HUMAN PAPILLOMAVIRUS INFECTION DURING PREGNANCY. (CASE REPORT)

Krutkova E. I.

CLINICAL AND EXPERIMENTAL MEDICINE

Scentific article

The paper presents the clinical case of human papillomavirus (HPV) infecton of the lower genital tract with undulatng clinical course in primigravida, observed from 12-13 weeks of gestaton to the 1 year post-partum period. In the I trimester HPV-infecton started sharply concomitant with bacterial vaginosis in the clinical form: disseminated papillomatosis of the uterine cervix (UC) and the vagina was expressed clinically; atypical colposcopic presentaton of the 1-2 degree was expressed colposcopically; HSIL (leukoplakia with atypia) was expressed cytologically and LSIL (CIN І) was expressed histologically. A temporary “recovery” was noted afer normalizaton of vaginal microflora and antviral phytotherapy. Exacerbaton of the HPV-infecton was manifested in the II trimester by the occurrence of big warts on the skin of the labia that led to its microsurgery and comprehensive immunomodulatng therapy with the follow-up improvement of the PAP-test and a decrease of viral load of the cervical samples; however, colposcopic presentaton remained almost without dynamics. Cesarean delivery was conducted with regard to premature rupture of membranes and ineffectve labor inducton that somehow “prevent” the morphological structure of the UC from injury, and the newborn from HPV-infecton. Apparently, premature discharge of waters was the consequence of condylomatous cervicits. Real metamorphosis was observed in absolute spontaneous disappearance of clinical and subclinical manifestatons of the HPV-infecton within 3 month post-partum with normalizaton of the colposcopic presentaton and PAP-test, a positve L1capsid test with the subsequent HPV-test, indicatng the actvaton of immune control of the body and self-eliminaton of HPV. Immune suppression, which is physiological for pregnant women, was the co-factor for CIN and warts, especially in the II trimester. On the other hand, the rates of immunomodulaton and eliminaton of pathogenic vaginal microflora contributed to the normalizaton of the UC structure at all levels and self-eliminaton of HPV.The reported clinical case demonstrates the feasibility of actve management of virus-infected pregnant women using antviral and immunomodulatng medicatons with regard to the period of pregnancy, advocatng the cesarean delivery.

human papillomavirus infecton, pregnancy, uterine cervix, immunomodulaton

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«Bulletin of problems biology and medicine» Issue 1 Part 2 (143), 2018 year, 146-151 pages, index UDK 618.2:616-006.52

10.29254/2077-4214-2018-1-2-143-146-151