Anogenital warts or genital warts

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

These wart growths cause discomfort, interfere with normal sex life, and can also cause more serious health problems. If the integrity of the condylomas is damaged, infection may occur and a 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 papillomavirus. This virus contains a certain DNA sequence 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, the human papillomavirus is code B97. 7. Code A63 is assigned. 0 for anogenital warts of venereal type.

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

Flows are divided into two main types:

• cutaneous, with a predominant appearance of the dermal layer;
• mucous membranes, which appear on the mucous epithelium of the genital organs, oral cavity, etc.

In addition, there is a difference between the types of papillomavirus depending on the risk of degeneration into an oncogenic to oncogenic, moderately oncogenic and non-oncogenic process.

Often, several different types are present within an infected person's body 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 transfer of an infectious agent from mother to child during pregnancy. It is currently unknown whether infection occurs in the prenatal period or directly during childbirth, but it is not desirable to perform a caesarean section on a mother with papillomavirus. Caesarean section is only chosen for bleeding papillomas inside the birth canal.
• A sexual path.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 intercourse does not guarantee protection against the virus, but it does make it less likely to be transmitted.
• Way home.This disease transmission mechanism is quite rare. Infection can occur through contact with the patient's personal items. Since the virus is in saliva and urine, it is possible to become infected by using someone else's dishes, shared towels, personal hygiene items, from the edge of the toilet or in a bathhouse.

The mode of infection is determined mainly by the age of the person: in infants, with a high level of confidence, it can be established that the infection came from the mother, and for older children, through contact and household contact. From the age of 17, in most cases, sexual transmission occurs.

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

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

Predictive 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 have previously had the human papillomavirus or other sexually transmitted diseases;
• pregnancy;
• imbalance of intestinal flora;
• any chronic disease;
• endometriosis;
• therapy with cytostatic or glucocorticosteroid drugs;
• overweight;
• disruption of the thyroid gland and disruption of insulin production;
• hypovitaminosis.

Frequent stress and non-compliance with the principles of personal hygiene greatly increase the chance of the infection entering the active phase after entering the body.

After being introduced, the virus spreads throughout the body through the bloodstream, binds to cells, penetrates their structure and integrates its DNA into the cell's DNA. Then the affected cells begin to grow and divide actively, due to 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, since 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 defense mechanisms of the immune system decrease. During this period, the first signs appear.
• Active development with increased symptoms.

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

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

Types of condylomas

There are several traditional types of condyloma papillomas:

• exophytic- protruding above the surface of the skin or mucous membrane with favorable growth out;
• endophytic- with dominant growth deep into the structures of the skin, therefore little was noticed during visual inspection;
• Buschke-Levenshtein education- characterized by rapid growth rates, large sizes and frequent relapses after a course of treatment. With this form, external growth and damage to the deep internal layers of tissue occur.

Genital warts can have a thin or wide base in shape. If the stem is thin, the tip may be sharp or club-like. Broad-based papillomas are quite rare. The color of all such outgrowths 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 like nodules. Sometimes such multiple groups reach sizes of 1. 5 cm. When several groups merge, formations that resemble cauliflower inflorescences or a rooster's comb appear. These growths make the disease easy to recognize when examined.

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 become saturated, bleed and worsen due to a secondary infection affecting the affected areas.

Signs

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

Condylomas occur as follows:

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

Localization depends on the specific strain and the point 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 buccal surfaces, tongue and inside of the lips).

The clinical picture may be different in each individual case depending on the health status of the person. In the case of small warts, no other symptoms may be noticed.

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

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

With physical activity, long walks or runs, all the above symptoms are intensified.

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

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

Productions in men

Condylomas in men often affect the scrotum, groin, pubis and various structural parts of the penis: head, body, frenulum and foreskin, coronal groove. When localized near the urethra, papillomas acquire a clear red color, and this location often results in bifurcation or flashing of the stream when urinating.

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

There is often a dull pain in the lower abdomen; during sex there is a burning sensation and pain, as well as during urinating.

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

Expressions in women

The most common places for papillomas in women are the perianal zones, where the humidity and temperature are always increased: epithelium of the clitoris, labia, vaginal outlet and urethral opening. If an infection occurs during anal sex, a growth ring may form around the anus.

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

In 50% of women, whitish elements form on the cervix of the uterus, detected during a routine colposcopy, before being treated with an acid disinfectant that can improve the white color of condylomas.

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

Women are often embarrassed by the presence of formations in private places, which forces them to refuse sex.

Papillomas rarely 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 increased if the woman took antiviral drugs during the therapy. After successful treatment and a maintenance interval, you can become pregnant safely.

If the disease is already detected 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 developmental abnormalities in the fetus.

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

If 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 the growths, you should consult a doctor immediately. Sometimes, with a high rate of progression of formations, their discharge is observed, which may 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, the risk is often premature.

When condylomas are damaged during the passage of the fetus through the birth canal, the child often develops an infection and laryngeal condylomatosis in the neonatal or thoracic period. Therefore, the presence of significant papillomas in the birth canal is a direct indication of a cesarean section.

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

It is not acceptable to use traditional medicine methods to get rid of condylomas during pregnancy, since this may not only have a positive result, but it may degenerate benign cells into malignant cells.

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

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

• time to detect the first symptoms by the patient;
• probable causes of infection;
• dynamics and development of the disease until you see a doctor.

After this, a clinical examination is carried out, in which the specialist determines the location, intensity, size and condition of the outgrowths. For women, an additional colposcopy (examination of individual reproductive organs with magnification) or an extended colposcopy (a similar procedure using a solution of acetic acid) is performed.

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

• PCR diagnostics, allows you to detect the pathogen in scrapings from the epithelium of the affected areas and determine its quantity (you can also determine the strain of the virus);
• anoscopy- visual inspection of the area near the anus with magnification;
• cytology and histologyfragments of formations to identify atypical cells or tissues;
• growth biopsyfrom epithelial tissues for microscopic study of tissue structure;
• Antibody titer detectionwith this virus;
• smearfrom the cervical canal and cervix for microscopic oncocytology.

If necessary, consultations with a dermatologist or proctologist are scheduled. If the diagnosis is made 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 for themselves, giving preference to local drugs that can remove visible manifestations, but do not heal the body of the infection, transferring it to a stagehidden. Relapse almost always occurs with such treatment. Therefore, for a final cure, an integrated approach is needed, which can only be determined by a specialist.

Treatment is carried out in the following areas:

• getting rid of growth;
• fight against the virus;
• strengthen the patient's immunity.

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

Radical methods

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

The following methods are used to remove it:

• Surgical excisionformations using a scalpel under local or general anesthesia. The cut site is sutured with surgical thread. Despite the fact that this method is considered classic, it often leads to postoperative bleeding and long-term rehabilitation in the hospital, so recently surgical removal has been used less and less.
• Cryo-destruction 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 and fall off. After a few weeks, there are no scars or scars left at the treatment site.
• laser removal.Despite the 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 stalk is destroyed. After cauterization, the condyloma is removed from nutrition, which within a few days leads to necrosis and the scabies disappears. Scars often remain after laser removal.
• Electrocoagulation.The method is affordable, but it is very painful, so it requires local anesthesia. Genital outgrowths are exposed to high temperatures, during which the papillomas are cautioned. The scabs fall off on their own after a few days, leaving scars behind.
• Radiosurgery.At the moment, this is the most high-tech, fast and efficient method, which determines its high cost. Using high-frequency radio waves, genital warts are removed painlessly in 15-30 minutes. After such removal there is no bleeding, healing occurs within a day, and after that there are still no marks on the skin.
• Destruction by chemicals.This technique is only suitable for small formations, without multiple fusions. Special strong substances are used, which causes the death of growing cells. These products are based on highly concentrated acids or alkalis that cause local chemical burns.

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

Drug therapy

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

• Pharmaceutical productsfor necrosis of warts, acceptable for home use. For several days, this product should be applied to a point on condylomas. If the drug gets on healthy tissue near the growth, a deep chemical burn will form, so you need to apply the medicine very carefully. After daily applications, take a short break of several days. If the shoot does not fall out, then the course is repeated. Pharmaceutical products that cause exgrowth necrosis include solutions and ointments.
• Antiviral agents.They can be used locally or systemically.
• Immunomodulatorsimprove 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 does not develop after treatment, so re-infection from a previous sexual partner is possible.

Potential conflicts

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

• Associated bacterial infection with damaged condylomatous papillomas, which leads to purulent formations, balanoposthitis and ulceration in the perianal area.
• When a growth develops in the urethra, viral-bacterial urethritis can develop, causing urinary problems, urinary retention and urinary tract infection.
• 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 intercourse. All this often leads to depression and psychological problems.
• Women may develop cervical erosion and dysplasia.
• The biggest danger is the risk of benign tumors degenerating into cancer (penis or cervix cancer).

Preventive measures

Prevention of condylomatosis divided into specific and general.

Specific preventive measures include vaccination with a new quadrivalent vaccine. These vaccines do not work against all types of human papillomavirus, but they have been successful in combating the most dangerous ones, which cause cervical cancer. The vaccination is carried out from the age of 11 and is repeated three times.

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

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

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