Anogenital warts or genital warts

The appearance of conical flesh-colored growths in the genital area causes concern, and this is fully justified, since the health of the genitals is an important point for the general physical and moral well-being of a person.

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

Appearance reasons

Papilloma warts are caused by 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, the human papillomavirus code is B97. 7. Code A63 is assigned to anogenital warts of venereal nature. 0.

There are many different strains of this virus, each of which causes specific warty papillomas. The type of virus determines the course of the pathological process, symptoms, place of manifestation and severity of complications.

Strains are divided into two main types:

• skin, with a dominant appearance on the dermis layer;
• mucous membranes that appear on the mucous epithelium of the genitals, oral cavity, etc.

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

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

Routes of infection and risk factors

There are several ways a pathogen can enter the body:

• "Vertical" transmission. It is the name given to the transmission of an infectious agent from mother to child during pregnancy. Currently, it is not known whether the infection occurs prenatally or directly during childbirth, but it is not advisable to perform a cesarean section on a mother with the papillomavirus. Caesarean section is chosen only in case of bleeding papillomas inside the birth canal.
• The sexual path.An infectious agent can enter the body during vaginal, oral or anal sex. The pathogen is also transmitted by saliva during kissing. Using condoms during intercourse does not guarantee protection against the virus, but it reduces the possibility of its transmission.
• Type of household.This mechanism of disease transmission is quite rare. Infection can occur through contact with the patient's personal items. Since the virus is present in saliva and urine, it is possible to get infected by using other people's dishes, shared towels, personal hygiene products, from the edge of the toilet or in the sauna.

The method of infection is mainly determined by the person's age: in infants, it can be established with a high degree of certainty that the infection came from the mother, and in older children - through contact and household contact. From the age of 17, sexual transmission takes place in most cases.

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 does not manifest itself in any way and is in the form of carriage.

The peak of the disease occurs at a young age of 17 to 25 years. It is associated with maximum sexual activity and high sensitivity of the epithelium on the organs of the genitourinary system.

Predisposing factors that increase the likelihood of the disease are:

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

Frequent stress and failure to observe the principles of personal hygiene significantly increase a person's chances that the infection will enter the active phase after entering the body.

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

Types 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:

• The hidden period. At this stage, the carrier is unaware of the presence of an infectious pathogen, as 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 disease begins when the virus multiplies sufficiently in the body or the protective mechanisms of the immune system decrease. During this period, the first symptoms appear.
• Active development with increasing symptoms.

The further course of events develops in one of the following directions:

• self-healing with complete disappearance of papilloma warts (most often observed after the end of pregnancy);
• slow pace and lack of growth of skin growths;
• active dynamics of papillomas with an increase in shape, size, number and merging of closely spaced groups;
• degeneration of benign formations into malignant ones.

Types of condylomas

There are several traditional types of condyloma papillomas:

• exophytic- protruding above the surface of the skin or mucous membrane with preferential growth outwards;
• endophytic- with dominant growth deep in the skin structures, so it is hardly noticeable on visual inspection;
• Buschke-Levenshtein education- characterized by a rapid growth rate, large sizes and frequent relapses after a course of treatment. With this form, both external growth and damage to the deep inner layers of tissue occur.

Genital warts can have a thin or wide base. If the stem is thin, the tip may be sharp or club-like. Papillomas with a broad base are quite 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 such several groups reach a size of 1. 5 cm, when several groups merge, formations resembling cauliflower inflorescences or a rooster's comb appear. These growths make it easy to identify the disease after examination.

Individual growths usually do not cause as much discomfort as large elements. In rare cases, they break and bleed a little.

Large formations are more problematic: they can ooze, bleed and worsen due to secondary infection taking root in the affected areas.

Symptoms

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

Condylomas occur as follows:

• slight redness appears on the skin, which begins to itch;
• rash appears on the skin or mucous membrane in the form of blisters or small bumps;
• tubers gradually increase to a length of 1-1. 5 centimeters;
• New rashes appear nearby, which also turn into condyloma papules.

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

• external genitalia;
• anal area (anogenital papillomas);
• inside the urethra;
• on the cervix;
• on the epithelium in the mouth (on the cheek surfaces, tongue and inside of the lips).

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

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

• itching or burning at the site of the rash;
• feeling of a foreign body in the perineal area;
• moisture in the area of neoplasms;
• unpleasant smell from the place where the warts are located.

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

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

There are some differences in symptoms between men and women. This is due to anatomical differences and characteristics of sexual behavior.

Manifestations for men

Male condylomas most often affect the scrotum, groin, pubis and various structural parts of the penis: head, body, frenulum and foreskin, coronary groove. Localized near the urethra, papillomas acquire a distinct red color, and this area often causes the stream to bifurcate or splash when urinating.

If the rash is located at the exit from the anus, severe pain may occur during bowel movements, and there may be blood in the stool. Due to this, a reflexive fear of defecation often appears, which leads to periodic constipation and sometimes hemorrhoids.

There is often vague pain in the lower abdomen, burning sensation and pain during sexual intercourse, as well as when urinating.

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

Manifestations for women

In women, the most common papillomas are perianal areas where humidity and temperature constantly increase: clitoral epithelium, labia, vaginal outlet and urethral opening. If the infection occurs during anal sex, a growth ring may form around the anus.

Large growths often become secondarily infected, causing a strong odor, bleeding, ulceration, and severe pain to the touch. When walking, irritation and severe discomfort are observed.

50% of women develop whitish elements on the cervix, which are detected during a regular colposcopy, before which they are treated with an acidic disinfectant, which can intensify the white color of the condyloma.

In some cases, all growths are located on the mucous membrane of a woman's internal genital organs, so she does not notice them until the planned visit to the gynecologist. This is often the reason why treatment is started later than in men.

Often, women feel embarrassed because there are formations in intimate places that force them to refuse sex.

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

Signs of condylomatosis during pregnancy

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

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

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

If the papillomas are located on the external parts of the genitals or in the perianal area and do not cause discomfort, then the question of treatment can be postponed until the birth of the child. But in case of rapid growth, increase in size and severe pain in growths, you should immediately consult a doctor. Sometimes, with a high rate of progression of formations, their relaxation is observed, which can lead to rupture of the vagina.

This disease, as a rule, does not affect the formation of the fetus, but its effect refers to the state of the mother and the birth process. If there are other infections, there is often a risk of preterm birth.

If condylomas are damaged during the passage of the fetus through the birth canal, this often leads to infection of the child and condylomatosis of the larynx in the newborn or thoracic period. Therefore, the presence of significant papillomas 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 medicine methods to get rid of condyloma during pregnancy is unacceptable, because it can not only not give a positive result, but also cause the degeneration of benign cells into malignant ones.

Formations that did not cause discomfort during pregnancy often disappear on their own without treatment within a few months after childbirth, as the woman's hormonal balance normalizes.

Diagnostics

If the patient notices symptoms reminiscent of the human papilloma virus, he should contact a gynecologist, urologist or venereologist.

First, the specialist conducts a survey to clarify the following points:

• the time when the patient reveals the first symptoms;
• possible causes of infection;
• the dynamics and development of the disease until you see a doctor.

After that, a clinical examination is performed, during which the specialist determines the location, intensity, size and condition of the growths. Women undergo an additional colposcopy (examination of individual genitals with magnification) or an extended colposcopy (a similar procedure using an acetic acid solution).

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

• PCR diagnostics, allows to determine the pathogen-affected area in the epithelial scratches and to determine its amount (also allows to determine the virus strain);
• anoscopy- visual examination of the area near the anus with magnification;
• cytology and histologyfragments of formations to identify atypical cells or tissues;
• biopsy of growthsfrom epithelial tissue for microscopic study of tissue structure;
• determination of antibody titerfor this virus;
• smearfrom the cervical canal and cervix for microscopic oncocytology.

If necessary, dermatologist or proctologist consultations are provided. If the diagnosis is made to a pregnant woman, an obstetrician-gynecologist should be contacted.

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

Treatment

Often with condylomatosis, people avoid visiting medical institutions and choose their own therapy, preferring local drugs that can remove the visible manifestations, but do not treat the infectious organism, transferring it to a latent stage. Such treatment almost always results in relapse. Therefore, the final treatment requires an integrated approach that can only be determined by a specialist.

Treatment is carried out in the following areas:

• removal of growths;
• fight against the virus;
• strengthening the patient's immunity.

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

Radical methods

Such methods are chosen if it is necessary to urgently eliminate external manifestations or if women have localized condylomas on the cervix.

The following methods are used for withdrawal:

• Surgical excisionformations using a scalpel under local or general anesthesia. The incision site is sutured with surgical suture. Despite the fact that this method is considered classic, it often causes postoperative bleeding and long rehabilitation in the hospital, so recently surgical removal is 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 protein of the formations is destroyed, the nodules dry up and fall off. After a few weeks, there are no scars or scars left at the treatment site.
• Laser removal.Despite its safety and high efficiency, the method requires anesthesia and is characterized by high costs, so it is prescribed when it is not possible to use other methods. When exposed to a laser beam, the structure of the growth stem is destroyed. After cauterization, the condyloma is deprived of nutrition, which in a few days leads to its necrosis and the scab disappears. Scars often remain after laser removal.
• Electrocoagulation.The method is acceptable, but very painful, so it requires local anesthesia. Genital growths are exposed to high temperatures, during which the papillomas are cauterized. After a few days, the scabs fall off on their own, leaving scars.
• Radiosurgery.At the moment, this is the most advanced, fastest and most effective method, which determines its high cost. Using high-frequency radio waves, genital warts are painlessly removed within 15-30 minutes. After such removal, bleeding does not occur, healing occurs within a day, after which no traces remain on the skin.
• Destruction by chemicals.This technique is only suitable for small formations without multiple fusions. Special strong substances are used that cause the death of growth cells. These products are based on highly concentrated acids or alkalis that cause local chemical burns.

If we limit ourselves to radical methods of combating condylomatosis, then condylomas recur in every third case.

Drug therapy

An integrated approach includes the elimination of benign formations, getting rid of the virus in the body and increasing the state of immunity. Therefore, drug treatment includes the use of the following drugs:

• Pharmacy productsfor wart necrosis, acceptable for home use. This remedy should be applied to condylomas for several days. If the drug gets into healthy tissue near the growth, a deep chemical burn will occur, so the drug should be used very carefully. After daily use, take a short break of several days. If the shoot does not fall, then the course is repeated. Pharmaceutical products that cause growth necrosis include solutions and ointments.
• Antiviral agents. They can be for topical or systemic use.
• Immunomodulatorsto improve immunity.

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

Immunity against condylomatosis does not develop after treatment, so re-infection from a previous sexual partner is possible.

Possible complications

If condylomatosis is not treated for a long time, it causes the following complications:

• Bacterial infection attachment to damaged condylomatous papillomas, causing purulent formations, balanoposthitis and ulcers in the perianal area.
• When growths grow in the urethra, viral and bacterial urethritis can develop, which can cause problems urinating, urinary retention, and urinary tract infection.
• If large formations are localized in the anal area, hemorrhoidal bleeding and paraproctitis occur.
• Genital warts can affect a person's sex life, forcing him to refuse sexual intercourse. All this often leads to depression and psychological problems.
• Women may develop cervical erosion and dysplasia.
• The greatest danger is the risk of benign tumors degenerating into cancer (penile head or cervical cancer).

Preventive measures

Prevention of condylomatosis is divided into specific and general.

Special preventive measures include vaccination with a new quadrivalent vaccine. These vaccines do not work against all strains of human papillomavirus, but they successfully fight the most dangerous ones that cause cervical cancer. Vaccination is carried out from the age of 11 and repeated three times.

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

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

In addition, stress, physical fatigue, hypothermia and any factors that weaken the immune system should be avoided. A healthy diet, improved health and proper sleep will help prevent the appearance of genital warts.