Accumulated in large quantities in a part of the skin or mucosa, the Papilloma Virus changes the function of epithelial cells. As a result, the cells begin to divide uncontrollably that leads to a wider coverage of the skin by the virus. This process causes the appearance of pointed condylomas.
At first, condylomas usually appear by a few then the number may grow up to a dozen simultaneously. In less frequent cases, pointed condylomas may develop gradually over a period of several days. And fortunately in extremely rare cases, genital condylomas may continue to grow on a regular, day to day basis covering a large area of the skin.
Clinical manifestations of condylomas depend on the type of HPV and localization of the viral conglomeration. Vaginal pointed condylomas and condylomas of external genital organs usually have a wide or thin base oftentimes resembling a cauliflower or rooster combs. If condylomas appear on the eyelids or the neck they may take form of filamentous outgrowths.
Common and plantar warts may show a pronounced thickening or excessive keratinization of the surface of the skin. Pointed condylomas of the anogenital region are usually soft, lobed and are heavily vascularized. It is known that during a chronic mechanical stimulation (rubbing) condylomas may reach up to 1 to 2 inches in diameter.
The exophytic (growing outward) form of pointed condylomas is the most specific manifestation of HPV. In addition to such common areas of infection like the skin and mucous membranes of the anal and urogenital area, HPV can also be found in the upper respiratory tract, conjunctiva of the eyes, mucous membranes of the mouth, esophagus and the rectum.
Genital condylomas mostly affect the areas of the most maceration. The typical localization of condylomas is the labia, vagina, cervix, urethra, clitoris, anus and other areas.
In a lot of cases, the HPV infection may affect large areas of the skin, including the skin on the genitals, pubic area and the skin around the anus.
The endophytic (growing inward) form subdivides into flat, inverted and atypical condylomas. These usually have the general term “flat warts”.
Flat warts are located in the thickness of mucosal epithelium and are difficult to distinguish with the naked eye. Most often flat condylomas affect the mucous membrane of the vagina and the cervix. In 50% of cases, flat condylomas may blend with dysplasia of varying degrees and in 5% of cases, with preinvasive carcinoma. Malignancy of flat condylomas with the signs of atypia leading to a variable degree of intraepithelial cancer occurs in 4-10% of cases within two years.
There are four probable ways known of how HPV progresses:
Regression of condylomas (15-17%), especially developed during pregnancy
More or less long-term stabilization of the process
Intensive growth, causing the need for radical intervention
In 5% of cases, malignancy within five years
Diagnostics of the HPV infection
Evidence of the presence of the HPV infection are:
Manifestations of HPV in form of pointed condylomas
The results of cytology (the study of the nature of the cells under a microscope) that indicate cervical dysplasia
HPV detection by PCR (polymerase chain reaction – see below)
Detection of antibodies in the blood against HPV (used for scientific research purposes)
Despite the high sensitivity of PCR, it’s not always possible to detect asymptomatic HPV forms. This is due to the peculiarities of this infection:
HPV can stay indefinitely in a latent (dormant) state. The virus can lurk deep within the skin and mucous membranes and not show on the surface. In a state like this, it is quite difficult to detect the virus by PCR.
With regard to the above said, there was an interesting study conducted. Women, who had previously shown signs of the HPV infection, were examined by method of PCR (polymerase chain reaction) on a weekly basis for a period of several months.
As the result of this study showed, not during every proctological examination was the virus detected in every woman that underwent the examination. Therefore, a negative result of the PCR test does not exclude the presence of HPV infection.