Anogenital warts or genital warts

The appearance of conical flesh-colored growths in the genital area is a completely justified cause for concern, since the health of the genital area is an important point for 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 condyloma 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 completely natural.

Reasons for the appearance

The cause of papillomatous 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 papilloma virus is coded B97. 7. Anogenital warts of a venereal nature are given the code A63. 0.

There are many different strains of this virus, each causing 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 on the dermal layer;
• mucous membranes, which appear on the mucous epithelium of the genitals, oral cavity, etc.

In addition, the types of papillomaviruses differ depending on the risk of degeneration in oncogenic processes into oncogenic, moderately oncogenic and non-oncogenic.

Most often, several different strains are present simultaneously in the body of an infected person.

Routes of infection and risk factors

The pathogen can enter the body in several ways:

• "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 HPV. Caesarean section is chosen only in cases of hemorrhagic papillomas inside the birth canal.
• Sexual journey.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 makes its transmission less likely.
• Domestic way.This mechanism of disease transmission 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 by using someone else's dishes, shared towels, personal hygiene items, on the edge of the toiletor in public baths.

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

According to statistics, the human papilloma virus 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 carriage.

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

Predisposing factors that increase the risk of disease are:

• early onset of sexual activity;
• frequent change of sexual partners;
• age up to 25 years;
• sexual contact with persons who have previously had human papillomavirus or other sexually transmitted diseases;
• pregnancy;
• imbalance of intravaginal flora;
• any chronic illness;
• endometriosis;
• treatment 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 significantly increase the chances that a person, after entering the body, will enter the active phase of infection.

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. Affected cells then begin to actively grow and divide, leading to the appearance of warts.

Means of development

After entering the human body, the virus does not cause any symptoms for some time.

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

• Hidden period. During this stage, the carrier is unaware 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 latency 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 protective mechanisms of the immune system weaken. During this period, the first symptoms appear.
• Active development with increasing symptoms.

The sequence of events develops in one of the following directions:

• self-healing with complete disappearance of papillomatous warts (most often observed after the end of pregnancy);
• slow progress and lack of growth of skin growths;
• active dynamics of papillomas with increase in shape, size, number and fusion of close groups;
• degeneration of benign growths into malignant growths.

Types of condyloma

There are several conventional types of condyloma papillomas:

• exophytic- protruding above the surface of the skin or mucous membranes with preferential growth towards the outside;
• endophyte- with a predominant growth deep in the skin structures, therefore not very noticeable during visual inspection;
• Education in Buschke-Levenshtein- characterized by rapid growth rates, large sizes and frequent relapses after treatment. With this form, external growth and damage to the deep inner layers of tissues occurs.

Genital warts can have a thin or broad base. If the stem is thin, the tip may be pointed or club-shaped. Broad-based papillomas are quite rare. The color of all these growths is close to the color of the skin: from flesh to pink. The surface may be soft or covered with a layer of keratin.

Warts can appear alone or in groups resembling nodules. Sometimes these multiple groups reach sizes of 1. 5 cm. When several groups merge, formations appear that resemble cauliflower inflorescences or a cock's comb. These growths make it easier to identify the disease during examination.

Single growths generally don't cause as much discomfort as large items. In rare cases, they break and bleed slightly.

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

Symptoms

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

The occurrence of condyloma occurs as follows:

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

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

• external genitalia;
• anal region (anogenital papillomas);
• inside the urethra;
• on the cervix;
• on 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, 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 body in the perineal region;
• moisture in the area of neoplasms;
• unpleasant smell coming from the area where the warts are located.

With physical activity, a long walk or run, 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, 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, coronal sulcus. When localized near the urethra, papillomas acquire a pronounced red color, and this location often causes bifurcation or splashing of the jet during urination.

If the rash is located at the exit from the anus, severe pain may occur during bowel movements and blood may be present in the stool. Due to 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 sexual intercourse there is a burning sensation and pain, as well as when urinating.

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

Protests among women

The most common places where papillomas appear in women are the perianal areas, where humidity and temperature are constantly increased: the epithelium of the clitoris, the labia, the vaginal outlet and the 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 are formed on the cervix, which are detected during routine colposcopy, before which they are treated with an acidic disinfectant that can enhance the white color of 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 the reason why treatment starts later than in men.

Women are often embarrassed due to 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 be planned no earlier than in a few months. The period of pregnancy abstinence is extended if the woman takes antiviral drugs during treatment. 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 the baby's organs are already formed. Treatment after 28 weeks does not cause abnormalities in fetal development.

The reasons why condylomatous warts appear in pregnant women include a standard decrease in immunity accompanied by increased stress on the body and significant hormonal fluctuations.

If the papillomas are located on the external parts of the genitals or in the perianal region and do not cause discomfort, then the question 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 area of 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.

As a rule, this disease does not affect the formation of the fetus, but its effect extends to the mother's condition and the process of childbirth. If other infections are present, there is often a risk of prematurity.

When condylomas are damaged as the fetus passes through the birth canal, it often leads to infection of the baby and laryngeal condylomatosis during the neonatal or thoracic period. Therefore, the presence of large papillomas in the birth canal is a direct indication for a cesarean section.

If necessary, the growth is removed during pregnancy, after which the tissue is sent for histology to check for benignity.

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

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

Diagnostic

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

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

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

After that, a clinical examination is carried out, during which the specialist determines the localization, intensity, size and condition of the growths. For women, 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 diagnosis, allows you to detect the pathogen in scrapings from the epithelium of the affected areas and determine its quantity (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 growthsfrom epithelial tissues for the microscopic study of tissue structure;
• antibody titer detectionto this virus;
• defameof 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 select individual tactics of treatment and complete relief from the disease.

Treatment

Often, with condylomatosis, people avoid visiting medical institutions and choose treatment themselves, giving preference to local drugs that can eliminate visible manifestations, but do not cure the body of the infection, transferring it to alatent stage. Such treatment almost always leads to relapse. Therefore, for a final cure, an integrated approach is necessary, which can only be determined by a specialist.

Processing is carried out in the following areas:

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

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

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 excisiontraining 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, which is why surgical removal has been used less and less recently.
• Cryodestruction with liquid nitrogen.This method is relatively inexpensive and safe and does not require anesthesia or anesthesia. After freezing, the proteins in the formations are destroyed, the nodules dry out and fall off. After a few weeks, no scars or scars remain at the treatment site.
• Laser removal.Despite its safety and high effectiveness, the method requires anesthesia and is characterized by high cost. It is therefore prescribed if other methods cannot be used. When exposed to a laser beam, the structure of the growing stem is destroyed. After cauterization, the condyloma is deprived of nutrition, which leads to its necrosis within a few days and the crust disappears. Scars often remain after laser removal.
• Electrocoagulation.The method is affordable, but it is very painful and therefore requires local anesthesia. Genital growths are exposed to high temperatures, during which the papillomas are cauterized. The scabs fall off on their own after a few days, leaving scars.
• Radiosurgery.Currently, this is the most technological, fastest and most 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, after which no marks remain on the skin.
• Destruction by chemicals.This technique is only suitable for small formations, without multiple fusions. Special powerful substances are used, which lead to the death of growth cells. These products are based on high concentration acids or alkalis which cause local chemical burns.

If we limit ourselves only to radical methods of combating condylomatosis, recurrence of condylomas occurs in one out of three cases.

Drug therapy

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

• Pharmacy productsfor wart necrosis, acceptable for home use. For several days, this product must be applied occasionally to the condyloma. 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 shoot does not fall, the course is repeated. Pharmaceuticals that cause necrosis of growths include solutions and ointments.
• Antiviral agents.They can be for local or systemic use.
• Immunomodulatorsto improve immunity.

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

Immunity against 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 leads to 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 develop in the urethra, viral-bacterial urethritis can develop, leading to problems with urination, 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 can affect a person's sex life, causing them to refuse sex. All this often leads to depression and psychological problems.
• Women may develop cervical erosion and dysplasia.
• The greatest danger is the risk of benign tumors degenerating 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 fight the most dangerous of them, those that cause cervical cancer. 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:

• 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;
• stop drinking alcohol and smoking.

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