The human papillomavirus causes symptoms of damage to epithelial tissue or mucous membranes due to the activation of a system of a certain number of divisions. Oncogenic pathogens of 16, 18 types contribute to the launch of an uncontrolled number of mitoses.

Scientists managed to identify about 200 types of papilloma virus that affect the genital and anus. According to the danger to the patient's life, papillomaviruses are divided into 2 categories: with low and high oncogenic risk.

The significance of the gradation determines the danger to life of the HPP. When a 16 or 18 type of virus is detected, precancerous conditions of the anogenital tract should be detected. In women, when these serotypes are detected, warts and genital warts are traced.

Uncontrolled cell division during infection with papillomavirus causes the E7 protein. Protein inhibits intracellular proteins responsible for a certain amount of mitosis, recognition of pathological cells by the immune system. With the blockade of controlling substances, the cell acquires malignant properties: it is prone to constant division, the development of metastases during internal organs... Protein E7 is a marker of the presence of the virus, determined by serological methods. According to clinical observations, serology can detect papillomavirus in 73% of cases.

Long-term persistence of HPV is dangerous not only for complications. Against the background of generalized human papillomavirus infection, immunodeficiency develops, contributing to the activation of secondary infections.

Human papillomavirus - causes of infection

The causes of infection with the human papillomavirus have been reliably established. The infection is transmitted sexually, in a household way (common washcloth, towel). In this way, children are often infected from the mother. The defeat of the cervix and vagina in a woman with warts or warts is a sign of careful observance of the hygiene of the genitals to prevent infection of the surrounding people.

At breastfeeding the location of the papillomavirus wart is dangerous near the nipple. Localization contributes to the entry of the virus into the child's body. Condylomas in the oral cavity rarely appear, as mucus has a number of strong antimicrobial substances. Larynx and vocal cords lack protection. With the transplantation method of transmission, the baby's rough voice and hoarseness are the first signs of human papillomavirus infection.

Pain and discomfort during conversation indicate the development of cancer of the larynx. According to ENT doctors, the proliferation of sinuses is more common in patients with human papillomavirus infection than in other diseases.

In most people, symptoms of the disease appear several years after active viral infection. Many men and women are unaware of the infection until clinical symptoms appear in the form of genital warts and warts. Carriage of the virus can be observed throughout life without an active stage of replication.

Human papillomavirus (HPV) is a major cause of morbidity and mortality worldwide. Today it is one of the most common sexually transmitted viruses. A significant part of the population of various ages is exposed to the threat of infection with the virus.

Every tenth person on the planet is infected with this virus.

Some types of diseases associated with HPV negatively affect the reproductive function of women. In Russia, there is a massive detection of new cases of oncology of the female reproductive system associated with human papillomavirus infection.

From the history.

Lesions of the skin and mucous membranes have been known to mankind for more than a millennium. Under the name "condylomas" they have been described by doctors Ancient Greece... The infection acquired particular relevance at the end of the twentieth century. The viral nature of warts was proven at the beginning of the last century, the sexual transmission of infection was reported in 1954.

The incidence of condylomatosis among young and middle-aged people:

1981-1986 - 5.4%

1987-1999 - 19.1%

Currently - up to 60%.

What is human papillomavirus infection?

Human papillomavirus infection is a chronic viral disease transmitted from person to person through sexual contact.

The causative agent of the infection.

The causative agent of the disease is the human papillomavirus (HPV), a common name for more than 80 types of viruses that provoke various diseases of the skin and mucous membranes of the body. Each of the viruses of the HPV group has its own serial number.

Human papillomavirus is detected:

• on the skin
• oral mucous membranes
• mucous membranes of the conjunctiva
• the mucous membrane of the esophagus

• mucous membrane of the bronchi, larynx
• rectal mucosa
• genital mucosa

Virus transmission.

The transmission of the virus only occurs from person to person.

The main transmission path is sexual .

Also possible:

- contact-household the route of infection transmission in the presence of microdamage to the epithelium - the virus can enter the human body through scratches and abrasions, the virus from an infected person remains in the bath, gym, pool, on a towel, razor

Medical personnel can become infected by inhaling dust during laser removal of genital warts, become infected through surgical instruments

Transmission to baby from mother during pregnancy

Factors contributing to the appearance or recurrence of HPV:

• Hypothermia
• Hormonal Disorders
• Medical manipulations (abortion, introduction intrauterine device)
• Pregnancy

Groups of human papillomavirus infections:

• non-oncogenic papillomaviruses (warts on the skin)
• papillomaviruses of low oncogenic risk (various types of genital warts)
• high oncogenic risk (tumor diseases in women and men)

The prevalence of HPV-associated diseases in the world

The incubation period of human papillomavirus infection can last from 2 months to 2-10 years, on average - 3 months.

Latent current is characteristic of PVI.

The clinical picture.

The course of the infection is varied. It can disappear spontaneously, then progress again.

There are 3 forms of the course of the disease:

• clinical - the presence of visible papillomas
• subclinical - no visible manifestations, asymptomatic course, detected only with additional examination (colposcopy or cell examination)
• latent - determined only by blood test

The main symptoms of human papillomavirus infection is the appearance:

• warts;
• papillomas - soft growths that are attached to the skin, thanks to the leg;
• genital warts - growths with a rough surface (mainly appear around the anus and on the genitals).

It is these symptoms that you need to pay attention to in the first place.

Consequences of human papillomavirus infection:

· Cervical cancer is in second place in the list of causes of death of women. the life expectancy of sick women is reduced, on average, by 26 years. Every day 20 Russian women die of cervical cancer. It has been proven that 70% of cervical cancers are caused by HPV types 16 and 18.

Cervical cancer is a completely preventable disease if it is detected on early stage cancer or at the stage of precancer.

· Cancer of the vulva and vagina.

• Anal cancer... About 100,000 cases of this type of cancer are recorded annually.
• Penile cancer... It is caused in 35% of cases of HPV 16 and 18, HPV 6 and 11-5% of cases.
• Anogenital warts. They are called HPV 6 and 11. According to the WHO, more than 30 million cases of anogenital warts are registered in the world every year.
• Oropharyngeal cancer in young men.

How to determine the presence of a virus in the body and its type?

In most cases, the infection is asymptomatic, so the virus in the patient is usually detected only with the help of a special test.

HPV diagnostics can include:

• clinical examination of the patient;
• examination of the cervix;
• Polymerase chain reaction (PCR) - effective method diagnostics, thanks to which you can determine the type of virus;
• cytological examination - the nature of the cells is studied under a microscope (smear for cytology from the cervix);
• a blood test to determine antibodies to HPV (this method is very rarely used);
• biopsy - during a diagnostic procedure, tissue particles are taken from a "suspicious place" (for example, from warts or papillomas). It is prescribed if there is a suspicion that the patient has an oncological disease.

What is a Pap Test?

This is a test that can identify precancerous or cancerous cells in the vagina and cervix. A smear is taken from the surface of the cervix or canal with a special spatula. The taken material is applied to glass and sent to a laboratory, where laboratory doctors carefully study the cellular structure.

The test is named after the Greek scientist Georgios Papanikolaou.

When and to whom should the Pap test be performed?

• A cytological smear should be carried out for every woman at least once a year, starting from the age of 18 or the beginning of sexual activity. In the absence of sexual intercourse, the analysis is permissible 1 time per 3 years.
• Twice a year, a cytological smear is recommended when using hormonal contraception, as well as for women who suffer from genital herpes.
• The reason for more frequent cytological examinations is a woman's frequent change of sexual partners, overweight (obesity), infertility, genital warts with genital warts.

Prevention of human papillomavirus infection.

Given the particular danger of this infection, the insufficient effectiveness of existing treatment methods, the prevention of this infectious disease is of prime importance.

Non-specific prophylaxis:

• sex education for adolescents
• limiting the number of sexual partners
• using a condom reduces the risk of HPV transmission
• cervical screening, which is a regular examination of women using a Pap test (smears from the cervix) for the timely detection and treatment of precancerous pathology
• to give up smoking

Specific prophylaxis:

Vaccination against the most dangerous (oncogenic) types of HPV in boys and girls aged 12-13 years before the onset of sexual activity and potential exposure to HPV. After vaccination, strong immunity is formed.

Why is a vaccine against human papillomavirus infection so necessary?

Human papillomaviruses cause malignant transformation of cells, that is, they are the cause of cancers, especially cervical cancer.

V last years there is a rapid increase in the incidence of genital cancers in men, in connection with which the question of introducing HPV vaccination for both sexes is increasingly being raised.

Currently, HPV vaccination is included in the vaccination schedule in 57 countries around the world, in six of them vaccination of both sexes has been introduced.

The vaccination efficiency reaches 98-100%, which has been proven by clinical studies.

Vaccination against HPV is carried out in Russia as part of regional immunization programs in the Moscow region, the Khanty-Mansiysk district, the Smolensk region, Chelyabinsk and St. Petersburg. In total, about 30 such programs have been implemented in the country in different regions.

In St. Petersburg, for the period from 2012 to 2015, at the expense of the city budget, 22,548 girls aged 9-14 years have already been vaccinated three times.

HPV vaccination is most effective before sexual intercourse, but is recommended for all young women.

There are 2 main vaccines in the world - Gardasil and Cervarix.

The introduction of large-scale vaccination will prevent up to 80-82% of all tumors in this group.

Prevention of human papillomavirus infection is one of the most important components of preventing cervical cancer in women and certain types of cancer in men.

Abbreviation HPV stands for “ human papillomavirus". It is extensive a group of viruses that integrate their DNA into the genome of skin cells and force cells to divide rapidly... You can become infected with the virus both through household and sexual contact.

No specific drugs have yet been developed to cure HPV. According to medical estimates, on this moment about 70% of all people are infected, the number of carriers continues to increase.

What is HPV

Human papillomavirus (referred to in medical documents as HPV - human papilloma virus) is a group of viruses that has about 100 varieties... For humans, about 80 strains are dangerous. HPV is dangerous because, getting into the cells of the skin or mucous membranes, it can integrate its DNA into its genome, causing uncontrolled, malignant division. In other words, papillomavirus can cause cancer.

According to the potential oncogenicity, HPV is divided into:

• non-oncogenic - types 1, 2, 3, 5
• moderate oncogenicity - 6, 11, 42, 43, 44
• oncogenic - 31, 18, 16, 51, 39, 45, 59, 33, 58, 35, 52, 56, 68

From oncogenic the most dangerous strains 16, 31 and 18... Infection of 16 types is about 70% of the population. Of these, about half of the cases are diagnosed with cancer.

How the virus enters the body

HPV is transmitted from person to person by contact, mainly sexually. After genital herpes, papillomavirus is in second place in terms of prevalence among diseases that are transmitted through intimate contact.

Note! HPV is not transmitted through saliva, blood, secretions. It enters the body with the cells of the skin or mucous membranes of the infected partner. The main source of infection is the existing growths - condylomas, papillomas, warts.

Ways of transmission of HPV:

1. Sexual- infection through direct contact, sexual intercourse is optional. Close skin contact is sufficient. This way, the most dangerous strains that cause cancer of the genitals, anus, mucous membranes of the rectum, vagina, urinary tract are transmitted
2. Domestic- infection when shaking hands, using common things, in the bath, in the pool. So you can get infected with warts, papillomas

The external manifestation of the virus depends on its type and location.

HPV localization and symptoms

Each type of virus has its own affected area. and specific external manifestation:

• Warts on arms, legs, body - 10, 4, 1, 2, 28, 3, 5, 49
• Filiform warts (papillomas) on the neck, chest, face, armpits in middle-aged and older people - 5, 3, 9 and 8
• Condylomas in the anogenital zone - 16, 6, 18, 35, 11, 13, 31
• Multiple papillomas in the larynx - 11
• Hyperplasia of the oral mucosa - 13, 32
• Oncogenic damage to the tissues of the cervix - 31, 16, 18, 40, 67, 61, 43, 59, 33, 39, 42, 55, 57, 62, 66, 35
• Oncogenic lesions of the skin of the penis - 16 and 18.

Note! Erosion of the cervix and dysplasia of the cervical tissue under the influence of HPV are different pathologies. Erosion is of an inflammatory nature. It is caused by mechanical damage to the epithelium during abortions, difficult childbirth, frequent sexual intercourse, inflammatory diseases of the female genital area.

Reasons for activating HPV

Once in the human body, papillomavirus can "act" in two ways:

1. The virus is located in a cell of the skin or mucous membrane, does not integrate into the genome (episomal existence), it is inactive and "dormant". A person becomes a carrier, without external manifestations of infection.
2. The virus integrates into the cell's DNA (introsomal lesion), altering it and provoking uncontrolled, atypical cell division. There are external manifestations of papillomavirus infection - warts, papillomas, condylomas.

The third option, which is typical for healthy young people, looks like this: an infected person heals on his own. The wearer may not be aware of the processes taking place in the body.

Photo 1. A partner may not know that he is a carrier of the virus, if he does not have external manifestations. Source: Flickr (Anna Lizman).

The activation of HPV and the appearance of external manifestations occurs for the following reasons:

• Weakened immunity... The direct link between papillomavirus disease and the state of the immune system is confirmed by 100% HPV resistance in HIV-infected patients;
• Hormonal Disorders(illness, taking hormonal medications) or natural hormonal changes in the body (menopause, pregnancy);
• Age-related changes;
• Severe illnesses, previous operations;
• Chronic stress, poor diet, alcohol and tobacco addiction.

Note! It is thanks to the ability of the human body to independently block and destroy HPV that humanity is not completely affected by this infection. In 90% of those infected, HPV is destroyed by the body without a trace within a year after infection.

Features of HPV in men and women

The female body is more vulnerable to malignant disease than the male... This is due to:

• features of the hormonal system of women
• a larger area of ​​contact between the skin and mucous membranes during sexual intercourse

Papillomavirus 16, 18, 31 types affects the female genital organs and is the main cause of uterine cancer... Genital warts occur on the labia, in the perineum, on the eve of the vagina and inside it. On the cervix, the virus provokes tissue dysplasia... Identification of this pathology in the early stages allows not only to cure a woman, but also to give her the opportunity to have children.

One of the most effective methods for detecting HPV is mandatory screening, which is carried out once every 3 years. During the examination, a visual examination is carried out, a smear is taken. If intraepithelial neoplasia of the cervical zone is suspected, colposcopy is performed. Clinical examination of women allows you to identify HPV and provide effective treatment.

Note! Advanced uterine cancer is diagnosed in women who have not visited a gynecologist in the past 10 years.

HPV in pregnant women

Papillomavirus dozing in a woman's body, often manifests itself during pregnancy... If papillomas (warts, condylomas) were before pregnancy, then they can grow and change. For the development of the fetus, infection of a woman does not pose a danger.

However, during childbirth, if there are warts in the birth canal, the baby may be infected... Until recently, a caesarean section was prescribed to prevent infection of the fetus. Now there are opponents of these measures, believing that the baby's immunity will cope with the virus on its own.

Treatment for pregnant women women shown as immunostimulating drugs. Drug treatment and removal of genital warts is prescribed after assessing the benefit / risk individually.

Photo 2. HPV does not pose a risk for fetal development, but can be transmitted to the fetus during childbirth. Source: Flickr (Dr Ruby Sehra).

HPV in men

The male body is less susceptible to the external manifestations of the papilloma virus. However, men become carriers of the virus and infect sexual partners without knowing it.

HPV in men causes:

• penile cancer
• damage to the urinary tract
• condylomas in the anogenital region, scrotum, inner side of the foreskin
• cancer of the rectal mucosa.

Special pain warts do not deliver to men. In case of internal lesion of the urinary tract, difficulty in urinating or "splashing" of urine may occur.

HPV diagnostics

As a rule, a person seeks a doctor after detecting growths on the body. For common warts, see a therapist, dermatologist or surgeon. In the case of anogenital growths women go to see a gynecologist, men should visit a urologist.

Diagnostics starts with visual inspection and questioning the patient. After examination, appoint:

• Pap smear (PAP test) from the cervical canal to determine whether the cervical tissue is benign, borderline, or malignant
• colposcopy - examination with a special device
• biopsy - analysis of tissue samples for the detection of oncopathology
• histological examinations
• PCR analysis to determine the type of HPV and their activity

Note! The patient does not have to undergo the full range of possible examinations. An examination is sufficient to make a diagnosis. Additional studies are carried out to find out the type of virus and its activity.

HPV treatment

Treatment of human papillomavirus infection is carried out in a complex way:

• appoint removal of growths as a source of active virus
• spend antiviral(general and local) medication therapy
• appoint immunostimulating treatment- to activate the body's own defenses.

Note! There is no definitive "cure for HPV". Even complex treatment cannot completely eliminate the presence of the virus. The main task of treatment is to suppress its vital activity, to reduce the amount.

Drug treatment

Medicines used to treat HPV:

• Antiviral drugs- Panavir, Cycloferon, Isoprinosin, Allokin alpha
• Immunomodulators- Immunomax, Interferon, Likopid, Polyoxidonium, Transfer factor
• Destructive drugs for topical use - Verrukatsid, Solkoderm, Superchistotel, Cryopharma, Kondilin.

Note! Preparations for the chemical destruction of neoplasms can be used independently only after a doctor's prescription. Unprofessional removal of warts, papillomas or genital warts leads to burns, scars, or an increase in growths.

Antiviral drug therapy is prescribed after determining the type and amount of viral infection. Immunomodulators should not be taken without assessing the current immune status.

Photo 3. Removing the external manifestations of papillomavirus is not enough. To avoid relapse, it is important to undergo a course of drug treatment.

It is a chronic disease in women, which is caused by a special pathogen called the human papillomavirus, or HPV for short. This disease is widespread throughout the world and requires treatment.

Human papillomavirus infection in women (the treatment of which should be prescribed by a specialist) has more than 100 types. Depending on the species that has entered the body, internal and external changes will occur.

Some of the species are absolutely not dangerous, and their presence on the body can be eliminated with the help of aesthetic medicine. Other types belong to the group of high oncogenicity; they can influence the formation of malignant tumors in the body.

The division of the papillomavirus into types allows doctors to choose the tactics of treating people with microorganisms found in the analyzes:

Stages and degrees

Human papillomavirus infection has 4 stages of formation:

Stage	Explanation
Stage 1	There is a virus in the body, but it is not active and does not manifest itself. At this stage, it can only be detected by PCR analysis.
Stage 2	Papillomas are formed. The virus causes rapid action of epidermal cells. At this stage, the virus can be detected by passing PCR and histology.
Stage 3	At this stage, the structure of the cells changes, since the DNA of the virus begins to activate with the DNA of the cells and causes the formation of an integrated form.
Stage 4	The virus causes cell degeneration and malignant cells appear. Invasive cancer is formed.

Symptoms

Human papillomavirus infection in women (which is treated on average for 3 months) at the initial stage, in the absence of conditions for its development in the body, may be completely inactive.

Otherwise, the virus will integrate into the genetic structure of cells and this will lead to the appearance of symptoms, which are combined into 3 groups:

In almost 90% of cases, when diagnosed with cervical cancer, the DNA of the human papillomavirus is detected. The armpits, the inside of the thigh, and the groin can become places of the disease. In men, this disease is hidden, but genital papillomas may appear, the presence of which can degenerate into malignant cells. Women may also develop genital papillomas.

Reasons for the appearance

Human papillomavirus infection in women may appear due to low immunity, due to long-term medication treatment for a certain disease. In addition, the virus can appear in the elderly, since it has accumulated toxins all its life.

Strong emotions can also activate the virus, because they lead to malfunctions of all systems in the body. The gastrointestinal tract suffers especially from this. During the stopping of the digestion procedure, the food inside decomposes and poison the person.

With high sweating, the HPV virus can also appear, since the body wants to remove toxins through sweat. HPV belongs to the category of sexually transmitted diseases. In addition, it is possible to get the virus through a wound on the skin if you wipe your hands with a towel other than your own.

People who were found to have any strain of the virus, doctors discovered gastritis, gynecological pathologies and diseases of the urinary tract.

Diagnostics

There are several methods of instrumental and laboratory methods for detecting HPV.

Colposcopic examination

This examination is prescribed for women in order to detect genital warts that are located on the cervix. Using the device, a specialist examines the cervix. By using this survey even the smallest warts can be seen.

Cytological examination

In this case, a smear containing virus cells is taken and examined under a microscope. This method is inexpensive, simple, but not very accurate, there is a risk of getting a false result, which will be ready after 5 days.

Histological examination

This examination is prescribed as an additional one to the previous one. In this case, a piece of tissue is taken for analysis. The doctor examines it under a microscope and evaluates the infected cells. With the help of this examination, you can determine the type of formation and distinguish warts from a tumor. The result can be found out after a couple of days.

PCR diagnostics

The most accurate diagnostic method for determining human papillomavirus infection. With this method, the virus can be detected even when its number in the blood is too low. A smear is taken for examination, but it happens that the doctor additionally examines the blood and urine. The survey results are ready in a couple of days.

The cost of any examination depends on the medical center. The price of colposcopy is about 1400 rubles, cytological examination 2500 rubles, histological 3000 rubles, PCR analysis 1900 rubles.

When to see a doctor

Human papillomavirus infection in women (the treatment of which requires a mandatory increase in immunity) implies a visit to a specialist even in cases where the growths are small.

It is also worth visiting a doctor when:

• papillomas on the body;
• warts of different sizes;
• growths on the genitals or in the anal area.

At the very beginning, you should contact a therapist or dermatologist. He will determine the presence of a problem and refer you to a narrow specialist for treatment.

Prophylaxis

The prevention of papillomas consists of several measures:

1. You need to give up bad habits. Tobacco, alcoholic beverages and drugs negatively affect the body. The immune system weakens because of them.
2. Do not self-medicate, which consists of taking medications.
3. The daily diet needs to be adjusted. It should exclude junk food, which contains preservatives and other additives. It is best to eat natural foods fortified with nutritious vitamins.
4. It is necessary to accustom yourself to exercise every day and walk more often in the fresh air.
5. You should protect yourself from emotional experiences and stress.

Treatment methods

It is difficult to cure this disease. To achieve a positive result, you need to carry out activities that include stimulation of immunity and excision of growths. This tactic prevents the risk of relapse, which is often seen in older people. In young people, it is enough to remove papillomas, and the immune system will cope with the infection on its own.

Antiviral medicines

Antiviral drugs are needed to suppress the infectious process.
The components that make up such drugs block the multiplication of viruses, due to which new viral foci do not appear. The drugs are injected under the skin; therapy consists of just a few injections.

Immunostimulants

Medicines, the main direction of which is to restore the body's immune system, which is an important component of competent treatment. These drugs help the body recover and create a protective barrier. Usually, such medicines are injected under the skin, the course of therapy lasts up to 8 weeks.

Hardware methods

With these methods, you can quickly get rid of growths on the body.

The main methods are:

1. Laser burning. The method has the advantage of being effective and accurate. The laser burns out all education.
2. Freezing with liquid nitrogen. Due to the low temperature, papillomas freeze and fall off.
3. Surgical removal. This procedure is rarely performed due to the high trauma.

Medications

Treatment of the virus with medicines should be combined and occur in several directions at the same time.

Isoprinosine

Human papillomavirus infection in women (treatment of which is prescribed even for small growths on the body) can be cured with Isoprinosine, which is a complex and artificial antiviral drug. The drug is widely used in pediatrics to activate immune cells in viral diseases.

The active ingredient of the drug inosine pranobex has immunostimulating activity. It also reduces the clinical manifestations of viral diseases and blocks viruses. The tool is produced in tablets.

Indications:

• Infectious mononucleosis;
• viral bronchitis;
• equine encephalitis;
• chicken pox;
• flu.

Contraindications:

• arrhythmia;
• urolithiasis disease;
• allergy to substance substances;
• gout.

The medication is prescribed based on body weight: 50 mg per 1 kg of a person's body weight per day. The maximum daily dosage is 3-4 g for adults. The product is sold without a prescription, the cost is from 550 rubles.

Likopid

Likopid is an immunomodulatory drug that is intended for the treatment of diseases accompanied by weak immunity. The active ingredient of the drug is glucosaminylmuramyl dipeptide, which can act on the cell population of the immune system. The use of the drug suppresses inflammatory processes in the body and stimulates anti-tumor immunity.

Indications:

• chronic and acute inflammation of soft tissues;
• viral infections: chronic hepatitis C and B;
• pulmonary tuberculosis;
• psoriasis.

Contraindications:

• allergy to drug substances;
• autoimmune thyroiditis;
• temperature above 38 ° C.

The medicine is produced in pill form. The agent is prescribed 1 tablet 2 times a day. The medication is sold without a prescription, the cost is from 230 rubles.

Immunomax

Immunomax is an immunomodulatory agent that stimulates the immune system. The drug contains a component of cell membranes isolated from potatoes - peptidoglycan. The medication activates the body's immunity against viruses and bacteria. The medicine is produced in powder for solution preparation.

Indications:

• to enhance immunity;
• herpes;
• chlamydia;
• mycoplasma.

The powder should be dissolved in 1 ml of water for injection. The finished solution is injected deep into the muscle, observing all the rules for administering the drug. Basically, up to 200 IU of medicine is prescribed per day. The duration of therapy is 6 injections. The product is sold by prescription, the cost is from 700 rubles.

Panavir

Panavir is an antiviral medicine that contains natural raw materials as an active ingredient that has an immunomodulatory effect. With its help, you can cure various diseases with short courses.

The product is produced in solutions for injections, gel, suppositories. The active ingredient of the drug is a complex saccharide, which consists of rhamnose, glucose and arabinose. The drug has antiviral, analgesic and neuroprotective effects.

Indications:

• low immunity against the background of long-term illnesses;
• warts in the genitals and anus;
• viral dermatosis;
• flu;
• chronic prostatitis.

The drug solution is slowly injected into a vein in 1 ampoule 1 time per day.

Contraindications:

• age under 18;
• time of bearing a child.

The product is sold by prescription, the cost is from 1,500 rubles.

Keraworth

Keravort is an immunomodulatory drug used in the treatment of genital warts. The medicine is produced in the form of a cream for external use. The active ingredient of the drug is imiquimod and additional xanthan gum, benzyl alcohol. The medication is prescribed for therapy in adults with genital warts, which are localized on the genitals.

Contraindications:

• age under 18;
• lactation period;
• allergy to drug substances.

The cream should be applied to clean skin with rubbing movements until completely absorbed. The medicine should remain on the skin for 10 hours. After this time, the cream should be washed off with warm water. The cream should be applied 3 times within 7 days and applied no more than 1 time per day. The medication is sold by prescription, the cost is from 2000 rubles.

Traditional methods

Disease therapy folk ways must be appointed by a specialist. To remove existing rashes from the body, you can use compresses and ointments with natural ingredients. Such methods give a positive result, subject to constant use.

Celandine juice

Celandine is called the most effective natural product used in the fight against infection. Celandine juice is often used, it contains useful substances that contribute to the destruction of papillomas. A fresh stem of celandine should be plucked.

From it you need to squeeze out all the juice and lubricate the papillomas on the body with it. From above, the treated skin should be covered with a sterile adhesive plaster or bandage. It is necessary to smear papilloma with celandine juice 4 times with an interval of 10 minutes. This manipulation must be repeated 3 times a day.

Vinegar

Perfectly destroys papillomas on the hands of ordinary vinegar. The skin around them must be protected by pre-lubricating with baby cream, and a mixture of vinegar and flour should be put on the papillomas themselves. When the mixture is dry, it must be removed. During the use of this medication, the skin begins to "burn". After a few days, the papillomas will change color and disappear.

Egg

Papillomas can also be removed from the skin chicken eggs... Fine and dry shells should be sprinkled on papillomas, covered with cotton wool and secured with a plaster. This procedure should be done once every 3 days. The duration of therapy for this medication is 3 weeks. After its completion, the result will already be noticeable. Small papillomas can be smeared with chicken protein 3 times a day. After 7 days, papillomas become invisible.

Garlic

A special cream can be made from garlic, which needs to be lubricated with papillomas.

To make a medicine you will need:

After 3 hours, the bandage should be removed, and the infected area should be washed with warm water and soap. This procedure must be repeated daily for a month.

Dandelion

Fill a 1 liter jar with dandelion flowers. It is best to compact the dandelion well. Then you need to fill the raw materials with triple cologne and insist for several days in a dark place. Next, you should decant the liquid into a separate glass container. With this infusion, you need to process infected areas 3 times a day.

Other methods

Quite often, doctors use radiofrequency coagulation to treat the disease. The procedure takes place under the supervision of a dermatologist. Here, a special apparatus is used that generates high-frequency radiation. Radio waves negatively affect the pathogenic tissues that make up the papilloma. They are precise and selective.

Possible complications

HPV is one of those infections that can be fatal, but completely invisible. The virus may not manifest itself in any way for several years. Basically, over the course of 2 years, papillomas can pass on their own and are not dangerous.

But if the signs do not disappear and appear on the genitals, then you need to see a doctor. Chronic HPV leads to cell changes that can turn malignant. From infection to diagnosis, cancer can take an average of 10-20 years.

Human papillomavirus infection in women is one of those diseases that are better prevented than cured. It might be a good idea to get the HPV vaccine. But it will be effective only if the body has not yet encountered this infection.

Article design: Vladimir the Great

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Human papillomavirus infection: a modern point of view on the problem

E.V. Faizullina
Kazan State Medical University

Genital papillomavirus infection is a common sexually transmitted disease. Human papillomavirus (HPV) is a highly specific human infection with the ability to infect epithelial cells caused by a virus from the Papovaviridea family. Infection with HPV of the genitals, as well as of the skin, occurs in the presence of microtraumas, while the reservoir of HPV infection is the urethra, Bartholin's glands, and seminal fluid. More than one hundred HPV species have been identified, of which 35 infect the human urogenital tract, causing damage to the integumentary epithelium of the skin and mucous membranes of the genital organs. HPV infection is the most common sexually transmitted infection (STI) that infects most of the sexually active population. In addition, papillomaviruses are the only group of viruses for which the induction of tumors in humans has been proven. The number of infected people in the world has increased 12 times over the past decade (Molochkov V.A., 2004).

ICD X revision, section A 63. Anogenital warts.

Etiology

The virus, belonging to the genus A of the Papovaviridea family, remains at a temperature of 50 ° C for 30 minutes. During the replication cycle, the viral genome expresses from 8 to 10 protein products; for the oncogenic properties of the virus, the oncoproteins E6 and E7 are responsible. Oncogenic activity distinguish low-risk HPV - HPV6, 11,42,43,44; medium - HPV31,33,35, 51.52, 58 and high - HPV16, 18,45,56 degree of risk. At least 50% of the sexually active adult population is infected with one or more types of HPV; in most cases, genital HPV infection in them is unrecognized, subclinical or asymptomatic. Genital HPV infection is highly contagious; infection with a single sexual contact occurs in about 60% of cases.

Pathogenesis

The invasion of the virus occurs through tissue microdamage. HPV infects stem cells of the basal layer, which are then a constant source of infection for epithelial cells. Viruses infect dividing immature cells of the basal cell layer that are close to the surface, which largely explains the frequency of infection of the cervix and the lower third of the vagina and vulva.

The viral DNA is incorporated into the nuclear material of the host cell. The integrated form of HPV is capable of malignant transformation, as viral DNA begins to control cellular genetic material for the reproduction of HPV-encoded proteins. Integration of high-risk HPV into the host's cellular genome enhances the production of two oncoproteins, E6 and E7, which interact with endogenous cellular regulatory proteins leading to deregulation of the cell progression cycle, which is a decisive moment in the formation of cervical neoplasia, the formation of flat warts invisible to the armed eye (Prilepskaya V. .N., 1997).

However, according to V.A. Molochkova et al. (2004), HPV infection of epithelial cells is a necessary but not sufficient event for the development of cancer. For the formation of irreversible neoplasia, the following factors are required: first, active expression of the E6 and E7 genes, with highly oncogenic HPV-16 and 18 types; secondly, the induction of metabolic mechanisms for the conversion of estradiol to 16-OH; third, induction of multiple damage to chromosomal DNA in the infected cell, which completes the process of degeneration.

The first stage of CIN I neoplasia is characterized by active viral replication and asymptomatic shedding. Tumor transformation occurs more likely when HPV interacts with other infectious agents (cytomegalovirus, herpes simplex virus type 2, C. trachomatis, mycoplasma and ureaplasma).

Risk factors

HPV is a necessary but not sufficient factor in cervical neoplasia. Predisposing risk factors for the development of the disease can be: unfavorable socio-economic status and sexual behavior, disorders of cellular and humoral immunity, concomitant sexually transmitted diseases (gonorrhea, herpes syphilis, chlamydia trichomoniasis, etc.), young age, smoking, pregnancy , dysbiosis of the vaginal biotope, hypo- and avitaminosis (Marchenko L.A., 2001).

The risk of HPV infection is highest in homosexuals. Cases of perinatal transmission of infection to infants born to infected mothers during delivery through the vaginal birth canal are not excluded, due to aspiration of amniotic fluid, cervical or vaginal secretions; cases of papillomatosis of the larynx, trachea, bronchi in children born with the use of a cesarean section, which, according to some authors, indicates the possibility of transplacental transmission of infection and the inappropriateness of the use of cesarean section for the sole purpose of preventing infection of the newborn with HPV (Koutsky LA, Kiviar NB, 1999).

The course of the disease and clinical varieties

The incubation period for anogenital warts is 1 to 3 months. In most cases, HPV infection does not manifest immediately, remaining asymptomatic for some time. The progression of high-risk HPV infection to cervical intraepithelial neoplasia and cancer in situ usually occurs within 5 to 30 years.

1. Clinical forms(visible to the naked eye):
1.1. Exophytic warts (genital typical, papillary, papular);
1.2. Vestibular papilomatosis (small papilloma-like formations of the vestibule of the vagina).

2. Subclinical forms(not visible to the naked eye and asymptomatic, detectable only by colposcopy and / or cytological or histological examination):
Flat warts (typical structure with many coilocytes);
Small forms (various lesions of the metaplastic epithelium with single coylocytes);
Condylomatous cervicitis / vaginitis.

3. Latent forms (absence of clinical, morphological or histological changes when HPV DNA is detected);

4. Cervical intraepithelial neoplasia(squamous intraepithelial lesions):
CIN - CIN 1 - mild dysplasia +/- coylocytosis, dyskeratosis;
4.2 CIN II - severe dysplasia +/- coylocytosis, dyskeratosis;
4.3 CIN III or CIS - severe dysplasia or carcinoma in situ +/- coylocytosis, dyskeratosis;
4.4 Microinvasive squamous cell carcinoma.

Clinical manifestations of HPV infection can be as follows: genital warts, fibroepithelial formations on the surface of the skin and mucous membranes on a thin stalk, on a broad base in the form of single nodules, or in the form of multiple outgrowths like "cauliflower".

The surface is covered with stratified squamous epithelium of the dyskeratosis type. In the underlying stroma there are atypical vessels, inflammation phenomena. Localization of OK is different, mainly in places of possible maceration: the clitoris, the labia minora, the mouth of the urethra, the vagina, the cervix, and the anus.

The manifestation of genital HPV infection is accompanied by the appearance of genital warts. Exophytic forms of genital warts are a typical manifestation of infection caused by benign HPV6 and HPV11 virus types. Endophytic condylomas can be flat and inverted, located on the cervix and look like flat or slightly elevated plaques, determined with extended colposcopy.

The subclinical form of the disease is detected only during colposcopy in the form of small flat warts or is established on the basis of a characteristic histological picture in the form of koilocytosis. The absence of clinical and histological signs of infection in the detection of HPV DNA indicates a latent or asymptomatic infection.

The external opening of the urethra in women is affected in 4-8% of cases, a deeper lesion of the urethra causes the phenomenon of sluggish urethritis.

Anal warts are more common in people who have anal sex and are rarely located above the dentate line of the rectum. In persons practicing oral-genital contacts, genital warts can affect the lips, tongue, palate.

Genital warts are usually asymptomatic and are often incidentally detected on examination or on the basis of a Pap smear. In this regard, at first, patients do not complain of discomfort associated with them. However, large, injured, ulcerated, or secondary infection warts are accompanied by itching, pain, and an unpleasant odor. Urethral warts in men can cause a bifurcation of the urine stream, obstruction of the urethral opening.

In patients with impaired cellular immunity (HIV infection, immunosuppressive therapy, pregnancy), very large genital warts develop - a giant condyloma Buschke-Levenshtein, an invasive and destructive tumor associated with HPV 6 and 1 type 1.

HPV infection caused by types of high oncogenic risk virus (HPV-16 and 18) is the etiological agent of a rather heterogeneous group of diseases: bowenoid papulosis, cervical intraepithelial neoplasia, cervical cancer, less often - cancer of the vagina, vulva, anus (Batkaev E.A. . et al., 2001; Kiselev V.I., Kiselev O.I., 2003).

Bowenoid papulosis is associated with HPV-16, as well as with other types of HPV - 1, 6, 11, 18, 31-35, 39, 42, 48, 51-54 and is manifested by flat papules and spots with a smooth, velvety surface. The disease usually develops in men with many sexual partners. The female partners of these patients are diagnosed with HPV infection of the cervix and cervical intraepithelial neoplasia. Bowenoid papulosis is usually benign. In some patients, bowenoid papulosis can persist for years, transforming (especially in the elderly) into squamous cell carcinoma.

Diagnosis of human papillomavirus infection

Laboratory diagnostics of HPV infection is carried out on the basis of cytological, histological examination of biopsies, determination of antibodies to HPV, detection of HPV DNA and E7 oncoprotein.

Clinical examination of the external genitalia, vulva, and vagina should be carried out in good light. An extended colposcopy is performed to detect subclinical genital HPV infection. False positive results with this method are usually the result of inflammation and dyskeratic processes of the vulva and vagina.

Colposcopy and biopsy are indicated for all women with class II (CIN II) or class III (CINIII) cervical intraepithelial neoplasia, regardless of whether they have HPV infection.

The simplest methods for identifying HPV are immunological methods: RSK, ELISA, PIF.

Diagnosis of HPV infection of the cervix includes Paponicolau testing (PAP test). Molecular biological methods in situ hybridization reaction, PCR, DNA probe. Histological examination of biopsies of epithelial and epidermal tissues is also used for asymptomatic or asymptomatic forms of viral diseases of the genitals. The use of molecular biological research methods is advisable for proving the presence of HPV with its typing, since both DNA hybridization and polymerase chain reaction make it possible to identify oncogenic types of the virus 16 and 18.

The main method for diagnosing HPV is cytological - the detection of coylocytic cells in a biopsy specimen of the cervical epithelium (MBE cells of intermediate and surface type with a multinucleated structure), pathognomonic for HPV.

Histological examination of genital warts reveals a moderate thickening of the stratum corneum with papillomatosis, parakeratosis and acanthosis; mitotic figures may be present. The presence of coylocytes, large epithelial cells with round hyperchromic nuclei and pronounced perinuclear vacuolization, is considered diagnostically important.

Treatment

When choosing a method for treating HPV infection, anamnesis, somatic status, previous antiviral therapy, localization, number, size of genital warts and flat warts are taken into account. The tactics of treatment should be individualized, taking into account the tolerability of certain methods of treatment. Local treatment of AB is aimed at removing genital warts and atypically altered epithelium, using different types chemical coagulants, cytostatics and physiosurgical methods of treatment. After removal of papillomatous growths, local and general therapy with antiviral drugs, interferon inducers, and nonspecific immunomodulators is necessary to prevent the recurrence of AB. Patients with papillomavirus infection should be warned that this disease is sexually transmitted, therefore, examination and treatment should be carried out by both partners, and for the period of therapy and the next 6-9 months, barrier methods of contraception should be recommended.

Local treatment of HPV (data are given according to Podzolkova N.M. et al, 2007).

1. Cytotoxic therapies:
   Podophyllin - 10-25% solution. Podophyllinotoxin 0.5% solution or gel. Resin with cytotoxic action. The solution is applied to the pathologically altered area, washed off after 4-6 hours with an interval of 3-6 days. The course of treatment is 5 weeks.
   Condillin - 0.5% solution, an analogue of podophyllotoxin, is applied with an applicator to the affected areas, avoiding contact with healthy skin. 2 times a day, the course of treatment is 3 days.
   Feresol is a mixture of 60% phenol and 40% tricreazole. Treatment of genital warts is carried out 1 time in 10 days until the clinical effect.
   5-fluorouracill - 5% cream. Cytotoxic drug for the treatment of genital warts. Apply once a day at night for 10 days.
   Drugs with a cytotoxic, antimitotic mechanism of action are not used to treat perianal, rectal, urethral, ​​vaginal and cervical warts. Possible side reactions: vomiting, nausea, weeping dermatitis. It is not recommended to apply the drug over an area of ​​more than 10 cm2. The drugs are contraindicated for pregnant women and children.
2. Chemical destructive therapies:
   Solkoderm is a mixture of organic and inorganic acids. It is applied to the affected area with an applicator after treatment with alcohol. At the same time, an area of ​​up to 4-5 cm is processed. The break between sessions is 1-4 weeks. It is possible to use the drug for the treatment of PVI of the vulva and perineum in pregnant women.
   Epigen spray - the main active ingredient glycyrrhizic acid - has antiviral, antipruritic, immunomodulatory, interferonogenic effects. The treatment is carried out by irrigating the surface of the elements 6 times a day for 7 days. When warts are localized in the vagina, the drug can be used with a vaginal nozzle 3 times a day for 5 days. The remaining elements are removed by methods of physical or chemical destruction, after which a repeated course of treatment of epithelialized areas with epigenome is carried out.
   Trichloroacetic acid - 80-90% solution. The drug causes local coagulation necrosis. Prescription for pregnant women is possible. The course of treatment is 6 weeks: one application per week. The drug is applied only to the changed surface, avoid contact with healthy tissues. The effectiveness of treatment is 70%, if after the recommended course of treatment there is no positive dynamics, physical destructive methods of treatment with systemic administration of immunocorrective and antiviral drugs are shown
3. Physical destructive treatments:
   Diathermocoagulation - the technique is contraindicated in the presence of a pacemaker in the patient or a violation of the heart rhythm of organic genesis. Leaves rough scars on the skin and mucous membranes.
   Laser therapy - removal of formations using a high-energy laser, is carried out both in a hospital and on an outpatient basis. Laser vaporation of the cervix is ​​performed without preliminary anesthesia on the 5-7th day of the menstrual cycle. Laser coagulation of anogenital warts is performed in the first phase of the menstrual cycle under conditions of infiltration anesthesia. Treatment of large elements of anogenital warts is carried out in parts by multiple sessions. Radiosurgery - removal of neoplasms using high-frequency electrosurgery. The incision effect is achieved without physical manual pressure. In the mode of electrodissection, it is recommended to remove genital warts of the vulva, vagina, anorectal region. In the electrocoagulation mode - for the removal of genital warts, flat warts of the cervix, dysplasia. The processing area should not exceed 5 sq. Cm.
   Cryodestruction - removal of neoplasms with liquid nitrogen.
   The method of cryodestruction ensures the death of tumor cells through the formation of extra- and intracellular ice crystals, followed by tissue necrosis, as well as activation of the humoral and cellular immune response of the macroorganism to cryotherapy. The effect is achieved by a single application of cryoprobe for 10-12 seconds. If necessary, repeat the procedure after 1-2 weeks.
   Surgical excision. Contraindications for physical and surgical methods of treatment are: acute inflammatory diseases of the genital organs, malignant neoplasms, with the prevalence of the process above the lower third of the cervical canal, since it is impossible to control the boundaries of the effect on the tissues.
   Currently, physical methods are considered the most effective in the pathogenetic treatment of human papillomavirus infection, have a minimum number of complications and contraindications.
4. Non-specific antiviral therapy:
   "PANAVIR" - solution in ampoules of 5.0 ml, colorless, transparent, odorless. The drug is administered intravenously at a dose of 5.0 ml with an interval of 48 hours. The course of treatment is 5 injections (25.0 ml), 0.002% protective gel. It is used topically as monotherapy for limited manifestations of AB and after destructive or surgical treatment to prevent relapses and complications, as well as rapid regeneration of the skin and mucous membranes. 2-3 times a day for 2-3 weeks.
   Ridoksolovaya 0.5% and Bonavtonovaya 2% ointments - applied to the affected areas, 5-6 times a day for 2-3 weeks.
   "Indinol" - a drug derived from indinol-3-carbinol, selectively inhibits estrogen-dependent expression of the E7 gene, causes apoptosis of cells infected with HPV. The drug is available in capsules at a dose of 200 mg. The course of treatment is 400 mg per day for 10-12 weeks.
5. Immunotherapy:
   The use of interferons in the complex treatment of PVI is effective not only for the treatment of the disease, but also for the prevention of clinical relapses. Derivatives of interferons are recommended to be used both before and after destructive and surgical methods of PVI treatment.
   Human leukocyte interferon (HLI) in the form of applications for 14 days, injections intracondyloma or under papilloma (HLI 100-500 thousand IU; up to 1 million IU daily dose). 3 times a week for 3 weeks.
   Candles "Reaferon" 10 thousand ME or "Viferon" 100 and 500 thousand ME3 times a week for 3 weeks.
   Interferon ointment 40 ME - topically 3 times a day for 10 days.
6. Adaptogens:
   extract of Chinese Schisandra, Eleutherococcus.
   Vitamins of groups: B, D, ascorbic acid, tocopherol acetate (according to the generally accepted scheme).
   Sedatives: valerian extract 1 tablet 3 times a day for 2-3 weeks, Persen 1 tablet 2 times a day for 3-4 weeks, Novopassit 1 tablet 2 times a day for 14 days, Relanium 1 tablet at night for 10 days.
   Requirements for treatment results - achieving clinical cure, reducing the number of relapses.
   Follow-up. In order to identify precancerous dysplastic conditions in women infected with HPV 16, 18 types, it is necessary to conduct cervical cytological and molecular biological studies in combination with colposcopy 2 times a year.
7. Vaccination "Gardasil" is a quadrivalent recombinant vaccine against human papillomavirus (types 6, 11, 16, 18). Registration number: LS-002293 dated November 24, 2006 Suspension for intramuscular administration. The human papillomavirus (HPV) quadrivalent vaccine is a sterile suspension for intramuscular administration prepared from a mixture of highly purified virus-like particles (HPV) of the recombinant basic capsid protein (11) HPV 6, 11, 16 and 18. L1 proteins are produced by separate fermentation in recombinant Saccharomyces cerevisiae CANADE ЗС-5 (strain 1895) and form HPV by self-assembly. HPPs for each type are cleaned and adsorbed on an aluminum-containing adjuvant (amorphous aluminum hydroxyphosphate sulfate).
   Immunobiological properties: Carrying out a full course of vaccination leads to the formation of specific antibodies to four types of HPV 6, 11, 16 and 18 - in a protective titer in more than 99% of vaccinated for a period of at least 36 months in all age groups. The Gardasil vaccine is almost 100% effective in preventing genital cancers, precancerous epithelial dysplasias and genital warts, induced by HPV types 6, 11, 16 and 18. The Gardasil vaccine is indicated for use in children and adolescents aged 9 to 17 years and young women aged 18 to 26 years to prevent the following diseases caused by human papillomavirus types 6, 11, 16 and 18:

For three years (2006-2008), we examined and treated 650 women with anogenital warts (AB). The data are presented in Table 1.

Table 1.
Patient groups by location and prevalence of AB

table 2.
The number of sessions of radio wave destruction of antibiotics required to achieve a stable remission of the disease in women

Group	1 session		2 session (10-12 days)		3 session (14-21 days)		More than 3 sessions		Total
	People	%	People	%	People	%	People	%	People	%
1	7	41,2	10	58,82352941	0	0	0	0	17	100
2	121	69,9	41	23,69942197	11	6,4	0	0	173	100
3	118	45,7	112	43,41085271	25	9,7	3	1,2	258	100
4	13	10,3	77	61,11111111	29	23,0	7	5,6	126	100
5	0	0,0	23	30,26315789	41	53,9	12	15,8	76	100
							Total:		650

The patients were treated with a destructive method of removal using a radio wave emitter from Surgitron (USA), followed by antiviral treatment with Panavir in the form of five intravenous injections of 0.04 mg / ml solution according to the administration scheme for the first, third, fifth, eighth and eleventh days of treatment. The drug was injected slowly in a stream. The sites of removal were treated with Panavir gel daily 3 times a day until the sites of destruction were completely healed.

The largest number of women in the first (58.8%) and fourth (61.1%) clinical groups required two destruction sessions to achieve a stable clinical effect. The more common the pathological process was (the larger the order and number of groups), the more sessions of radio wave destruction were required to achieve a stable clinical result. At the same time, treatment with Panavir was effective in 86.5% of cases in patients of all five clinical groups.

The obtained clinical effect is largely explained by the high antiviral effect of the drug. The active substance of Panavir is a plant polysaccharide obtained from the plant Solanum tuberosum and belonging to the class of high molecular weight hexose glycosides of a complex structure: glucose (38.5%), galactose (14.5%), rhamnose (9%), mannose (2, 5%), xylose (1.5%), uronic acids (3.5%)

Panavir has a cytoprotective effect, protecting cells from the effects of viruses, since it is able to inhibit their replication in infected cell cultures, which leads to a significant decrease in the infectious activity of viruses.

"Panavir" induces the synthesis of interferon in the body, increases the viability of infected cells. The mechanism of action of the drug is based on preventing the adhesion of the virus into the cell by inhibiting penetration and preventing the opening of the viral capsid. At the next stage, the drug acts on the transcription of the viral DNA with subsequent disruption of viral DNA replication and disruption of the synthesis of capsid proteins, which leads to disruption of the assembly of viral particles and the final death of the viral cell.

We consider it expedient to use Panavir in the complex treatment of AB of various localizations.

Literature

1. Batkaev E.A., Kitsak V.Ya., Korsunskaya I.M., Lipova E.V. Viral diseases of the skin and mucous membranes: a tutorial, M., 2001.
2. Kiselev V.I., Kiselev O.I. Human papillomaviruses in the development of cervical cancer. SPb-M., 2003.
3. L.A. Marchenko Genital herpes. New clinical aspects. Reproduction problems 2001; 4: 29-33.
4. Molochkov V.A., Kiselev V.I., Rudykh I.V., Shcherbo S.N. Human papillomavirus infection: clinical picture, diagnosis, treatment: a guide for doctors. M., MONIKI, 2004.
5. Panavir. Experience of application in medical practice. Dermatovenereology. M., 2008.
6. Podzolkova N.M., Sozaeva L.G., Osadchev V.B. Human papillomavirus and herpes infections in obstetrics and gynecology. Study guide. M., 2007.46 p. Prilepskaya V.N. Diseases of the cervix. Clinical lectures. M., 1997.
7. Koutsky L.A., Kiviar N.B. Genital human papillomavirus. In: Sexual Transmited Diseases / Ed. K. K. Holmes et al. 3rd ed. -Mc. Grow-Hill., 1999.-NewYork, -P. 347-160.