Anogenital warts or genital warts

The appearance of cone-shaped flesh-colored growths in the genital area is a cause for concern, which is completely justified, because the health of the genital area is an important point for the overall physical and moral well-being of a person.

These warts cause discomfort, interfere with normal sex life, and can also cause more serious health problems. If the integrity of the condyloma is damaged, infection may occur and the transition to malignant formation may occur. Therefore, the desire to get rid of such manifestations is understandable and quite natural.

Because of appearance

The cause of papilloma warts is the human papillomavirus. This virus contains a specific set of DNA that successfully integrates into the cells of the human body and causes them to change their developmental cycle, shape and structure.

According to the international classification of diseases ICD-10, human papillomavirus is coded B97. 7. Venereal anogenital warts are coded A63. 0.

There are many types of this virus, each of which causes a specific papilloma wart. The type of virus determines the course of the pathological process, symptoms, location of manifestation and severity of complications.

Strains are divided into two main types:

• the skin, with the main appearance on the skin layer;
• mucous membrane, which appears on the mucous epithelium of the genital organs, oral cavity, etc.

In addition, papillomavirus types differ depending on the risk of degeneration to oncogenic processes to oncogenic, moderately oncogenic and non-oncogenic.

Often, several different strains are present in the body of an infected person at the same time.

Route of infection and risk factors

There are several ways for pathogens to enter the body:

• "Vertical" delivery.. This is the name given to the transfer of infectious agents from mother to child during pregnancy. Currently it is not known whether the infection occurs in the prenatal period or directly during delivery, but it is undesirable to perform a cesarean section in mothers with papillomavirus. Cesarean section is chosen only in case of bleeding papilloma in the birth canal.
• Sexual passage.Infectious agents can enter the body during vaginal, oral or anal sex. Pathogens are also transmitted through saliva during kissing. Using a condom during sex does not guarantee protection against the virus, but it does make transmission less likely.
• Household ways.The transmission mechanism of this disease is quite rare. Infection can occur through contact with the patient's personal belongings. Since the virus is contained in saliva and urine, it is possible to get infected by using other people's dishes, shared towels, personal hygiene items, from the side of the toilet or in the bathhouse.

The method of infection is mainly determined by the age of the person: in infants, with a high degree of certainty, it can be ascertained that the infection comes from the mother, and for older children, through contacts and household contacts. From the age of 17, in most cases, sexual transmission occurs.

According to statistics, the human papillomavirus is present in the body of more than half of the sexually mature population, but in most cases it is not manifested in any way and is present in the form of transport.

The peak of this disease occurs at a young age from 17 to 25 years. This is due to maximum sexual activity and high sensitivity of the epithelium on the organs of the genitourinary system.

Predisposing factors that increase the likelihood of disease are:

• initiation of early sexual activity;
• frequent changes of sexual partners;
• age up to 25 years;
• sexual contact with people who previously had human papillomavirus or other sexually transmitted diseases;
• pregnancy;
• intravaginal flora imbalance;
• any chronic disease;
• endometriosis;
• therapy with cytostatic drugs or glucocorticosteroids;
• overweight;
• thyroid gland disorders and insulin production disorders;
• hypovitaminosis.

Frequent stress and non-compliance with the principles of personal hygiene greatly increase a person's chances that, after entering the body, the infection will enter the active phase.

After introduction, the virus spreads throughout the body through the bloodstream, attaches to cells, penetrates its structure and integrates its DNA into the cell's DNA. The affected cells then begin to actively grow and divide, as a result of which condylomas appear.

Ways of development

After entering the human body, the virus does not cause any symptoms for a certain period of time.

The course of the disease occurs according to the following algorithm:

• Hidden period. During this stage, the carrier is not aware of the presence of an infectious pathogen, because there are no clinical manifestations. However, at this stage a person is already contagious and can infect his partner through sexual contact. This latent period can last from 2-3 months to several years.
• The onset of the disease occurs when the virus multiplies sufficiently in the body or when the immune system's protective mechanisms are reduced. During this period, the first symptoms appear.
• Active development with increasing symptoms.

The course of further events is developing in one of the directions:

• self-healing with the complete disappearance of papilloma warts (most often observed after the end of pregnancy);
• damp course and lack of skin growth;
• active dynamics of papilloma with an increase in shape, size, number, and merging of groups located nearby;
• degeneration of a benign growth into a malignant one.

Types of condyloma

There are several types of conventional condyloma papilloma:

• exophytic- protruding above the surface of the skin or mucous membrane with preferential growth outwards;
• endophytes- with dominant growth deep into the skin structure, therefore slightly noticeable during visual inspection;
• Buschke-Levenshtein education- characterized by rapid growth rate, large size and frequent relapses after undergoing treatment. With this form, both external growth and damage to the internal layer in the tissue occur.

Genital warts can have a thin or wide base. If the stem is thin, the tip may be sharp or stick-like. Papilloma with a broad base is relatively rare. The color of all such growths is close to the color of the skin: from flesh to pink. The surface can be soft or covered with a layer of keratin.

Warts can appear singly or in groups resembling nodules. Sometimes multiple such groups reach a size of 1. 5 cm. When several groups merge, the formation looks like a cauliflower inflorescence or a rooster's comb. These growths make it easier to identify the disease during examination.

Single growths usually do not cause discomfort like large elements. In rare cases, they rupture and bleed a little.

Large formations are more problematic: they can become wet, bleed, and worsen due to secondary infections taking root in the affected area.

symptoms

The first symptoms appear after the end of the latent period, which lasts several weeks in the shortest cases.

The incidence of condyloma occurs as follows:

• slight redness appears on the skin, which begins to itch;
• rash appears on the skin or mucous surface in the form of blisters or small bumps;
• tubercles gradually increase to 1-1. 5 centimeters long;
• A new rash appeared nearby, which also turned into a condyloma papule.

Localization depends on the specific strain and the place of entry of the pathogen into the body:

• external genitalia;
• anal area (anogenital papilloma);
• in the urethra;
• on the cervix;
• on the epithelium in the mouth (on the buccal surface, tongue and inner part of the lips).

The clinical picture may differ in each specific case depending on the health status of the person. For small warts, no other symptoms can be observed.

With a more severe course, the following symptoms are observed:

• itching or burning at the site of the rash;
• foreign object sensation in the perineal area;
• moisture in the neoplasm area;
• unpleasant odor from the area where the condyloma is.

With physical activity, long walks or running, all the above symptoms intensify.

In severe cases, fatigue, weakness, signs of intoxication, prolonged headache, fever and high temperature are observed.

In men and women, the symptoms have some differences. This is due to anatomical differences and sexual behavior characteristics.

Manifestations in men

Condyloma in men most often affects the scrotum, groin, pubis and various parts of the structure of the penis: head, body, frenulum and foreskin, coronary groove. When localized near the urethra, the papilloma acquires a clear red color, and this location often causes branching or splashing of the flow during urination.

If the rash is located at the exit of the anus, severe pain may occur during bowel movements, and blood may be present in the stool. Because of this, the fear of defecation reflex often appears, which causes periodic constipation, and sometimes hemorrhoids.

Often there is a vague pain in the lower abdomen; during sex there is a burning sensation and pain, as well as during urination.

The prolonged presence of infection reduces a man's immunity, making him more susceptible to respiratory diseases, which are more difficult to treat than usual.

Manifestations in women

The most common place for papillomas to occur in women is the perianal zone, where humidity and temperature are constantly increased: the epithelium of the clitoris, labia, vaginal outlet and urethral opening. If the infection occurs during anal sex, a ring of growths may be concentrated around the anus.

Large growths often become secondarily infected, causing a strong odor, bleeding, ulcers and severe pain when touched. When walking, severe irritation and discomfort is observed.

In 50% of women, whitish elements are formed on the cervix of the uterus, which are detected during routine colposcopy, before which they are treated with acidic disinfectants that can increase the white color of the condyloma.

In some cases, all tumors are located on the mucous membrane of the internal genital organs of a woman, so she does not notice it until a scheduled visit to the gynecologist. This is often the reason for starting treatment later in life than men.

Often women experience shame due to the presence of formations in intimate places, which forces them to refuse sex.

Rarely, papillomas occur in the mouth, and in very rare cases - on the pubis, thighs, neck or face.

Features of condylomatosis during pregnancy

If condylomatosis has been treated, pregnancy should be planned no earlier than in a few months. The period of abstinence from pregnancy is extended if the woman takes antiviral drugs during therapy. After successful treatment and maintained intervals, you can safely become pregnant.

If the disease is discovered during pregnancy, it is recommended to wait for treatment until all the baby's organs are formed. Treatment after 28 weeks does not cause developmental abnormalities in the fetus.

The reasons why condylomatous warts appear in pregnant women include a standard decrease in immunity with increased stress on the body and significant hormonal fluctuations.

If the papilloma is located on the outside of the genital organ or in the perianal area and does not cause discomfort, then the question of treatment can be postponed until the child is born. But in case of rapid growth, increase in size and severe pain in the tumor, you should immediately see a doctor. Sometimes, with a high rate of development of formations, their relaxation is observed, which can cause rupture of the vagina.

This disease, as a rule, does not affect the formation of the fetus, but its effects extend to the condition of the mother and the delivery process. If there are other infections, there is often a risk of prematurity.

When the condyloma is damaged during the passage of the fetus through the birth canal, this often leads to infant infection and laryngeal condylomatosis in the neonatal or thoracic period. Therefore, the presence of a significant papilloma in the birth canal is a direct indication for cesarean section.

If necessary, the growth is removed during pregnancy, after which the tissue is sent for histology to confirm its benign nature.

The use of traditional medical methods to remove condyloma during pregnancy is unacceptable, as this may not only not give positive results, but may cause the degeneration of benign cells into malignant ones.

Formations that do not cause discomfort during pregnancy often disappear on their own without treatment within a few months after delivery when the woman's hormonal balance returns to normal.

Diagnostics

If the patient sees symptoms reminiscent of human papillomavirus, then he should contact a gynecologist, urologist or venereologist.

First of all, experts conduct a survey to clarify the following:

• time of first symptom detection by the patient;
• possible cause of infection;
• dynamics and progression of the disease until you see a doctor.

After this, a clinical examination is carried out, where the specialist determines the location, intensity, size and condition of the growth. For women, additional colposcopy (examination of individual genital organs with magnification) or advanced colposcopy (a similar procedure using acetic acid solution) is performed.

For a more accurate diagnosis, the doctor prescribes the following additional tests:

• PCR diagnostics, allows you to detect pathogens in scrapings from the epithelium of the affected area and determine their quantity (also allows you to determine the strain of the virus);
• anoscopy- visual examination of the area near the anus with magnification;
• cytology and histologyformation fragments to identify atypical cells or tissues;
• growth biopsyfrom epithelial tissue for microscopic study of tissue structure;
• antibody titer detectionto this virus;
• smudgefrom the cervical canal and cervix for microscopic oncocytology.

If necessary, a consultation with a dermatologist or proctologist is scheduled. If the diagnosis is carried out in a pregnant woman, then it is necessary to contact an obstetrician-gynecologist.

After receiving all the necessary data, the specialist can choose individual tactics for therapy and complete relief from the disease.

Treatment

Often, with condylomatosis, people avoid going to medical institutions and choose self-therapy, giving preference to local drugs that can eliminate visible manifestations, but do not cure the body of the infection, transferring it to a latent stage. Such treatment almost always leads to relapse. Therefore, for the final cure, an integrated approach is needed, which can only be determined by experts.

Treatment is carried out in the following areas:

• growth removal;
• fight viruses;
• strengthen the patient's immunity.

All methods used to combat genital warts are divided into radical and medical.

Radical method

Such a method is chosen if it is necessary to eliminate external manifestations immediately or when condyloma is localized on the cervix in women.

The following methods are used for removal:

• Surgical removalformation using a scalpel under local or general anesthesia. The cut site is sutured with surgical sutures. Although this method is considered classic, it often causes postoperative bleeding and long-term recovery in the hospital, so recently surgical removal has been used less and less.
• Cryodestruction with liquid nitrogen.This method is relatively cheap and safe, and does not require anesthesia or anesthesia. After freezing, the proteins of the formation are destroyed, the nodules dry and fall off. After a few weeks, no scars or scars remain at the treatment site.
• Laser removal.Despite high safety and efficiency, this method requires anesthesia and is characterized by high costs, so it is prescribed if other methods cannot be used. When exposed to the laser beam, the structure of the growth stalk is destroyed. After cauterization, the condyloma loses nutrition, which in a few days leads to its necrosis and the scab disappears. Scars often remain after laser removal.
• Electrocoagulation.This method is affordable, but very painful, so it requires local anesthesia. The genital plant is exposed to high temperatures, where the papilloma is burned. The scab will go away on its own after a few days, leaving a scar.
• Radiosurgery.Currently, this is the most high-tech, fast and effective method, which determines its high cost. Using high frequency radio waves, genital warts are painlessly removed in 15-30 minutes. After such removal there is no bleeding, healing occurs within a day, after which no marks remain on the skin.
• Destruction by chemicals.This technique is only suitable for small formations, without multiple combinations. Special strong substances are used, which lead to the death of growth cells. These products are based on highly concentrated acids or alkalis that cause local chemical burns.

If we limit ourselves only to radical methods of combating condylomatosis, then the recurrence of condyloma occurs in every third case.

Drug therapy

An integrated approach involves eliminating benign formations, getting rid of viruses in the body and improving immune status. Therefore, drug treatment includes the use of such drugs:

• Pharmaceutical productsfor wart necrosis, acceptable for home use. For several days, this product should be used as directed on the condyloma. If the drug hits healthy tissue near the growth, a deep chemical burn will form, so you need to use the drug carefully. After daily application, take a short break for a few days. If the shoots do not fall, then the course is repeated. Pharmaceutical products that cause growth necrosis include solutions and ointments.
• Antivirus agent.They can be for local or systemic use.
• Immunomodulatorsto increase immunity.

In addition, to improve the body's defenses, a systematic intake of multivitamin complexes, a special diet and a healthy lifestyle are prescribed.

Immunity to condylomatosis is not developed after treatment, so re-infection from a previous sexual partner is possible.

Possible complications

If left untreated for a long time, condylomatosis causes the following complications:

• Attachment of bacterial infection to the damaged condylomatous papilloma, which leads to the formation of purulence, balanoposthitis and ulcers in the perianal area.
• When tumors grow in the urethra, viral-bacterial urethritis can develop, leading to problems urinating, urinary retention and urinary tract infections.
• When large formations are localized in the anus, hemorrhoidal bleeding and paraproctitis occur.
• Genital warts can affect a person's sex life, causing him to refuse sexual intercourse. All this often leads to depression and psychological problems.
• Women may experience cervical erosion and dysplasia.
• The greatest danger is the risk of benign tumor degeneration into cancer (cancer of the head of the penis or cervix).

Preventive measures

Prevention of condylomatosis is divided into specific and general.

Specific preventive measures include vaccination with the new quadrivalent vaccine. This vaccine does not work against all types of human papillomavirus, but it successfully fights the most dangerous, which causes cervical cancer. Vaccination is carried out from the age of 11 and is repeated three times.

Non-specific prevention is similar to measures that exist in many sexually transmitted diseases:

• use of barrier contraceptives;
• personal hygiene at the appropriate level;
• regular sexual partners;
• regular examination by a gynecologist or andrologist;
• timely treatment of diseases of the pelvic organs;
• quit alcohol and smoking.

In addition, it is necessary to avoid stress, physical fatigue, hypothermia and any factor that weakens the immune system. A healthy diet, improved health, and proper sleep patterns will help prevent the appearance of genital warts.