Anogenital warts or genital warts

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

These warts cause discomfort, interfere with normal sex life, and can also cause more serious health problems. If the integrity of the condylomas is damaged, an 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 the 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, the human papillomavirus is coded B97. 7. Anogenital warts of a venereal nature are coded 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.

Strains are divided into two main types:

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

In addition, the types of papillomavirus differ depending on the risk of degeneration in an oncogenic process into 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 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 the infection occurs in the prenatal period or directly during childbirth, but it is undesirable to perform a cesarean section on a mother with papillomavirus. Caesarean section is chosen only in case of hemorrhagic papillomas inside 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 intercourse does not guarantee protection against the virus, but it makes its transmission less likely.
• Domestic way.This disease transmission mechanism is quite rare. Infection can occur through contact with the patient's personal items. Since the virus is contained in saliva and urine, it is possible to become infected using someone else's dishes, shared towels, personal hygiene items, on the edge of the toilet or in the shower room.

The method of infection is mainly determined by the age of the person: in babies, 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 transport form.

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

The 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 have had human papillomavirus or other sexually transmitted diseases;
• pregnancy;
• imbalance of intravaginal flora;
• any chronic illness;
• endometriosis;
• therapy with cytostatic drugs or glucocorticosteroids;
• 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 a person's chances of infection entering 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. The affected cells then begin to actively grow and divide, due to the appearance of condylomas.

Forms of development

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

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

• Hidden period. During this phase, the carrier is unaware of the presence of an infectious pathogen, as there are no clinical manifestations. However, at this stage the person is already contagious and can infect their partner through sexual contact. This latent period can last from 2 to 3 months to several years.
• The onset of the disease occurs when the virus multiplies sufficiently 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 papillomatological warts (most often observed after the end of pregnancy);
• slow course and lack of growth of skin growths;
• active dynamics of papillomas with an increase in shape, size, number and fusion of nearby groups;
• degeneration of benign growths into malignant ones.

Types of condylomas

There are several conventional types of condyloma papillomas:

• exophytic- projecting above the surface of the skin or mucous membrane with preferential growth outward;
• endophytic- with predominant growth in the skin structures, therefore little noticeable on visual inspection;
• Buschke-Levenshtein Education- characterized by rapid growth rates, large sizes and frequent relapses after a course of treatment. With this form, outgrowth and damage to the deep inner layers of tissue occur.

Genital warts can have a thin or wide base. If the shaft is thin, the tip may be sharp or club-like. Broad-based papillomas are quite rare. The color of all these growths is close to the color of the skin: from pulp to pink. The surface may be smooth or covered with a layer of keratin.

Warts may appear singly or in nodule-like groups. Sometimes these multiple groups reach sizes of 1. 5 cm. When several groups merge, formations appear that resemble cauliflower inflorescences or cockscomb. These growths make it easier to identify the disease on examination.

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

Large formations are more problematic: they can become waterlogged, bleed and worsen due to a 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 case.

The occurrence of condylomas occurs as follows:

• a slight 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;
• tubers gradually increase to 1-1. 5 centimeters in length;
• New rashes appear nearby, which also turn into condyloma papules.

The location 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 of the mouth (on the buccal surfaces, tongue and inside of the lips).

The clinical picture may differ in each specific case depending on the person's health status. For small warts, no other symptoms may 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 region;
• 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 high temperature are observed.

In men and women, symptoms present 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 groove. When located close to 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, severe pain may occur during bowel movements and there may be blood in the stool. Because of this, a reflexive fear of defecation often appears, which causes periodic constipation, and sometimes hemorrhoids.

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

The prolonged presence of the 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 for papillomas to occur in women are the perianal zones, 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 form around the anus.

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

In some cases, all the growths are localized 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 for starting treatment later compared to men.

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

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

Features of condylomatosis during pregnancy

If condylomatosis has been treated, pregnancy should not be planned for a few months. The abstinence period during pregnancy is prolonged if the woman takes antiviral drugs during therapy. After successful treatment and a maintained interval, you can safely get pregnant.

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

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 papillomas are located on the external parts of the genitals or in the perianal area and do not cause discomfort, the issue of treatment can be postponed until the birth of the child. But in case of rapid growth, increase in size and severe growing pains, 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 mother's condition 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 eliminate condylomas during pregnancy is unacceptable, as in addition to not having a positive result, it can lead to the degeneration of benign cells into malignant ones.

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

Diagnosis

If a patient notices symptoms that resemble human papillomavirus, he needs to contact a gynecologist, urologist or venereologist.

First, the specialist carries out research 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.

Next, a clinical examination is carried out, during which the specialist determines the location, intensity, size and condition of the lumps. For women, an additional colposcopy (examination of individual genital organs with magnification) or 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 affected areas and determine its quantity (it also allows you to determine the strain of the virus);
• anoscopy- visual inspection of the area close to the anus with magnification;
• cytology and histologyfragments of formations to identify atypical cells or tissues;
• biopsy of growthsof epithelial tissues for microscopic study of tissue structure;
• antibody titer detectionto 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, 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 medicines that can remove visible manifestations, but do not cure the body of the infection, transferring it to a latent stage. This treatment almost always leads to relapse. Therefore, for final healing an integrated approach is required, which can only be determined by a specialist.

Treatment is carried out in the following areas:

• removal of growths;
• fight the virus;
• strengthening 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 localized 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 prolonged rehabilitation in the hospital, which is why recently surgical removal has been 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 in the formations is destroyed, the nodules dry out and fall off. After a few weeks, there are no more scars or scars at the treatment site.
• Laser removal.Despite the 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 within a few days leads to its necrosis and the disappearance of the crust. Scars often remain after laser removal.
• Electrocoagulation.The method is affordable, but it is very painful, which is why it requires local anesthesia. Genital protuberances 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, fast and effective method, which determines its high cost. Using high-frequency radio waves, genital warts are removed painlessly in 15 to 30 minutes. After this removal there is no bleeding, healing occurs within a day, after which no marks remain on the skin.
• Destruction by chemicals.This technique is only suitable for small formations, without multiple mergers. Special strong substances are used, which lead to the death of growing cells. These products are based on high concentration acids or alkalis that cause local chemical burns.

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

Drug therapy

An integrated approach involves eliminating benign formations, eliminating the virus from the body and increasing the immune status. Therefore, drug treatment includes the use of the following medications:

• Pharmaceutical productsfor wart necrosis, acceptable for home use. For several days, this product must be applied punctually to the condylomas. If the medicine comes into contact with 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 for several days. If the sprout does not fall off, the course is repeated. Pharmaceutical products that cause lump necrosis include solutions and ointments.
• Antiviral agents.They can be used locally or systemically.
• Immunomodulatorsto improve immunity.

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

Immunity to condylomatosis is not developed 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, which leads to purulent formations, balanoposthitis and ulceration in the perianal region.
• When growths grow in the urethra, viral-bacterial urethritis can occur, causing problems with urination, retention of urine 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 refuse sexual intercourse. 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 cervix).

Preventive 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 the human papillomavirus, but they successfully combat the most dangerous of them, which cause cervical cancer. Vaccination is carried out from the age of 11 and repeated three times.

Nonspecific prevention is similar to measures inherent in 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;
• give up alcohol and smoking.

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