Anogenital warts or genital warts

The appearance of cone-shaped flesh-colored growths on the genitals causes concern, which is quite justified, because the health of the genital area is an important point for the general physical and spiritual well-being of a person.

These wart growths cause discomfort, interfere with normal sex life and can also lead to more serious health problems. If the integrity of condylomas is violated, 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.

Reasons for appearance

The cause of papilloma warts is the human papilloma virus. This virus contains a certain set of DNA that successfully integrates into 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 B97. 7 is coded. Anogenital warts of a venereal nature A63. A code of 0 is given.

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.

Cuttings are divided into two main types:

• skin, with a predominant appearance in the dermal layer;
• mucous membranes appearing in the mucous epithelium of the genitals, oral cavity, etc.

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

Often, an infected person has several different strains in their body at the same time.

Routes of infection and risk factors

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

• "Vertical" transfer. 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 it is undesirable to perform a cesarean section in a mother with papillomavirus. Cesarean section is selected only in the case of bleeding papilloma inside the birth canal.
• Sexual way.The infectious agent can enter the body during vaginal, oral or anal sex. The pathogen is also transmitted through saliva during kissing. Using a condom during sex does not guarantee protection against the virus, but it does reduce the chance of its transmission.
• Household road.This mechanism of disease transmission is extremely rare. Infection can occur through contact with the patient's personal belongings. Since the virus is in saliva and urine, it is possible to get infected by using other people's dishes, shared towels, personal hygiene products, the edge of the toilet or the bathroom.

The mode of infection is mainly determined by the person's age: in infants, with a high degree of certainty, it can be determined that the infection came from the mother, and for older children, it can be determined by contact and household contacts. From the age of 17, it is transmitted sexually 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 exists in the form of carriage.

The peak of the disease occurs in young people between the ages of 17 and 25. This is due to the maximum sexual activity and the high sensitivity of the epithelium to 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 human papillomavirus or other sexually transmitted diseases;
• pregnancy;
• imbalance of intravaginal flora;
• any chronic disease;
• endometriosis;
• therapy with cytostatic or glucocorticosteroid drugs;
• overweight;
• thyroid gland disorder and insulin production disorder;
• hypovitaminosis.

Frequent stress and failure to observe the principles of personal hygiene greatly increase the chances of an infection entering the body into an active phase.

After administration, the virus spreads throughout the body through the bloodstream, attaches to cells, penetrates their structure, and integrates its DNA into the cell's DNA. Affected cells then begin to actively grow and divide, which is why condylomas appear.

Ways of development

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

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

• Secret period. Since there are no clinical manifestations at this stage, the carrier is not aware of the presence of an infectious pathogen. But 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 the protective mechanisms of the immune system decrease. During this period, the first symptoms appear.
• Active development with increasing symptoms.

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

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

Types of condyloma

There are several conventional types of condyloma papillomas:

• exophytic- preferential growth from the surface of the skin or mucous membrane upwards;
• endophytic- with predominant growth in the depths of the skin structures, so it is less noticeable during visual inspection;
• Buschke-Levenshtein study- characterized by rapid growth rates, large sizes and frequent relapses after a course of treatment. With this form, both external growth and damage to the deep inner layers of the tissue occur.

The shape of genital warts can have a thin or wide base. If the stem is thin, the tip may be sharp or stick-like. Broad-based papillomas are extremely rare. The color of all such protrusions 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 alone or in groups that look like nodules. Sometimes several such groups reach 1. 5 cm in size. When several groups are combined, cauliflower inflorescences or combinations that look like a rooster's comb appear. These growths make it easier to identify the disease during examination.

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

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

Symptoms

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

The formation of condylomas occurs as follows:

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

Localization depends on the specific strain and where the pathogen enters the body:

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

The clinical picture may be different 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 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;
• unpleasant smell from the area where the condylomas are located.

All the above symptoms intensify with physical activity, long walking or running.

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

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

Manifestations in men

In men, condylomas mostly affect the scrotum, groin, pubis and various structural parts of the penis: head, body, frenulum and foreskin, coronary groove. When localized near the urethra, papillomas acquire a bright red color, and this place often causes bifurcation or splashing of the flow when urinating.

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

There are often vague pains in the lower abdomen, burning sensation and pain during sexual intercourse, as well as during urination.

Prolonged 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 places for papillomas in women are the perianal zones, where humidity and temperature are constantly increasing: clitoral epithelium, labia, vaginal outlet and opening of the urethra. If the infection occurs during anal sex, a growth ring may form around the anus.

Large shoots are often secondarily infected, causing a strong odor, bleeding, ulcers, and severe pain to the touch. Irritation and severe discomfort are observed during walking.

In 50% of women, whitish elements form on the cervix, which is detected during regular colposcopy, before which it is treated with an acid disinfectant that can increase the white color of condylomas.

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

Often, women feel embarrassed due to the presence of joints in intimate places, which forces them to refuse sex.

Rarely, papillomas are found in the mouth, and very rarely - in the pubis, thighs, neck or face.

Features of condylomatosis during pregnancy

If condylomatosis has been treated, pregnancy should be planned no later than a few months later. If a woman takes antiviral drugs during therapy, the period of rejection of pregnancy is prolonged. After successful treatment and a maintained interval, you can safely become pregnant.

If the disease is already detected during pregnancy, it is recommended to wait for treatment until all the organs of the baby are already formed. After 28 weeks, treatment does not cause developmental abnormalities in the fetus.

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

If papillomas are located on the external parts of the genitals or in the perianal region and do not cause discomfort, the issue of treatment can be postponed until the child is born. But in case of rapid growth, increase in size and severe pain in the growths, you should immediately consult a doctor. Sometimes, with the formations moving at a high speed, their discharge is observed, which can cause 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 birth process. If there are other infections, there is often a risk of premature birth.

When condylomas are damaged during the passage of the fetus through the birth canal, this often leads to infection of the baby and laryngeal condylomatosis in the neonatal 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 check its benignity.

The use of traditional medical methods to get rid of condyloma during pregnancy is unacceptable, because it can not only give a positive result, but also cause the degeneration of benign cells into malignant ones.

Formations that do not cause concern during pregnancy disappear on their own without treatment within a few months after childbirth, as the hormonal balance of the woman normalizes.

Diagnostics

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

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

• the time when the first symptoms were detected by the patient;
• probable causes of infection;
• the dynamics and development of the disease until consulting a doctor.

After that, a clinical examination is carried out, during which the specialist determines the location, intensity, size and condition of the growths. For women, an additional colposcopy (examination of individual genitals with magnification) or extended 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 to detect and quantify the pathogen in scraps from the epithelium of the affected areas (also allows to determine the strain of the virus);
• anoscopy- visual examination of the area near the anus with a magnifying glass;
• cytology and histologyfragments of formations to identify atypical cells or tissues;
• biopsy of growthsfrom epithelial tissues for microscopic examination of tissue structure;
• detection of antibody titerto this virus;
• smearfrom the cervical canal and cervix for microscopic oncocytology.

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

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

Treatment

Often, people with condylomatosis avoid going to medical institutions and choose therapy themselves, preferring local drugs that can eliminate the visible manifestations, but do not treat the body of the infection, moving it to a latent stage. Such treatment almost always leads to relapse. Therefore, an integrated approach is required for the final treatment, which can only be determined by a specialist.

Treatment is carried out in the following areas:

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

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

Radical methods

Such methods are chosen if external manifestations need to be removed urgently or when condylomas are localized on the cervix in women.

The following methods are used to remove:

• Surgical excisionformations using a scalpel under local or general anesthesia. The incision is sutured with surgical thread. Although this method is considered classic, it often leads to postoperative bleeding and long-term rehabilitation in the hospital, so recently surgical removal is used less and less.
• Cryodestruction with liquid nitrogen.This method is relatively cheap and safe, 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, no marks or scars remain at the treatment site.
• Laser removal.Despite the safety and high efficiency, the method requires anesthesia and is characterized by a high price, so it is prescribed when other methods cannot be used. When exposed to a laser beam, the structure of the growth stem is destroyed. After cauterization, the condyloma is deprived of nutrition, which results in its necrosis within a few days, and the itching disappears. Scars are often left after laser removal.
• Electrocoagulation.The method is convenient, but very painful, so local anesthesia is required. Genital protrusions are exposed to high temperature, during which papillomas are cauterized. The crusts fall off on their own after a few days and leave scars.
• Radiosurgery.Currently, this is the most high-tech, fast and effective method that determines its high price. Using high-frequency radio waves, genital warts are painlessly removed within 15-30 minutes. After such removal, there is no bleeding, healing occurs within a day, after which no traces remain on the skin.
• Destruction by chemicals.This technique is suitable only for small formations without many joints. Special strong substances are used, which 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 only to radical methods of combating condylomatosis, then recurrence of condylomas occurs 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 immune status. Therefore, drug treatment includes the use of such drugs:

• Pharmacy productsfor necrosis of warts, acceptable for home use. For several days, this product should be applied pointwise to the condylomas. If the drug enters the healthy tissue near the growth, a deep chemical burn will occur, so you must apply the drug very carefully. After daily applications, take a short break of several days. If the shoot does not fall, the course is repeated. Pharmaceutical products that cause necrosis of the exits include solutions and ointments.
• Antiviral agents.They can be for local or systemic use.
• Immunomodulatorsto improve immunity.

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

Immunity to condyloma does not develop 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 damaged condylomatous papillomas causes purulent formations in the perianal region, balanoposthitis and ulcers.
• When growths grow in the urethra, viral-bacterial urethritis can develop, which causes urination problems, retention of urine in the body, and urinary tract infection.
• When large formations are localized in the anus, hemorrhoidal bleeding and paraproctitis occur.
• Genital warts affect a person's sex life, causing him to refuse sex. All this often leads to depression and psychological problems.
• Cervical erosion and dysplasia may develop in women.
• The biggest 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, the ones that cause cervical cancer. Vaccination is carried out from the age of 11 and is repeated three times.

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

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

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