Papilomaviry (HPV) u homosexuálů

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Pavel Čermák

Lidské papilomaviry jsou zodpovědné za 90 – 99 % případů rakoviny děložního čípku a 70 – 100 % případů rakoviny konečníku.

Jejich genetická informace je kódovaná v DNA a jsou známé pod anglickou zkratkou HPV (Human papillomavirus).

Dnes jsou zmapované genetické sekvence více než 170 typů lidských papilomavirů, které se dělí do pěti rodů: Alphapapillomavirus, Betapapillomavirus, Gammapapillomavirus, Mupapillomavirus Nupapillomavirus.

Kromě toho bylo zjištěno přinejmenším dalších 200 domnělých typů virů, které teprve čekají na zmapování svého genomu a klasifikaci.

Wikipedie nabízí následující přehled onemocnění způsobených papilomaviry a u nich vždy čísla typů , které je vyvolávají:

 

Onemocnění

Typ HPV

Common warts

2, 7, 22

Plantar warts

1, 2, 4, 63

Flat warts

3, 10, 8

Anogenital warts

6, 11, 42, 44 and others[13]

Anal dysplasia (lesions)

6, 16, 18, 31, 53, 58[14]

Genital cancers

  • Highest risk:[13] 16, 18, 31, 45
  • Other high-risk:[13][15] 33, 35, 39, 51, 52, 56, 58, 59
  • Probably high-risk:[15] 26, 53, 66, 68, 73, 82

Epidermodysplasia verruciformis

more than 15 types

Focal epithelial hyperplasia (oral)

13, 32

Oral papillomas

6, 7, 11, 16, 32

Oropharyngeal cancer

16

Verrucous cyst

60

Laryngeal papillomatosis

6, 11

 

DNA papilomavirů však byla zjištěna také v periferní krvi u 8,3 % zdravých dárců krve.

V další studii (Carlo Foresta) byly bílkoviny HPV nalezeny v lymfocytech Cd20+ a Cd56+ v periferní krvi a spermatu. Nález souvisel s infekcí spermatu papilomavirem typu 16.

Informace o nepřehledném počtu typů lidských papilomavirů a jejich výskytu v různých typech lidských tkání zde uvádím úmyslně, aby bylo jasné, o jak složitou problematiku se jedná a kolik toho ještě zbývá prozkoumat, protože jednotlivé typy virů se geneticky i chováním v organismu poměrně výrazně liší.

Nechci však vyvolávat paniku. S papilomaviry se během života setká každý a velká část z nich je pokládána za neškodné. Lidský organismus se jich většinou dokáže po infekci zbavit sám a vážné onemocnění způsobí jen v některých případech.

Na druhé straně se však nejedná o zanedbatelnou problematiku, jak vidíme z mohutné kampaně podporující očkování proti některým typům papilomavirů. Základní informaci o papilomavirech je možné nalézt například v článku, který napsal MUDr Fait.  http://www.hpv-guide.cz/clanek-mudr-tomas-fait-phd-co-dokazi-lidske-papilomaviry

Papilomaviry u homosexuálů

Výskytem papilomavirové infekce u mužů kteří mají sex s muži (MSM) se zabývá studie, kterou publikoval Stephen Goldstone a další autoři. Průměrný věk byl 22 let a do studie byli úmyslně vybráni muži, kteří nebyli nakaženi HIV (virem AIDS).

Přítomnost typů papilomavirů 6, 11, 16 nebo 18 byla zjištěna u 30 % MSM (mužů kteří mají sex s muži) v porovnání s 8 % heterosexuálních mužů. Tato studie pracovala s mladými muži o průměrném věku 22 let a tak je počet nakažených relativně nízký v porovnání s jinými studiemi.

Peter Newman a spoluautoři provedli metaanalýzu více studií a uvádějí, že anální infekce papilomaviry se vyskytuje u 15 % heterosexuálních mužů, 60 % MSM kteří jsou HIV negativní a téměř 95 % MSM HIV+ (mužů kteří mají sex s muži a jsou nakaženi virem působícím AIDS).

Vysoký výskyt anální infekce HPV souvisí se zvýšeným výskytem rakoviny konečníku, který je u MSM 44krát vyšší, než v běžné populaci. V případě MSM, kteří jsou nakaženi HIV je výskyt rakoviny konečníku dokonce 60krát vyšší.

Infekce papilomaviry, které patří k nejrozšířenějším původcům sexuálně přenosných nemocí, se tedy vyskytuje přibližně čtyřikrát častěji u mužů, kteří mají sex s muži, než u heterosexuálních mužů. Z toho vyplývají podobná varování jako u jiných pohlavních nemocí. Toto varování se týká v první řadě všech mužů, kteří mají někdy sex s jiným mužem (MSM). Týká se však také žen, které by měly být zvláště ostražité kdykoli mají podezření, že muž který o ně projevuje zájem je homosexuál, bisexuál, nebo má někdy homosex za peníze. Důsledky jsou jasné i pro případné dárcovství krve nebo jiných orgánů homosexuály.

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3 месяц (9—12 недели). С третьего месяца у плода начинает функционировать орган равновесия — вестибулярный аппарат. Чем больше двигается мать, тем лучше он развивается. Кожа плода стеклообразно прозрачна. Верхние конечности растут быстрее, чем нижние. Трехмесячный плод приобретает характерный человеческий облик. Его длина — 9 см, вес 45 г. Голова и шея выпрямляются, составляя половину всей длины. Хорошо сформировано лицо. Под кожей просвечивают кровеносные сосуды. Плод выглядит тощим, кости и мышцы выделяются под кожей, не имеющей жирового слоя. Скелет плода полностью хрящевой. Скелет и мускулатура настолько выражены, что плод совершает первые свои движения — двигает руками, ногами, сжимает кулаки, открывает рот, глотает, пытается делать сосательные движения. Прослушивается сердцебиение плода — оно почти в два раза чаще, чем у матери. 10 недель — начинают различаться половы органы мальчиков и девочек. 12 недель — появляются голосовые связки. Сближаются глаза, появляются веки, развивается глазное яблоко, уменьшается рот, ноздри широко раздвинуты, уши похожи на две щелочки. Концы пальцев затвердевают. Значительно развиваются печень, почки. Появляются первые волоски — над верхней губой и над глазами. За день малыш в среднем вырастает на 1, 8 мм, и прибавляет в весе 1, 4 г.!
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До 15—16 недели — активный рост мозга, который замедляет рост всего тела. 4 месяц — третий критический период развития плода. При нехватке витамина Е может наступить выкидыш. 15 недель — начинает вырабатываться мужской половой гормон — тестостерон. Женский — чуть позднее. Заканчивается дифференциация половых органов. Внутренние половые органы уже частично сформированы. В четвертом месяце меняется цвет кожи плода. Стеклообразно-беловатая окраска становится матово-красной. На коже появляются мелкие волоски. Четырехмесячный плод имеет длину около 16 см, вес около 120 г. Кисть четырехмесячного плода — 1, 4 см. Четырехмесячный плод имеет длину около 16 см, вес около 120 г. Кисть четырехмесячного плода — 1, 4 см. До начала пятого месяца главным местом кроветворения является печень, которая разрастается очень рано и уже способна накапливать гликоген и вырабатывать желчь. Меняются пропорции. Голова кажется меньше по отношению к туловищу, чем раньше. Начинают функционировать сальные и потовые железы, почки. В кишечнике скапливается меконий. Ежедневная прибавка в весе 2, 6 г., в росте — 2, 5 мм.

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