Anogenital warts or genital warts

The appearance of cone-shaped flesh-colored formations in the genital organ is a reason for concern, which is quite justified, since the health of the genital area is an important point for the overall physical and moral well-being of a person.

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

Reasons for appearance

The cause of papilloma warts is the human papilloma virus. This virus contains a certain set of DNA that successfully combines with the cells of the human body and causes them to change their development cycle, shape and structure.

According to the International Classification of Diseases ICD-10, human papillomavirus is coded B97. 7. Anogenital warts of venereal nature are assigned code A63. 0.

There are many different strains of this virus, each of which causes specific wart 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 superior appearance to the layer of skin;
• Mucous membranes that appear on the mucous epithelium of the genitals, mouth, etc. Sh.

In addition, papillomavirus types differ according to the risk of oncogenic process degeneration into oncogenic, moderately oncogenic and non-oncogenic.

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

Routes of infection and risk factors

There are several ways for the pathogen to enter the body:

• "Vertical" transmission. This 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 in the prenatal period or directly during childbirth, but caesarean section of a mother infected with papillomavirus is undesirable. Cesarean section is chosen only in the case of bleeding papillomas inside the birth canal.
• sexual wayAn infectious agent can enter the body during vaginal, oral or anal sex. The pathogen is also transmitted by saliva during kissing. Using a condom during intercourse does not guarantee protection against the virus, but it does reduce its transmission.
• Household road.This mechanism of disease transmission 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 toilet bowl or in the bathroom.

The method of infection is mainly determined by the age of the person: in infants, with a high degree of confidence, it can be determined that the infection came from the mother, and for 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 is not manifested in any way and is present in the form of carriage.

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

Predisposing factors that increase the likelihood of the disease are:

• early initiation of sexual activity;
• frequent change of sexual partners;
• Age up to 25 years;
• sexual contact with people who previously had human papillomavirus or other sexually transmitted diseases;
• pregnancy;
• imbalance of intravaginal flora;
• any chronic disease;
• endometriosis;
• therapy with cytostatic or glucocorticosteroid drugs;
• Excess weight;
• Disruption of the thyroid gland and disruption of insulin production;
• Hypovitaminosis.

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

Once ingested, the virus spreads throughout the body through the bloodstream, attaches to cells, penetrates their structure, and integrates its DNA into the cell's DNA. Then the affected cells begin to actively grow and divide, due to which condylomas appear.

Ways of development

After entering the human body, the virus does not cause any symptoms for some time.

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

• hidden period. At this stage, the carrier does not know about the presence of an infectious pathogen, since there are no clinical manifestations. However, at this stage, a person is already contagious and can infect a 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 protective mechanisms of the immune system are reduced. During this period, the first symptoms appear.
• Active development with increasing symptoms.

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

• self-healing with the complete disappearance of papilloma warts (most often observed after the end of pregnancy);
• sluggish course and lack of growth of skin rash;
• active dynamics of papillomas with an increase in shape, size, number and fusion of closely located groups;
• Degeneration of benign formations into malignant ones.

Types of condyloma

There are several common types of condyloma papillomas:

• exophytic- with a predominant growth protruding above the surface of the skin or mucous membrane;
• endophytic- with a predominant increase in the depth of the skin structures, so it is less noticeable during visual inspection;
• Buschke-Lewenstein education- It is characterized by fast growth rates, large sizes and frequent relapses after a course of treatment. In this form, both external growth and damage to the deep inner layers of tissue occur.

Genital warts can have a thin or wide base shape. If the stem is thin, the tip may be sharp or stick-like. Papillomas with a wide base are quite rare. The color of all such rashes is close to the color of the skin: from flesh to pink. The surface can be smooth or covered with a layer of keratin.

Warts can appear singly or in nodule-like groups. Sometimes such numerous groups reach the size of 1. 5 cm, when several groups merge, formations are formed that resemble cauliflower flowers or a rooster's comb. These formations make it easier to identify the disease during examination.

A single increase usually does not cause as much discomfort as large elements. In rare cases, they rupture and bleed a little.

Large growths are more problematic: they can ooze, bleed and become inflamed due to a secondary infection that takes 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.

Condyloma occurs as follows:

• A small redness appears on the skin, which begins to itch;
• A rash appears on the skin or mucous surface in the form of blisters or small bumps;
• Tuberculosis gradually grows to 1-1, 5 centimeters;
• A new rash appears there, which also turns into condyloma papules.

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

• external genitalia;
• anal region (anogenital papillomas);
• inside the urethra;
• on the cervix;
• on the epithelium of the oral cavity (on the buccal surfaces, on the tongue and inside the lips).

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

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

• itching or burning at the site of the rash;
• sensation of a foreign object in the perineal area;
• moisture in the area of neoplasms;
• An unpleasant smell from the place where there are condylomas.

With physical exertion, long walking or running, all the above symptoms are aggravated.

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

Symptoms in men and women have some differences. This is due to anatomical differences and characteristics of sexual behavior.

Manifestations in men

Condyloma in men most often affects the scrotum, groin, pubis and various structural parts of the penis: head, body, frinulum and foreskin, coronary groove. When localized near the urethra, papillomas acquire a bright red color, and this location often causes a bifurcation of the flow or during urination.

If the rash is localized in the anus, severe pain may develop during bowel movements and blood may be present in the stool. Due to this, there is often a reflex fear of defecation, which leads to periodic constipation, and sometimes hemorrhoids.

Undefined pain in the lower part of the abdomen is common, burning and pain are felt during sex, as well as when urinating.

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

Manifestations in women

The most common places for the appearance of papillomas in women are the perianal zones, where humidity and temperature constantly increase: the epithelium of the clitoris, the labia, the vaginal opening and the opening of the urethra. If the infection occurs during anal sex, a ring of formations may be concentrated around the anus.

Large growths often become secondarily infected, causing a strong odor, bleeding, ulcers, and severe pain when touched. Irritation and severe discomfort are observed while walking.

In 50% of women, whitish elements appear on the cervix, which are detected during a routine colposcopy, before 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 the internal genital organs of a woman, so she does not notice them until the planned visit to the gynecologist. This is often the reason why treatment will start later than in men.

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

Rarely, papillomas appear in the oral cavity, and in extremely rare cases - on the pubis, thighs, neck or face.

Features of condylomatosis during pregnancy

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

If the disease is already detected during pregnancy, then it is recommended to wait for treatment until all the organs of the child are already formed. After 28 weeks, treatment does not cause fetal development disorders.

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

If the papillomas are located on the external parts of the genital organs or in the perianal area and do not cause discomfort, then the issue 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 weakening is observed, which can lead to vaginal rupture.

This disease, as a rule, does not affect the formation of the fetus, but its effect extends to the condition of the mother and the process of childbirth. If other infections are present, there is often a risk of premature birth.

When condylomas are damaged while passing through the birth canal of the fetus, this often leads to infection of the child and laryngeal condylomatosis in newborns or in the chest period. Therefore, the presence of significant papillomas in the birth canal is a direct indication of cesarean section.

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

The use of traditional medicine methods to remove condylomas during pregnancy is unacceptable, because it not only does not have a positive result, but can also lead to the degeneration of benign cells into malignant ones.

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

diagnosis

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

First of all, the specialist conducts a survey to find out the following points:

• the time of the patient's first symptoms;
• Probable causes of infection;
• Dynamics and development of the disease before going to the doctor.

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

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

• PCR diagnostics, allows you to detect the pathogen in scratches from the epithelium of the affected areas and determine its quantity (also allows you to determine the strain of the virus);
• Anoscopy- visual inspection of the area surrounding the anus with magnification;
• Cytology and histologyfragments of formations to identify atypical cells or tissues;
• Biopsy of formationsfor the microscopic study of tissue structure from epithelial tissues;
• Antibody titer detectionagainst this virus;
• smearFrom the cervical canal and cervix for microscopic oncocytology.

If necessary, consultations with a dermatologist or proctologist are prescribed. If the diagnosis is carried out on 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 therapy themselves, preferring local drugs that can remove the visible manifestations, but do not cure the infection, moving it to a latent stage. Such treatment almost always leads to relapse. Therefore, an integrated approach is needed for the final cure, which can only be determined by a specialist.

Treatment is carried out in the following areas:

• removal of formations;
• fight against the virus;
• Strengthening the patient's immunity.

All methods used to fight genital warts are divided into radical and therapeutic.

radical methods

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

The following methods are used for removal:

• surgical excisionformations using a scalpel under local or general anesthesia. The cut area is sutured with surgical thread. Although this method is considered classic, it often leads to 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 more scars and scars at the treatment site.
• laser removal.Despite safety and high efficiency, the method requires anesthesia and is characterized by a high cost, so it is prescribed if other methods cannot be used. When exposed to a laser beam, the structure of the growth rod is destroyed. After cauterization, the condyloma loses nutrition, which causes its necrosis and disappears in a few days. Scars often remain after laser removal.
• electrocoagulation.The method is affordable, but very painful, so it requires local anesthesia. Genital growths are exposed to high temperature during which papillomas are cauterized. The scars fall off on their own after a few days, leaving scars.
• Radiosurgery.At the moment, it is the most high-tech, fast and effective method, which accounts for its high cost. Using high-frequency radio waves, genital warts can be painlessly removed in 15-30 minutes. After such removal, there is no bleeding, healing occurs in a day, after which no traces remain on the skin.
• Destruction by chemicals.This technique is suitable only 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 only radical methods of combating condyloma, then condyloma relapse occurs in every third case.

drug therapy

An integrated approach involves eliminating benign growths, removing the virus from the body and increasing the immune status. Therefore, drug treatment includes the use of such drugs:

• Pharmacy productsFor necrosis of warts, it is acceptable for home use. For several days, this product should be applied to condylomas. If the drug gets on healthy tissue near the growth, a deep chemical burn will occur, so it is necessary to use the drug very carefully. After daily applications, rest for a few days. If the shot does not fall, then the course is repeated. Pharmaceutical products that cause necrosis of the rash include solutions and ointments.
• Antiviral agents.They can be for local 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 to condylomatosis is not formed after treatment, so re-infection from a previous sexual partner is possible.

Possible complications

Without treatment for a long time, condylomatosis causes the following complications:

• Attachment of bacterial infection to damaged condylomatous papillomas, causing purulent formations, balanoposthitis and ulceration in the perianal area.
• When cysts grow in the urethra, viral-bacterial urethritis can develop, causing 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 them to refuse to have sex. 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 turning 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. These vaccines do not work against all strains of human papillomavirus, but they successfully fight the most dangerous of them, which causes cervical cancer. Vaccination is carried out from the age of 11 and is repeated three times.

Non-specific prevention is similar to the measures inherent 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;
• Avoiding 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 genital warts.