes papillomavirus can still affect the fetus. This happens when condylomas (growths of the epidermis and skin in the form of flesh-colored warts, usually located in the genital area and anus) appear in the vagina. There is a possibility that the child, passing through the birth canal, will inhale ahead of time, and through it Airways papillomavirus enters the body. In this case, the risk of infection of the child during childbirth with the papillomavirus is quite high. As a result, warts appear on the baby's vocal cords. Therefore, women with vaginal warts are recommended C-section. If the vagina is clean and the condylomas are outside of it, then the child is not at risk of infection with the papillomavirus.
However, a pregnant woman with papillomavirus, in order not to weaken her immunity, should support her body and take care of herself. After all, it is this virus that can exacerbate such unpleasant disease like a milkmaid.
If a woman has formations on the skin, then she must be tested for papillomavirus before pregnancy, since some of its types are oncogenic. If this type of virus is detected, a pregnant woman should be under the close supervision of a doctor.
Cautions
You should know that if the papillomavirus is detected in a woman before pregnancy, then the child should be born some time after the course of treatment.
For a complete cure for the human papillomavirus, a cure has not yet been found. At modern treatment only the symptoms are being fought and the infection is drowned out. Condylomas and papillomas are either removed, or the concentration of the virus in the body is reduced with the help of appropriate drugs.
According to some researchers, one of the causes of cervical cancer is the human papillomavirus. Their arguments are that the treatment during pregnancy of warts (papillomas) on the cervix by freezing with liquid nitrogen or any other method is unacceptable, since such intervention can provoke premature birth.
Human papillomaviruses (HPV) are a large group of viruses that can cause proliferative activity of the mucosa and skin. Outwardly, it manifests itself in the form of various papillomas ( benign neoplasms): warts, genital and flat condylomas, etc. There are several hundred strains of papillomaviruses. Many of them are harmless, others cause aesthetic defects, some are capable of causing malignant pathologies.
The strains of papillomaviruses that are directly related to the development of oncological processes, predominantly cervical cancer, have been identified. According to the results of studies, it was found that in 90% of women with cervical cancer, the human papillomavirus was detected in the blood.
According to the risk of oncogenicity, several strains (types) of human papillomaviruses are distinguished:
- Low oncogenic risk (examples of common strains: 3, 6, 11, 13, 32, 34, 40, 41, 42, 43, 44, 51, 61, 72, HPV);
- Average oncogenic risk (examples of common strains: 30, 35, 45, 52, 53, 56, 58 HPV);
- High oncogenic risk (examples of common strains: 16, 18, 31, 33, 39, 50, 59, 64, 68, 70 HPV).
The most common types of viruses that cause dysplasia and oncology are type 16.18.
Papillomaviruses can be latent (hidden) for a long time. The clinical picture of the disease begins to manifest itself under the influence of external factors. The main impetus to the growth of neoplasms gives depressed immunity. The reason for this may be HIV infection, drugs, unhealthy lifestyle, especially smoking. The virus is also activated due to concomitant gynecological diseases. Erosion, endocervicitis and other infections can provoke active proliferation of epithelial cells, which will lead to rapid growth genital warts (a type of HPV, usually affects the genitals and).
If warts affect the anogenital area, then they are easy to detect on their own. But if the human papillomavirus manifests itself on the cervix, then the disease is much more difficult to diagnose.
The disease has a long incubation period, which can be several years. The presence of one type of HPV in the body does not exclude infection with other types. With short-term immunosuppression and further restoration of immunity, self-healing is possible. In the absence of such, the disease can become chronic and recur periodically.
In women, the human papillomavirus infection of the cervix can cause the following symptoms:
- Allocations;
- Pain during intercourse;
- Problems with urination.
The reasons
Infection with the human papillomavirus mainly occurs through sexual contact. Infection can occur in the absence of penetration, but simply by contact of the genitals. Therefore, mechanical protection devices such as condoms cannot always prevent the transmission of papillomavirus.
The virus can be passed from mother to child during natural (vaginal) delivery. The mode of transmission of HPV is not fully understood, but scientists put forward several assumptions:
- Transmission of the virus through semen (during conception);
- Transmission of the virus through amniotic fluid and placenta;
- Through the blood (the theory has not been proven, but it has the right to exist, since in some cases HPV is found in blood leukocytes).
As a result of such infection, papillomatosis of the larynx is often detected in children, this does not exclude the further appearance of formations on the cervix and genitals.
The household method of transmission of papillomavirus is also common. Swimming pools, saunas, common utensils can be a source of infection for some time. The virus does not live long outside the human body. Infection occurs through scratches and microcracks on the skin.
Diagnostics
The cytological method of research for the presence of papillomaviruses is common, but has its drawbacks. The problem is the human factor. The result of the study is influenced by how the endocervical smear was taken and, of course, the experience of the specialist who will examine the material taken.
Empirically, various results of a cytological study of the same material were revealed, which indicates the inaccuracy of such an analysis.
To get a clearer picture, you need a detailed examination of the cervix - colposcopy. The walls of the vagina and cervix are examined under a microscope. To identify the affected foci, the cervical mucosa is treated with Lugol's solution, it is possible to use a solution of acetic acid. In this case, the affected layers of the epithelium acquire a white tint and stand out on the surface of the mucosa.
Doctor Ekaterina Vyacheslavovna Makarova
Friends! A lot of questions are raised by the topic of treatment of the human papillomavirus - HPV. Who says: “To be treated!”, Who: “Not to be treated!”, Who says: “It is necessary to treat!”, Who: “It is not necessary to treat!”. Let's shed some light on this burning topic. The human papillomavirus has a certain oncogenicity. This means that in the future, cells infected with the virus can be reborn. Therefore, HPV must be treated, and HPV is almost always perfectly treated.
How to treat HPV? It is a combination of destruction and immunotherapy methods. That is, you are prescribed some kind of immunomodulator and on a certain day of treatment, the procedure of physical destruction (removal) of the elements is carried out. According to statistics, 25% of HPV cases recur during destruction with nitrogen, laser, slightly less with surgitron treatment, negligible with photodynamic therapy. If a relapse happened, then the procedure must be repeated again - to the bitter end!
What to do if in HPV tests yes, but clinically, in the form of papillomas, no? In these cases, it is necessary to observe for a long time, and at the first signs of HPV on the skin and mucous membranes (appearance of warts), immediately remove it.
Good luck!Source: http://forum-makarova.ru/virus-papillomy-cheloveka.t432/
PCR (Polymerase chain reaction) diagnostics is also widely used to detect human papillomaviruses. The material for analysis is usually a smear taken from the mucosa. Thanks to PCR, HPV DNA can be detected, but nothing more. The result may be false positive or false negative.
The most accurate method for determining HPV is DNA diagnostics. Widely used in conjunction with cytological examination. Advantage this method diagnostics in that it reliably determines the type of papillomaviruses. When a virus of a highly oncogenic type (HPV 16, 18, 31, 33, 39, 50, 64, 68, 70) is detected, there is every reason to believe that the process can lead to cervical cancer. With a low oncogenic type, the development of a tumor process is unlikely.
Histological examination involves taking a biopsy from the cervix. Such an analysis gives an absolutely accurate result. Allows you to determine the type of papillomavirus, the presence of dysplasia or oncological process, the rate of proliferation in the affected tissues.
A histological examination is rarely prescribed if HPV is suspected exclusively, but if there are prerequisites for a malignant disease, then the analysis is mandatory.
If a highly oncogenic type of papillomavirus is detected, it is necessary to observe a gynecologist and periodically repeat the examination.
Methods of treatment
In the treatment of papillomavirus on the cervix, a combination therapy is used, consisting of medications and destructive methods.
Cryodestruction
It involves the removal of genital warts with liquid nitrogen. Using a special probe, the doctor treats the affected areas. The procedure is bloodless and well tolerated. After cryodestruction, a woman may be disturbed by discharge, which will pass on its own. This method of treatment is suitable for nulliparous girls, as it does not contribute to the appearance of scars on the cervix.
Of the minuses, it is worth noting the prolonged healing on the foci of nitrogen exposure and the inability to assess the depth of the lesion, as a result of which a second procedure may be required.
Laser therapy
Impact laser beams very effective in removing genital warts. The method is very painful, so the use of anesthesia is required, with which the patient feels comfortable. Allows you to deal with extensive lesions of the cervix, full control depth of tissue destruction. The laser promotes coagulative processes, thanks to which the risk of bleeding is excluded. The treated areas heal quickly, there is no scarring on the uterus.
Diathermocoagulation
The method of removing genital warts by means of electric current. Currently, it is rarely used, with its effectiveness it is very traumatic and painful. It is not recommended to carry out diathermocoagulation in nulliparous women.
radioknife
The radio wave method of excision of genital warts on the cervix is carried out using the Surgitron apparatus. The procedure is carried out under local anesthesia. When treating the cervix, an anesthetic spray is usually used.
Removal of warts is non-contact. The radioknife electrodes emit radio waves, excising the formation from healthy tissue. Radio waves have a coagulative effect, due to the sterilizing property they provide rapid healing. But there is a risk of scarring on the cervix, which will not contribute to its disclosure during childbirth.
Important! Each of the methods of treatment has absolute and relative indications. It is necessary to consult a doctor about the method of treatment in order to exclude possible negative consequences.
With small volumes of damage, the method of chemical destruction is used. That is, they act on condyloma with acid. The use of trichloroacetic and salicylic acid, the drug "Solcoderm", due to their low cost. The procedure is not always effective, requires repeated repetition. High risk of relapse. In such cases, cytostatic ointments may be prescribed, which do a good job with a small area of damage.
After removal external signs diseases need to enhance antiviral immunity. The use of interferons (subcutaneously, intramuscularly) showed good results. But overall efficiency antiviral therapy in the treatment of HPV has not been proven, and the cost modern drugs(for example, Allokin alpha) is very high.
Reception of multivitamin complexes healthy lifestyle life also contribute to boosting immunity.
The sexual partner should also be treated, even in the absence of external signs of HPV.
The appearance of warts on the cervix during pregnancy is a common phenomenon. At this time, a total hormonal restructuring and a serious decrease in immunity occur in the woman's body. If the human papillomavirus is present in the blood, it may manifest itself for the first time or reactivate after treatment in the past.
Condylomas, located precisely on the cervix, require mandatory treatment, despite the course of pregnancy. They pose a great danger to the fetus. There is a high risk of contracting HPV, as well as the risk of infections. Condylomas on the cervix will contribute to various complications in the process of labor. In such cases, a caesarean section may be indicated.
Treatment of cervical warts is recommended in the third trimester. The gynecologist, taking into account the area of the lesion and growth activity, will select best option therapy. The use of cryodestruction, laser therapy and cytostatic drugs is strictly prohibited.
If warts were detected during the planning period of pregnancy, then this process should be postponed. To begin with, immunotherapy should be carried out, the formations removed.
After treatment, it takes 3-6 months for the full restoration of immunity, in order to reduce the risk of recurrence of the disease during a future pregnancy.
Cervical warts and oncology
Localization of genital warts on the cervix, together with highly oncogenic types of human papillomavirus, create a risk of developing cervical cancer.
With such a course of the disease, a woman must be observed by a gynecologist and take care of herself. With the appearance of intermenstrual bleeding, other vaginal discharge, severe pain in the pelvis and lumbar(if not previously disturbed), increased fatigue, weight loss, etc. a timely examination by a doctor is necessary.
A biopsy of the cervix will be prescribed, followed by a histological examination to identify the oncological process.
A strong immune system inhibits the development of dysplasia. The transformation of healthy cells into tumor cells can take up to 20 years. With severe immunosuppression, pathological processes caused by papillomavirus can lead to cancer within 5-10 years.
Flat condyloma is difficult to identify when viewed with mirrors, which makes early diagnosis difficult. Colposcopy and histology will not be scheduled in the absence of any manifestations. However, the presence of this type of genital warts indicates a long-term pathological process on the cervix.
Flat warts are considered the worst option, as in most cases they are accompanied by cervical dysplasia. With dysplasia, there is an extensive growth of atypical cells on the neck, this condition is called precancerous.
Dysplasia caused by human papillomavirus types 16 and 18 must be treated at the same time as the virus itself. The treatment is largely similar - immunomodulating agents and various destructive methods are used (cryotherapy, electrocoagulation, etc.).
Preventive measures in the fight against HPV
It is possible to reduce the risk of cervical cancer as a result of human papillomavirus infection through vaccination. To date, several vaccines have been developed and successfully used to prevent infection with highly ongenic HPV types. The action of drugs can also suppress the occurrence of certain viruses with a low risk of developing oncology.
It makes sense to vaccinate childhood before the onset of sexual activity. Both girls and boys are subject to vaccination. Vaccination is not included in the mandatory list, and is optional.
Video: Human papillomavirus and cervical cancer
Papillomavirus infection is a lesion of the mucous membranes of the urogenital tract (vulva, vagina, cervical canal) by the human papillomavirus.
SYNONYMS
HPV infection; genital warts.
ICD 10 CODE
A63 Other predominantly sexually transmitted diseases, not elsewhere classified.
A63.8 Other specified STIs
B97.7 Papillomaviruses as the cause of diseases classified elsewhere.
EPIDEMIOLOGY OF PAPILLOMAVIRUS INFECTION
Human papillomavirus (HPV) is the cause of benign and malignant neoplasms. The virus infects the stratified squamous epithelium of the skin and mucous membranes. The route of transmission is contact, including sexual. Transmission of papillomavirus infection during childbirth is rare. The clinical picture of perinatal infection develops within 2 years. The presence of genital warts in children older than 18 months, especially those older than 2 years, indicates the possibility of sexual abuse.
HPV is determined both in damaged tissues and in unchanged epithelium. In 80% of cases, with an unchanged cervix, HPV type 16 is detected. Among young women ( average age 22.9 years) HPV is detected in 33%. Most often, the virus is found in the cervical canal and vulva - 46%. Most infections are caused by HPV types 16 and 18. Not all women infected with oncogenic types of HPV, including the 16th and 18th, will develop a clinically pronounced disease that turns into cervical cancer (CC).
As a result of epidemiological and molecular biological studies, it was found that the most important factor in cervical carcinogenesis is infection HPV women. different types HPV was found in 99.7% of biopsies taken from patients with cervical cancer worldwide, both in squamous epithelial carcinomas and adenocarcinomas.
The incubation period for external warts is 2-3 months, for cancer and precancer - years.
ETIOLOGY (CAUSES) OF PAPILLOMAVIRUS INFECTION
HPV is a small virus containing double-stranded DNA. Currently, more than 120 types of HPV are known. More than 30 types can infect the genital tract. All types of HPV are divided into two groups: high oncogenic risk, which are detected in malignant tumors, and low oncogenic risk, detected in benign lesions of the cervix and warts. The high oncogenic risk group includes 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, 68, 73, 82 virus types, and the low risk group includes 6, 11, 36 , 42, 43, 44, 46, 47 and 50. In Europe, HPV type 16 is the most common, was detected in more than half of the cases of cervical cancer. If we add to this four other types of HPV (18, 31, 33 and 45), then they are detected in more than 85% of all cases of this disease. HPV infection of low oncogenic risk is usually benign with a rapid recovery within 12–18 months.
PATHOGENESIS
The main target for the impact of oncogenic types of HPV is the transformation zone of the cervix, where dysplastic and precancerous changes develop. Progression from cellular changes associated with HPV infection to the development of cervical cancer is possible. The whole process usually takes 10–40 years, but in rare cases it can take 1–2 years.
CLINICAL PICTURE (SYMPTOMS) OF INFECTION WITH HPV IN PREGNANT WOMEN
Development on the skin and / or mucous membranes of the anogenital region of exophytic growths similar to cauliflower; keratinizing, rising above the level of the skin, which cause bleeding, itching, discharge. In women, frequent localization is the cervix. Often several sites are affected at the same time (for example, the cervix, vagina, and vulva). The size and number of warts are different. During pregnancy clinical picture may change. External warts are rarely malignant. Only certain types of HPV cause cervical and anorectal cancer, as well as cancer of the vulva and penis. Often the infection is asymptomatic. The most formidable complication is cervical cancer.
Complications of gestation
HPV carriage does not affect the course and outcome of pregnancy. Only isolated cases of the development of papillomatosis of the larynx in newborns born from mothers with extensive genital warts are described.
DIAGNOSTICS OF HPV IN PREGNANCY
Diagnostics is aimed at identifying oncogenic types of HPV: typing the virus with the determination of specific genotypes, the duration of the persistence of the virus in the cervical canal of the cervix; viral load (amount of virus) and degree of integration of the virus into the host cell. In the presence of oncogenic types of HPV, a cytological examination is mandatory, and if dysplasia of the cervical epithelium of the cervix is detected, a biopsy with a histological examination is required.
ANAMNESIS
Risk factors:
age over 35 years;
pathology of the cervix;
a history of STIs;
· prostitution;
early onset of sexual activity;
The presence of a large number of sexual partners;
frequent change of sexual partners;
Immunodeficiency states.
PHYSICAL EXAMINATION
Identification during examination in the mirrors of anogenital warts, cervical erosion and other lesions of the cervical canal.
LABORATORY RESEARCH
In asymptomatic forms, scraping of the epithelium of the urethra and / or cervical canal is used as a material for research on oncogenic types of HPV. To detect the virus, only molecular biological diagnostic methods are used (PCR, real-time PCR, PCR using a hybrid trap) with typing of oncogenic and non-oncogenic types and determining the viral load (the amount of virus DNA).
If oncogenic types of HPV are detected, it is necessary to carry out cytological examination with the establishment of the degree of dysplasia of the epithelium of the cervical canal. With a high degree of dysplasia, histological examination. If there are external genital warts, HPV typing is not performed.
Serological testing is not used.
INSTRUMENTAL STUDIES
With the localization of warts on the cervix, colposcopy is performed, and with localization in the area of the external opening of the urethra - ureteroscopy. To visualize the subclinical manifestations of human papillomavirus infection on the skin and mucous membranes, the method of detecting damage using acetic acid is used: 5% acetic acid applied to the skin of the genitals or cervix, after 3-5 minutes damage is observed in the form of whitened areas. Patients with clinically visible lesions do not undergo this technique.
SCREENING
All existing guidelines for the prevention of cervical cancer contain practical recommendations regarding the selection of target groups for screening, screening intervals, as well as strategies for special patient groups.
Existing in Russia regulations do not give unambiguous answers to questions regarding the start time of cervical cancer screening and the time interval between tests.
Based on the experience of various countries in organizing cervical cancer screening, for the first time in our country, the following recommendations have been proposed for conducting preventive programs in Russia.
Screening start age is 25 years.
· The age at which it is inappropriate to continue screening is 65 years.
· Screening intervals are every 3 years in women under 50 years of age and every 5 years in women aged 50–65 years.
Special patient groups:
- women with uterine diseases;
- women with subtotal hysterectomy;
- women with hysterectomy for invasive cervical cancer.
Pregnant women who did not take part in the screening should undergo a cytological examination when registering for pregnancy, and then, according to the recommendations, outside of pregnancy.
DIFFERENTIAL DIAGNOSIS
Molluscum contagiosum
Micropapillomatosis of the labia
Pearly papules of the penis
· seborrheic keratosis
Intradermal nevus
Cancer in situ
INDICATIONS FOR CONSULTATION OF OTHER SPECIALISTS
When detecting dysplasia of the epithelium of the cervical canal II–III degree, cancer in situ, cervical cancer, a consultation with an oncogynecologist is indicated.
EXAMPLE FORMULATION OF THE DIAGNOSIS
Papillomavirus infection.
TREATMENT OF PAPILLOMAVIRUS INFECTION DURING PREGNANCY
There are no methods of therapy that effectively guarantee a complete cure for papillomavirus infection. Own cellular immunity can suppress HPV activity for a while, but warts are prone to recurrence. It is believed that the removal of genital warts reduces the risk of transmission of the virus, and also reduces the risk of malignant degeneration, but does not completely eliminate them.
GOALS OF TREATMENT
Elimination of the virus does not always occur, therefore, treatment is aimed at removing anogenital warts, treating cervical erosion, and dysplasia of the cervical canal epithelium. All diagnostic, preventive and therapeutic measures are aimed at preventing cervical cancer.
NON-DRUG TREATMENT
With small external genital and perianal warts, as well as with mild intraepithelial lesions of the cervix, it is possible to use the cryotherapy method. With extensive genital warts, including damage to the vagina, cervical canal, cervix and external opening of the urethra, laser destruction is used, surgical method or electroexcision and plastic. This requires special equipment and a trained specialist. Required local anesthesia or anesthesia. Usually a good result is achieved, but in some cases scars may remain.
MEDICAL TREATMENT OF PAPILLOMAVIRUS INFECTION DURING PREGNANCY
In the presence of small external genital and perianal warts drug therapy not carried out during pregnancy.
SURGERY
It is used in the presence of extensive genital warts or severe cervical lesions (cancer in situ or cervical cancer).
INDICATIONS FOR HOSPITALIZATION
If necessary surgical intervention hospitalization is required.
PREVENTION AND PREDICTION OF GESTATION COMPLICATIONS
To prevent papillomatosis of the larynx in a newborn in the presence of large or multiple condylomas in the genital area of a woman, CS surgery is recommended. In the presence of HPV of high oncogenic risk, there are no special recommendations.
Primary prevention of cervical cancer involves taking measures against people who do not have signs of the disease in order to prevent its development in the future. A classic example primary prevention of any disease is vaccination, which is carried out outside of pregnancy.
Secondary prevention of cervical cancer involves early detection and treating individuals who show signs of the disease to slow or stop its progression.
Tertiary prevention is the surgical removal of an advanced tumor in combination with radiation therapy or chemotherapy.
TREATMENT EFFECTIVENESS ASSESSMENT
The control of cure is carried out with the help of periodic (once every 6–12 months) examinations of patients, cytological examination, determination of oncogenic types of the virus and their genotyping. Contact identification is not required. Sexual partners must be examined and examined, if there are manifestations of human papillomavirus infection - treated.
If anogenital warts are detected, registration is carried out in accordance with the form 089 / y-sq.
INFORMATION FOR THE PATIENT
Possible long-term persistence of the virus without the development of cervical cancer, as well as the elimination of the virus without treatment. With prolonged persistence of the virus genotype with increased oncogenic activity, its integration into the cell genome with the development of cervical dysplasia, malignancy is possible. In connection with sexual transmission of the virus, sexual partners should be examined. If a high oncogenic risk of HPV is detected in the cervical canal, it is necessary to conduct a colpocytological examination once a year, and if grade III cervical dysplasia or cervical cancer is detected, observation and treatment by an oncogynecologist should be carried out.
If HPV types of high oncogenic risk are detected in pregnant women, pregnancy continues. In the presence of cervical dysplasia, a colposcopic and colipocytological examination is performed.
The human papillomavirus is very common: about 90% of the world's population are its carriers. Infection can occur through sexual contact, household contact or during childbirth. For a long time, the disease may not manifest itself in any way, but a woman becomes pregnant, and the papilloma enters the stage of exacerbation. Neoplasms often appear on the skin of the neck, cheeks, chest, armpits and in the inguinal region.
Papilloma is the name of a whole group of viruses. Therefore, in order to answer the question about its danger during pregnancy, it is necessary to determine the type and localization. Sometimes the infection does not pose any threat to the child, sometimes it requires treatment.
Papillomavirus infection can be latent for a long time. Exacerbations occur with a decrease in immunity, for example, during pregnancy. According to statistics, about 80% of expectant mothers find papillomas on their skin. Outwardly, the rashes are the same as those of all other people: flesh-colored or slightly darker, rounded, often on a leg. But during this period they appear on a larger scale and faster.
Neoplasms themselves are painless, but unaesthetic, so many women want to eliminate them as quickly as possible. Human papillomavirus can be non-oncogenic and oncogenic, with a low or high risk of degeneration into a cancerous tumor.
In order to find out what type of rashes are, it is necessary to conduct laboratory diagnostics.
Discomfort is caused by papillomas located in places of contact with the edge or seam of clothing, as well as on the folds of the limbs. In these cases, there is a possibility of damage and bleeding.
Particularly fragile are condylomas - wart-like growths that are attached to the surface with a thin stem. Often they are found on the genitals and can cause discomfort, itching, bloody or yellow-green vaginal discharge.
Impact on the body of the pregnant woman and the fetus
Since papillomas are viral disease, many women are concerned about their possible impact on the intrauterine development of the fetus and the course of pregnancy in general. If the neoplasms are not located on the genitals, then they do not pose any danger.
When papillomas are located on the genitals, the growth of rashes accelerates, the risk of damage and bleeding increases. Vaginal discharge also appears, a moist environment ideal for the reproduction of HPV and other infectious agents. Against this background, hormonal imbalances and a decrease in immunity can occur.
In rare cases, genital papillomas can be passed on to the baby during childbirth. Often the baby's body copes on its own and the disease passes into an asymptomatic phase that does not pose a danger. Sometimes, after infection, the baby develops growths on the vocal cords (respiratory papillomatosis) or elsewhere. These conditions are dangerous and require treatment, but are extremely rare.
The reasons
In expectant mothers, skin rashes appear quickly and often cover large areas of the skin. The causes of exacerbation of papillomavirus infection during pregnancy are as follows:
- natural decrease in immunity, necessary for the successful bearing of a child;
- exacerbation of certain chronic diseases;
- hormonal changes that cause changes in the upper layers of the skin;
- more frequent damage to the skin, which is associated with an increase in the weight of a woman, as well as with immune and endocrine changes;
- diabetes mellitus, exacerbated by hormonal surges.
Diagnostics
A dermatologist or venereologist is engaged in the identification of papillomavirus infection in a pregnant woman. Each type of virus manifests itself in its own way. Based on the examination data, it is possible to establish a diagnosis only in the case of genital warts. However, to determine their type and degree of oncogenicity without laboratory methods research is not possible.
The main diagnostic method for papillomavirus infection is analysis PCR method. To obtain the material, the doctor makes a scraping from the cervix (less often - from the urethra). The essence of the method is that under the action of special enzymes, the amount of virus DNA in the sample increases exponentially. After that, the infection is easier to see with a microscope.
PCR diagnostics helps to detect the human papillomavirus, determine what type it belongs to, how oncogenic it is, and also quantify it. The combination of these parameters is significant, it helps to determine when the infection occurred, and therefore those people who were carriers and need treatment.
In some cases, a biopsy is prescribed to obtain more accurate information about the structural features of the tissue and the correct arrangement of the layers. Data histological analysis allow to judge the stage of the disease and the risk of degeneration of formations into oncological ones.
Treatment
If a woman is diagnosed with pregnancy and papilloma, depending on how dangerous the virus is, treatment can be carried out with or delayed until the end of the gestation process. When localizing rashes in a future mother in places where skin injury often occurs, papillomas must be removed.
For this, surgical excision with local freezing of the skin, cryodestruction, laser treatment, and electrocoagulation can be used. But it is worth remembering that most of the papillomas disappear on their own after childbirth, so such an intervention is an extreme measure necessary for the growth of genital warts.
From the 28th week, all organs have already been formed in the fetus and the placenta partially protects it from harmful substances that come with the mother's blood. From this period it is possible to use medicines. Ointments and gels are used locally: Viferon, Solcoderm, Acyclovir, Oxolinic ointment. Inside, drugs with an immunomodulatory effect are prescribed: Kipferon, Anaferon, Reaferon, Viferon.
Treatment of human papillomavirus infection is best done before pregnancy. This will help to avoid discomfort and unnecessary worries in such a crucial period.
Complications
Most dangerous complication papillomavirus infection - cancer of the cervix, vagina or vulva. Of the more than 30 types of genital HPV, 15 are oncogenic. In 70% of cases the cause malignant tumor become viruses 16 and 18 types.
In addition to oncological diseases, without timely treatment papillomas can become a source of infection. For example, condylomas, growing, begin to fester and bleed, as a result of which the mucous membrane becomes covered with ulcers. Pus along with blood contribute to the spread of the inflammatory infectious process. Immunity decreases, exacerbation occurs chronic diseases various organs.
During pregnancy, a pronounced proliferation of genital papillomas can prevent natural process childbirth. In such cases, it is carried out. The risk of complications in the child is low. Occasionally, infection occurs when passing through the birth canal, the disease manifests itself in an infant with papillomas in the respiratory tract, as well as on the genitals, anus, neck and armpits.
Prevention
Despite the fact that the main route of transmission of the infection is sexual, condoms do not protect against infection. A vaccine against human papillomavirus infection is under development. Therefore, prevention is based on maintaining activity. immune system: walks in the fresh air, a balanced diet, taking vitamin and mineral complexes, etc.
Also, in order to prevent rashes, a pregnant woman should monitor weight gain and wear comfortable underwear made of natural fabric to avoid irritation of the groin area. If papillomas nevertheless appear during pregnancy, then it is worth informing the doctor about this as soon as possible and discussing with him the need for treatment.
Pregnancy and human papillomavirus infection often occur simultaneously. Exacerbation of the disease is provoked by a decrease in immunity, hormonal changes, weight gain. In most cases, it does not require treatment, as it does not pose a threat to the fetus and the gestation process. But if the rashes cause discomfort, then local antiviral agents, immunomodulatory drugs are used, and surgical removal of papillomas is also practiced.
Useful video: pregnancy planning for papillomavirus infection
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The presence of papillomavirus, except for the oncogenic risk group, does not interfere with the conception and bearing of a healthy baby.
If a virus that threatens the development of oncological pathology is detected, it is necessary to pass a smear for a cytological examination. Normal performance are not a contraindication to pregnancy planning, and the virus will not affect the bearing of the child, therefore can you get pregnant with warts.
If the analysis showed unwanted changes in the cervical mucosa, the doctor will recommend treatment. Also, you can not plan a pregnancy with existing growths.
These factors affect the timing of pregnancy, can cause premature birth.
Planning for conception
- Schedule an annual pelvic exam and Pap smear.
- Tell your midwife if you are planning a pregnancy. In rare cases, treating genital warts can cause infertility by damaging the cervix, reducing mucus production and, as a result, difficulty conceiving.
- Talk to your doctor about any concerns you may have about being pregnant with HPV.
- Make sure you don't have genital warts when planning. These growths are highly contagious and can be transmitted through the skin.
- Advise your partner to take the HPV vaccine to protect against genital warts.
- For the treatment of HPV (as for Garbasil), 3 injections are prescribed. The second is done a month after the first. And the third, after 6 months.
- Doctors treat genital warts with electric current, chemicals, or remove them surgically.
- If your Pap smear shows the presence of pre-malignant cells, then the doctor will monitor you in more detail to make sure that they do not progress during pregnancy. Pregnancy can cause the rapid development of abnormal cells. In most cases, after the birth of a child, these cells are destroyed on their own.
- There is no link between HPV and preterm birth, miscarriage, or other pregnancy complications.
- Ordinary, vaginal delivery is not possible if genital warts block the cervix.
- In very rare cases, HPV can cause infection throat, called respiratory papillomatosis in infants, which requires frequent laser surgery to prevent warts from blocking the airways of newborns.
How dangerous is the disease for women in position?
As you can see, even with the widespread spread of the virus, there are no significant large-scale changes in the body of the fetus or the expectant mother, so we can say that the pathogen rarely affects the child.
How can the virus affect the course of pregnancy and conception?
The pathogen can affect fertility and the possibility of conception. This is due to the development of changes in the epithelium of the cervix.
It can be either a precancerous pathology or early stages of cancer. Cervical cancer, which is detected on early stage well responds to treatment. For these reasons, women of childbearing age are recommended to undergo screening for the presence of atypical mucosal epithelial cells.
If its properties are changed, it can do not skip male sex cells then pregnancy will not occur. In this way, the pathogen provides the most favorable environment for itself, so it can be more difficult to get pregnant with HPV.
Another danger is virus transmission during pregnancy to kid. This occurs through the amniotic membranes, as well as during childbirth, regardless of the mode of delivery.
The same risk of infection of the child is seen in women who gave birth by vaginal delivery, as well as by caesarean section. For this reason, the operation is not prescribed only to protect the newborn.
Consequences for the child
In the only case when the virus can pose a threat to the life of the fetus, this is formation of anogenital warts, or genital warts. The reason for the appearance of such formations is infection female body HPV type 6 or 11.
If at conception the virus was present in the body of a woman in a latent form, then during the bearing of a child, most likely, it will make itself felt in the form of the appearance of papillomas.
These types of the virus are classified as highly oncogenic, therefore, against the background of a physiological decrease in the immune status, they provoke development of cervical cancer. In addition, there is a small chance of transmitting the pathogen to the baby when it passes through the natural birth canal.
In the future, these children are at high risk of developing papillomatosis of the larynx(growths form on the vocal cords). The disease makes breathing difficult, causes a change in the timbre of the voice, up to aphonia.
If warts are located outside the birth canal, the risk to the child is reduced many times over. But the woman herself is still at risk of significantly weakening the immune system, so the treatment of papillomas should begin even before pregnancy.
In a situation where warts were already on the body before conception, with the course of pregnancy they can increase in size and change shape. Infection with the virus occurs more often if papillomas are located in the vagina and anus, then during childbirth, the infection enters the body of the child. But, do not worry, usually the immune system of the newborn copes with the infection on its own.
Childbirth with HPV
Not all types of papilloma pose such a danger. More than a hundred types of papillomaviruses are known to science, but only types 6 and 11 have the symptoms described above. The main part of the pathogens not only does not manifest itself, but is also transmitted in other ways, only a third of the types of the virus can be infected sexually.
Thus, you can give birth if the virus is in a passive stage when there are no symptoms of the disease. If there are formed inside the vagina skin growths, and the likelihood of infection of the newborn is high, it is recommended to do a caesarean section instead of the natural method. Those who have given birth with HPV should be treated after the pregnancy ends.
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