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 for the general 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 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 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, the human papillomavirus is coded as B97. 7. Anogenital warts of a venereal nature are assigned the code A63. 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.

The strains are divided into two main types:

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

In addition, the types of papillomaviruses are differentiated according to the risk of degeneration in an oncogenic process into oncogenic, moderately oncogenic and non-oncogenic.

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

Infection routes and risk factors.

There are several ways the pathogen enters 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 the infection occurs in the prenatal period or directly during childbirth, but it is not desirable to perform a cesarean section on a mother with papillomavirus. Caesarean section is chosen only in the case of bleeding papillomas within the birth canal.
• 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 sexual relations does not guarantee protection against the virus, but it does make its transmission less likely.
• Domestic way.This disease transmission mechanism 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 become infected by using someone else's dishes, shared towels, personal hygiene items, on the edge of the toilet, or in a bathhouse.

The form of infection is determined mainly by the age of the person: in infants, with a high degree of certainty, it can be established that the infection came from the mother, and in older children - through contact and household contact. 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 does not manifest itself in any way and is present in the form of a carrier.

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

The predisposing factors that increase the probability of suffering from 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 human papillomavirus or other sexually transmitted diseases;
• the pregnancy;
• intravaginal flora imbalance;
• any chronic illness;
• endometriosis;
• therapy with cytostatic drugs or glucocorticosteroids;
• overweight;
• alteration of the thyroid gland and alteration of insulin production;
• hypovitaminosis.

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

After its 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. The affected cells then begin to grow and divide actively, which is why condylomas appear.

Forms 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 their 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 enough in the body or when the immune system's protective mechanisms decrease. During this period the first symptoms appear.
• Active development with increasing symptoms.

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

• self-healing with complete disappearance of papilloma warts (most often observed after the end of pregnancy);
• slow 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 growths into malignant ones.

Types of condylomas

There are several conventional types of condyloma papillomas:

• exophytic- protruding from the surface of the skin or mucous membranes with preferential growth outwards;
• endophytic- with a predominant growth in the skin structures, which is why it is barely noticeable during visual inspection;
• Buschke-Levenshtein Education- characterized by rapid growth rates, large sizes, and frequent relapses after 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 shape. If the stem is thin, the tip may be sharp or club-like. Papillomas with a wide base are quite rare. The color of all these 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 may appear singly or in groups that resemble nodules. Sometimes these multiple groups reach sizes of 1. 5 cm, and when several groups merge, formations appear that resemble cauliflower inflorescences or a rooster's comb. These growths make it easier to identify the disease during the exam.

Single growths usually do not cause as much discomfort as large items. In rare cases, they tear and bleed slightly.

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

Symptoms

The first symptoms appear once the latency period has ended, which lasts at least several weeks.

The appearance of condylomas occurs in the following way:

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

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

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

The clinical picture may differ in each specific case depending on the person's health status. For small warts, other symptoms may not be seen.

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;
• humidity in the area of neoplasms;
• unpleasant odor from the area where the condylomas are located.

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

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

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

Manifestations in men.

Condylomas in men most often affect the scrotum, groin, pubis and various structural parts of the penis: head, body, frenulum and foreskin, coronary sulcus. When located near the urethra, papillomas acquire a pronounced red color, and this location often causes bifurcation or splashing of the stream when urinating.

If the rash is located at the exit of the anus, there may be severe pain when defecating and there may be blood in the stool. Because of this, a reflex fear of defecation often appears, which causes periodic constipation and sometimes hemorrhoids.

Often there is a vague pain in the lower abdomen, during sexual intercourse there is a burning and painful sensation, as well as when urinating.

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

Manifestations in women.

The most common places where papillomas appear in women are the perianal areas, where humidity and temperature constantly increase: the epithelium of the clitoris, labia, vaginal outlet and urethral opening. If an infection occurs during anal sex, a ring of growths may concentrate around the anus.

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

In 50% of women, whitish elements form on the cervix, which are detected during a routine colposcopy, before which they are treated with an acidic disinfectant that can enhance the white color of condylomas.

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

Often women feel embarrassed due to the presence of formations in intimate places, which forces them to abandon sexual relations.

In rare cases, papillomas appear in the mouth and, in extremely rare cases, on the pubic bone, thighs, neck or face.

Features of condylomatosis during pregnancy.

If condylomatosis has been treated, pregnancy should not be planned before a few months. The pregnancy withdrawal period is prolonged if the woman takes antiviral medications during treatment. After successful treatment and a maintained interval, she 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 already formed. Treatment after 28 weeks does not cause abnormalities in the development of 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 papillomas are located on the external parts of the genital organs or in the perianal zone and do 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 growths, you should immediately consult a doctor. Sometimes, with a high rate of progression of formations, their loosening 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 state of the mother and the birth process. If other infections are present, there is often a risk of prematurity.

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 verify its benign nature.

The use of traditional medicine methods to get rid of condylomas during pregnancy is unacceptable, since this not only may not have a positive result, but also may lead to the degeneration of benign cells into malignant ones.

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

Diagnosis

If a patient notices symptoms reminiscent of human papillomavirus, she should consult a gynecologist, urologist or venereologist.

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

• moment of detection of the first symptoms by the patient;
• probable causes of infection;
• dynamics and development of the disease until you consult a doctor.

Subsequently, a clinical examination is performed, during which the specialist determines the location, intensity, size and condition of the excrescences. For women, an additional colposcopy (examination of individual genital organs with magnification) or an extended colposcopy (a similar procedure using an acetic acid solution) is performed.

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

• PCR diagnosis, allows you to detect the pathogen in scrapings from the epithelium of the affected areas and determine its quantity (it also allows you to 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;
• biopsy of growthsof epithelial tissues for the microscopic study of the structure of the tissues;
• detection of antibody titersto this virus;
• smearof the cervical canal and cervix for microscopic oncocytology.

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

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

Treatment

Often, with condylomatosis, people avoid going to medical institutions and choose therapy themselves, giving preference to local medications that can eliminate visible manifestations, but do not cure the body of the infection, transferring it to a latent stage. This type of treatment almost always leads to relapse. Therefore, a definitive cure requires an integrated approach, which can only be determined by a specialist.

Treatment is carried out in the following areas:

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

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

Radical methods

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

The following methods are used for removal:

• 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 causes postoperative bleeding and long-term rehabilitation in the hospital, so surgical removal is used less and less lately.
• Cryodestruction with liquid nitrogen.This method is relatively inexpensive and safe, and does not require anesthesia or anesthesia. After freezing, the protein of the formations is destroyed, the nodules dry out 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 cost, therefore it is prescribed if other methods cannot be used. When exposed to a laser beam, the growth stem structure is destroyed. After cauterization, the condyloma is deprived of nutrition, which after a few days causes its necrosis and the scab disappears. Scars often remain after laser removal.
• Electrocoagulation.The method is affordable, but very painful, requiring local anesthesia. Genital outgrowths are exposed to high temperatures, during which papillomas are cauterized. The scabs fall off on their own after a few days, leaving scars.
• Radiosurgery. At the moment, this is the most technological, fastest and most effective method, which determines its high cost. Using high-frequency radio waves, genital warts are painlessly removed in 15 to 30 minutes. After such removal, there is no bleeding, healing occurs within a day and there are no marks left on the skin afterwards.
• Destruction by chemicals.This technique is only suitable for small formations, without multiple fusions. Special strong substances are used that cause 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 of combating condylomatosis, the recurrence of condylomas occurs in one out of three cases.

drug therapy

An integrated approach involves removing benign formations, removing the virus from the body and improving the immune state. Therefore, drug treatment includes the use of such drugs:

• Pharmacy productsfor wart necrosis, acceptable for home use. For several days, this product should be applied punctually on condylomas. If the medication comes into contact with healthy tissue near the growth, a deep chemical burn will form, so you should apply the medication very carefully. After daily applications, take a short break of several days. If the sprout does not fall off, the course is repeated. Pharmaceutical products that cause necrosis of excrescences include solutions and ointments.
• Antiviral agents.They can be for local or systemic use.
• Immunomodulatorsto improve immunity.

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

Immunity to condylomatosis does not develop after treatment, so reinfection from a previous sexual partner is possible.

Possible complications

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

• The attachment of a bacterial infection to damaged condylomatous papillomas, leading to purulent formations, balanoposthitis and ulcerations in the perianal zone.
• When growths grow in the urethra, viral-bacterial urethritis can develop, leading to problems urinating, urine retention in the body, and urinary tract infection.
• When large formations are located in the anus, hemorrhoidal bleeding and paraproctitis occur.
• Genital warts can affect a person's sex life, causing them to reject sexual relations. All this often leads to depression and psychological problems.
• Women can develop cervical erosion and dysplasia.
• The greatest danger is the risk of degeneration of benign tumors into cancer (cancer of the head of the penis or the cervix).

Precautionary measures

Prevention of condylomatosis is divided into specific and general.

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

Nonspecific prevention is similar to the measures inherent to many sexually transmitted diseases:

• use of barrier contraceptives;
• personal hygiene at the appropriate level;
• regular sexual partner;
• periodic 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, better health, and proper sleeping patterns will help prevent the appearance of genital warts.