Anogenital warts or genital warts

The appearance of flesh-colored, cone-shaped lumps in the genital area does cause concern, this is natural, because the health of the genital area is an important point for a person's overall physical and moral well-being.

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

Reasons for appearance

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

According to the international classification of diseases ICD-10, human papillomavirus is assigned the code B97. 7. Anogenital warts of a genital nature are given the code A63. 0.

There are many different types of viruses, 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.

Strains are divided into two main types:

• skin, 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 papilloma viruses differ depending on the risk of degeneration of the oncogenic process into oncogenic, moderately oncogenic and non-oncogenic.

Often, several different strains are present in an infected person's body at the same time.

Routes of infection and risk factors

There are several ways pathogens enter the body:

• "Vertical" transmission.. This is the name given to the transfer of infectious agents 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 caesarean section on a mother suffering from the papilloma virus. Caesarean section is chosen only if papilloma bleeding occurs in the birth canal.
• Sexual path.Infectious agents can enter the body during vaginal, oral or anal sex. This pathogen is also transmitted through saliva during kissing. Using a condom during sexual intercourse does not guarantee protection against the virus, but it reduces the possibility of transmitting it.
• Household way.The mechanism of transmission of this disease is quite rare. Transmission can occur through contact with the sufferer's personal items. Because this virus is contained in saliva and urine, we can be infected by using other people's plates, shared towels, personal hygiene tools, from the edge of the toilet, or when showering.

The mode of transmission is mainly determined by the person's age: in babies, with a high degree of certainty, it can be confirmed that the infection came from the mother, and in older children, through contact and household contacts. From the age of 17, sexual transmission occurs 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 this virus does not manifest itself in any way and is present in a congenital form.

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

Predisposing factors that increase the likelihood of this disease are:

• early sexual activity;
• frequent change of sexual partners;
• age up to 25 years;
• sexual contact with a person who previously had human papillomavirus or other sexually transmitted diseases;
• pregnancy;
• intravaginal flora imbalance;
• any chronic disease;
• endometriosis;
• therapy with cytostatic drugs or glucocorticosteroids;
• overweight;
• disorders of the thyroid gland and impaired insulin production;
• hypovitaminosis.

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

Once inside, 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, leading to the appearance of warts.

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. At this stage, the carrier is unaware of the presence of the infectious pathogen, as there are no clinical manifestations. However, at this stage a person is already infected and can infect their partner through sexual intercourse. 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 protective mechanisms of the immune system decrease. During this period, the first symptoms appear.
• Active progression with increasing symptoms.

Further events develop in one of the directions:

• self-healing with complete disappearance of papilloma warts (most often observed after the end of pregnancy);
• sluggish course and lack of growth 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 types of conventional papilloma condyloma:

• exophytic- protrudes above the surface of the skin or mucous membrane with predominant growth outward;
• endophyte- with predominant growth deep into the skin structure, so that it is slightly visible during visual inspection;
• Buschke-Levenshtein Education- characterized by rapid growth rate, large size and frequent recurrence after treatment. With this form, there is external growth and damage to the internal tissue layers.

Genital warts can have a thin or wide base shape. If the stem is thin, the tip may be sharp or club-shaped. Wide-based papillomas are quite rare. The color of all such results is close to skin color: from flesh to pink. The surface can be soft or covered with a layer of keratin.

Warts can appear singly or in groups resembling nodules. Sometimes some of these groups reach a size of 1. 5 cm. When several groups merge, formations appear that resemble cauliflower flowers or cock's combs. 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 a little.

Large formations are more problematic: they can get wet, bleed, and worsen due to secondary infections taking root in the affected area.

Symptom

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

The occurrence of condyloma occurs as follows:

• 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;
• tubercles gradually increase in length to 1-1. 5 centimeters;
• A new rash appeared nearby, which also turned into condyloma papules.

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

• external genitalia;
• anal area (anogenital papilloma);
• in the urethra;
• in the cervix;
• on the epithelium in the mouth (on the buccal surface, tongue and inside of the lips).

The clinical picture may differ in each case depending on the person's health status. For small warts, there are no other visible symptoms.

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

• itching or burning at the site of the rash;
• foreign body sensation in the perineal area;
• dampness in the neoplasm area;
• unpleasant odor from the area where the condyloma is located.

With physical activity, long walks or running, all the above symptoms worsen.

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

In men and women, the symptoms have some differences. This is due to differences in anatomy 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, frenulum and foreskin, coronary groove. When localized near the urethra, the papilloma acquires a clear red color, and this location often causes bifurcation or splashing of the stream during urination.

If the rash is located at the outlet of the anus, severe pain may occur during defecation, 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.

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

Prolonged infections will lower a man's immunity, making him more susceptible to respiratory illnesses, which are more difficult to treat than usual.

Manifestations in women

The most common place of occurrence of papillomas in women is the perianal zone, where humidity and temperature are constantly elevated: the clitoral epithelium, labia, vaginal outlet and urethral opening. If the infection occurs during anal sex, the growth rings may be concentrated around the anus.

Large growths often become secondary infections, causing a pungent odor, bleeding, ulcers, and severe pain when touched. When walking, severe irritation and discomfort is observed.

In 50% of women, vaginal discharge forms in the cervix, which is detected during routine colposcopy, before treatment with acidic disinfectants that can increase the white color of the condyloma.

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 a reason to start treatment later than men.

Often women experience embarrassment due to formations in intimate places, which forces them to refuse sex.

Rarely, papillomas occur in the mouth, and in very rare cases - on the genitals, thighs, neck or face.

Characteristics of condylomatosis during pregnancy

If condylomatosis has been treated, pregnancy should be planned within a few months at the earliest. The period of gestational abstinence is extended if the woman takes antiviral drugs during therapy. After successful treatment and maintained intervals, you can get pregnant safely.

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

The reasons why condylomatous warts appear in pregnant women include a standard decrease in immunity with an increased load on the body and significant hormonal fluctuations.

If the papilloma is located on the outside of the genitals or in the perianal area and does not cause discomfort, then the question of treatment can be postponed until the child is born. However, if the growth is rapid, increases in size and there is severe pain during the growth, you should immediately consult a doctor. Sometimes, with a high degree of development of the formation, loosening occurs, which can lead to vaginal rupture.

This disease usually does not affect the formation of the fetus, but its influence extends to the mother's condition and the birth process. If other infections are present, there is often a risk of premature birth.

If the condyloma is damaged as the fetus passes through the birth canal, this often results in 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 caesarean section.

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

The use of traditional medicine methods to remove warts during pregnancy is unacceptable, as this not only does not give positive results, but can also lead to the degeneration of benign cells into malignant ones.

Formations that do not cause discomfort during pregnancy often disappear on their own without treatment within a few months after giving birth as the woman's hormonal balance normalizes.

Diagnostic

If the patient notices symptoms reminiscent of human papillomavirus, then he needs to contact a gynecologist, urologist or venereal disease specialist.

First of all, specialists conduct a survey to clarify the following points:

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

After that, a clinical examination is carried out, during which the specialist determines the location, intensity, size and conditions of growth. For women, additional colposcopy (examination of individual genital organs 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 you to detect the pathogen in scrapings of the epithelium of the affected area and determine its quantity (also allows you to determine the type of virus);
• anoscopy- visual inspection of the area near the anus with enlargement;
• cytology and histologyformation fragments to identify atypical cells or tissues;
• growth biopsyfrom epithelial tissue to microscopic study of tissue structure;
• antibody titer detectionagainst this virus;
• smearof 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, it is necessary to contact an obstetrician-gynecologist.

After receiving all the necessary data, the specialist can choose individual tactics for therapy and completely eliminate the disease.

Treatment

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

Treatment is carried out in the following areas:

• removal of growths;
• fight viruses;
• strengthening the patient's immunity.

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

Radical method

Such methods are chosen if there is an urgent need to eliminate external manifestations or when warts are localized on the cervix in women.

The following methods are used to delete:

• Surgical excisionformation using a scalpel under local or general anesthesia. The cut site is sutured with surgical thread. Although this method is considered classic, it often leads to postoperative bleeding and long-term hospital rehabilitation, so surgical removal is used less and less nowadays.
• Cryodestruction with liquid nitrogen.This method is relatively cheap and safe, and does not require anesthesia or anesthesia. After freezing, the protein formation is destroyed, the nodules dry out and fall off. After a few weeks, no scars or scars remain at the treatment site.
• Laser removal.Although safe and efficient, this method requires anesthesia and is expensive, so it is prescribed when other methods cannot be used. When exposed to a laser beam, the structure of the growth stalk is destroyed. After cauterization, the condyloma loses nutrients, which within a few days causes necrosis and the scab disappears. Scars often remain after laser removal.
• Electrocoagulation.The method is affordable, but very painful and requires local anesthesia. The genital growth is exposed to high temperatures, during which the papilloma is burned. The scab will fall off on its own after a few days, leaving a scar.
• Radiosurgery.Currently, this is the most high-tech, fast and effective 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, after that there are no traces left on the skin.
• Destruction with chemicals.This technique is only suitable for small formations, without much fusion. Special potent substances are used, which cause the death of growth cells. These products are based on high concentrations of acids or bases that cause local chemical burns.

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

Drug therapy

An integrated approach involves removing benign formations, eliminating viruses in the body and improving the immune status. Therefore, drug treatment includes the use of such drugs:

• Pharmaceutical productsfor wart necrosis, acceptable for home use. For several days, this product should be applied precisely on the condyloma. If the drug gets on healthy tissue near the growth, a deep chemical burn will form, so you need to apply the drug very carefully. After daily use, take a short break for a few days. If the shoots do not fall, then the course is repeated. Pharmaceutical products that cause growth necrosis include solutions and ointments.
• Antiviral agent.They can be for local or systemic use.
• Immunomodulatorto increase immunity.

In addition, to increase the body's defenses, 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 previous sexual partners is possible.

Possible complications

If left untreated over a long period of time, condylomatosis causes the following complications:

• Adherence of bacterial infection to the damaged condylomatous papilloma, leading to purulent formation, balanoposthitis and ulceration in the perianal area.
• When growths grow in the urethra, viral-bacterial urethritis can develop, causing urination problems, urinary retention in the body, 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 sexual relations. All this often leads to depression and psychological problems.
• Women may experience cervical erosion and dysplasia.
• The biggest danger is the risk of degeneration of benign tumors into cancer (cancer of the head of the penis or cervix).

Preventive measure

Prevention of condylomatosis is divided into specific and general.

Special preventive measures include vaccination with the new quadrivalent vaccine. This vaccine does not work against all types of human papilloma virus, but it is successful against the most dangerous type of virus, which causes cervical cancer. Vaccination is carried out from the age of 11 years and repeated three times.

Nonspecific prevention is similar to measures common to many sexually transmitted diseases:

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

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