Резюме
Аль каси Мей Гази. Методы профилактики папилломавирусной инфекции и дисплазии шейки матки.
В статье представлены данные литературы относительно методов первичной и вторичной профилактики дисплазии шейки матки и папилломавирусной инфекции. Для первичной профилактики рассматриваются факторы риска, а также перспективы вакцинопрофилактики. Проанализированы возможности вторичной профилактики. Установлено, что решающим фактором вторичной профилактики является широта охвата с созданием компьютерных баз данных, а также чувствительность скрининговых диагностических методов. Доказано, что обязательным компонентом профилактического осмотра должно быть проведение тестирования на вирус папилломы человека.
Ключевые слова: папилломавирус человека, дисплазия шейки матки, факторы риска, вакцинация, скрининг, чувствительность.

Резюме
Аль касі Мей Газі. Методи профілактики папілломавірусної інфекції та дисплазії шийки матки.
У статті представлені дані літератури відносно методів первинної і вторинної профілактики дисплазії шийки матки і папілломавірусної інфекції. Для первинної профілактики розглядаються чинники ризику, а також перспективи вакцинопрофілактики. Проаналізовані можливості вторинної профілактики. Встановлено, що вирішальним чинником вторинної профілактики є широта охоплення із створенням комп’ютерних баз даних, а також чутливість скринінгових діагностичних методів. Доведено, що обов’язковим компонентом профілактичного огляду має бути проведення тестування на вірус папіломи людини.
Ключові слова: папіломавірус людини, дисплазія шийки матки, чинники ризику, вакцинація, скринінг, чутливість.

Summary
Al kasi Mej Gazi. The preventive measures of papillomavirus infection and cervical dysplasia.
In the article is presented review of the primary and secondary prevention of cervical dysplasia and human papillomavirus infection. It is analyzed risk factors and approaches to prophylactic human papillomavirus vaccine. The opportunities of secondary prophylaxis are examined. It is set that the main factor of secondary prophylaxis is sample range due to computer database of patients. The sensitivity in human papillomavirus and cervical dysplasia screening is also very significant. It is proven fact, that human papillomavirus testing should be the obligatory component of the screening.
Key words: human papillomavirus, cervical dysplasia, risk factors, vaccination, screening, sensitivity.

Рецензент: д.мед.н., проф. В.В. Сімрок

УДК 616.22

Донецкий национальный медицинский університет им. М. Горького

Донецкий национальный медицинский университет им. М.Горького

M. Gorky Donetsk National Medical University

info@aspirantura.org.ua

In the article is presented review of the primary and secondary prevention of cervical dysplasia and human papillomavirus infection. It is analyzed risk factors and approaches to prophylactic human papillomavirus vaccine. The opportunities of secondary prophylaxis are examined. It is set that the main factor of secondary prophylaxis is sample range due to computer database of patients.

Cervical cancer (CC) is one of the most actual problems of genecology. The sickness rate of CC and the number of dysplasia are steadily growing. According to the data this pathology amounts nearly 30% of all gynaecological diseases. The main means of fighting with appearance of CC is complex preventive measures. The initial preventive measures of CC are based on the application of the system of measures on detection of the factors of risk and their elimination. They includes: sanitary-educational work, preventive measures and detection of the risk factors of distribution of the papillomavirus infection, development and implementation of the preventive vaccines. Today the trigger factors of PVI are 1) sexual behaviour; 2) usage of the oral contraceptives; 3) vitamin deficiencies; 4) smoking; 5) urbanization; 6) change of the immune status; 7) availability of other infections, transmitted sexually. 

Molecular-biological studies are the direct methods of detection of PVI and have considerable higher sensibility than the cytological study. At the last one the latent forms of infection and virus forms integrated with the genome of the cell with its malignant transformation are not determined by the cytological means. At the same time the method of polymerase chain reaction (PCR) has the highest sensibility.

The sensibility of methods based upon PCR is so high that it allows detection of E6 and E7 cancer-causing transcripts of HPV of type 16 even in those scrapings of uterine cervix, in which the dysplastic changes of epithelium were not detected.

The conception of the secondary preventive measures and the initial screening lies in the following: 1) for women under 30 it is possible to use only cytological diagnostics; 2) for women under 30 HPV-testing and cytological studies of cervical smears are absolutely necessary.

Thus, the policy is determined by the fact that at women under 30 more than 70% of damages caused by HPV regress spontaneously, while at women of the middle age in connection with the virus persistence, damages regress much rarely. 

At conduction of the secondary screening, expect for the cytological studies, colposcopy plays the special role. It is connected with the possibility of colposcopy determination of different stages of subclinical PVI, including SIL damages of the low severity level. At that the application of HPV-testing allows identify women with SIL of low severity level, which have the risk of development of damages of higher severity level.

The calculation of the clinical effectiveness of the complex preventive measures of HPV and cervical dysplasia was conducted by Castellsagué X. et al. According to the data of this study, only vaccination allows reducing the risk of cervical dysplasia for 91%, vaccination and screening each 5 years – for 97%.

Therefore, we should remember that the preventive measures of cervical dysplasia and HPV-infection must be complex and include all known methods beginning from the sanitary-educational work to vaccination and organized screening. Only such approach during the whole life will provide the best protection from the cervical cancer.

The sensitivity in human papillomavirus and cervical dysplasia screening is also very significant. It is proven fact, that human papillomavirus testing should be the obligatory component of the screening.

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