Anogenital warts or genital warts

The appearance of cone-shaped flesh-colored 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 in the general physical and moral well-being of a person.

These warty growths cause discomfort, interfere with normal sex life and can also cause more serious health problems. If the integrity of condylomas is damaged, infection and transition to a malignant formation may occur. Therefore, the desire to get rid of such phenomena is understandable and completely natural.

Reasons for appearing

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, causing them to change their development cycle, shape and structure.

According to the international classification of diseases ICD-10, the human papillomavirus is classified as B97. 7 coded. Anogenital warts of venereal nature are given 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 the severity of complications.

Tribes are divided into two main types:

• cutaneous, appearing predominantly on the dermal layer;
• Mucous membranes that appear on the mucous epithelium of the genital organs, oral cavity, etc.

In addition, depending on the risk of degeneration into an oncogenic process, the types of papilloma viruses differ 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

The pathogen can enter the body in several ways:

• "Vertical" transmission. This term refers to the transmission 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 birth. However, it is undesirable to perform a cesarean section in a mother with papilloma viruses. Caesarean section is chosen only for bleeding papillomas in the birth canal.
• Sexual route.The infectious agent can enter the body during vaginal, oral or anal sex. The pathogen is also transmitted via saliva when kissing. Using a condom during sexual intercourse does not provide protection against the virus, but it does reduce the chance of transmission.
• Household way.This mechanism of disease transmission is quite rare. Infection can occur through contact with the patient's personal belongings. Since the virus is contained in saliva and urine, infection is possible through the use of someone else's dishes, shared towels, personal hygiene items, from the edge of the toilet or in a bathhouse.

The route of infection is determined primarily by the age of the person: in infants it can be determined with a high degree of certainty that the infection came from the mother, in older children through contact and household contact. In most cases, sexual transmission occurs from the age of 17 onwards.

According to statistics, the human papillomavirus is found 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 in the form of carriers.

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

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 previously had human papillomavirus or other sexually transmitted diseases;
• Pregnancy;
• imbalance of intravaginal flora;
• any chronic illness;
• endometriosis;
• Therapy with cytostatics or glucocorticosteroids;
• obesity;
• Thyroid disorder and insulin production disorder;
• Hypovitaminosis.

Frequent stress and non-observance of the principles of personal hygiene significantly increase the likelihood that the infection will enter the active phase after entering the body.

After introduction, the virus spreads throughout the body via 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, forming condylomas.

Development paths

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 an infectious pathogen in the absence of clinical manifestations. However, at this stage a person is already contagious and can infect their partner through sexual contact. This latency period can last between 2-3 months and several years.
• The outbreak of the disease occurs when the virus multiplies sufficiently in the body or when the immune system's protective mechanisms weaken. This is when the first symptoms appear.
• Active development with increasing symptoms.

The further course develops 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 growths;
• active dynamics of papillomas with an increase in shape, size, number and fusion of closely spaced groups;
• Degeneration of benign growths into malignant ones.

Types of condylomas

There are several common types of condyloma papillomas:

• exophytic- protrude above the surface of the skin or mucous membrane and prefer to grow outwards;
• endophytic- with predominant growth deep into the skin structures, therefore hardly noticeable on visual examination;
• Buschke-Levenshtein training- characterized by rapid growth rates, large sizes and frequent relapses after treatment. This form causes both external growth and damage to the deep internal tissue layers.

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

Warts can appear singly or in nodule-like groups. Sometimes such multiple groups reach 1. 5 cm in size. When several groups merge, formations are formed that resemble cauliflower inflorescences or a cockscomb. These growths make it easier to detect the disease during examination.

Individual growths usually do not cause as much discomfort as large elements. In rare cases they break and bleed easily.

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

Symptoms

The first symptoms appear after the latency period has expired, which in the shortest case lasts several weeks.

The appearance of condylomas occurs as follows:

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

Localization depends on the specific strain and the place where the pathogen enters the body:

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

The clinical picture can vary in each individual case depending on the person's state of health. With small warts, no other symptoms can be observed.

If the course is more severe, the following accompanying symptoms are observed:

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

With physical activity, long walking or running, all of the above symptoms increase.

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

Symptoms have some differences in men and women. This is due to anatomical differences and features of sexual behavior.

Manifestations in men

Condylomas in men most often affect the scrotum, groin, pubic bone and various structural parts of the penis: head, body, frenulum and foreskin, coronary groove. When papillomas are localized near the urethra, they acquire a pronounced red color, and in this place there is often a bifurcation or splashing of the stream during urination.

If the rash is at the exit of the anus, severe pain may occur during bowel movements and there may be blood in the stool. For this reason, a reflexive fear of defecation often occurs, leading to periodic constipation and sometimes hemorrhoids.

There is often vague pain in the lower abdomen, burning and pain during sex, as well as when urinating.

The persistent presence of infection reduces a man's immunity and makes him more susceptible 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 zones, where humidity and temperature are constantly increased: the epithelium of the clitoris, labia, vaginal exit and urethral opening. If an infection occurs during anal sex, a ring of growth may form around the anus.

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

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

In some cases, all the growths are located on the mucous membrane of the woman's internal genital organs, so she notices them only during a scheduled visit to the gynecologist. This is often the reason for starting treatment at a later date compared to men.

Women often feel embarrassment due to the presence of formations in intimate places, which forces them to refuse sex.

Papillomas rarely occur 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 for a few months at the earliest. Abstinence from pregnancy is prolonged if the woman takes antiviral drugs during therapy. After successful treatment and adherence to the interval, you can safely become pregnant.

If the disease is discovered during pregnancy, it is advisable to wait until all of the child's organs have developed before treatment. Treatment after 28 weeks does not cause developmental problems in 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 papillomas are located on the external parts of the genital organs or in the perianal area and do not cause any discomfort, the question of treatment can be postponed until the birth of the child. However, if there is rapid growth, an increase in size and severe pain in the growths, you should immediately consult a doctor. Sometimes with a high progression of formations, their loosening is observed, which can lead to vaginal rupture.

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

When condylomas are damaged during the passage of the fetus through the birth canal, it 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. The tissue is then sent for histology to check whether it is benign.

The use of traditional medical methods to eliminate condyloma during pregnancy is unacceptable, as this not only may not lead to a positive result, but can also lead to the degeneration of benign cells into malignant cells.

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

diagnosis

If a patient notices symptoms reminiscent of the human papillomavirus, he must contact a gynecologist, urologist or venereologist.

First, the specialist conducts 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 up to the visit to the doctor.

A clinical examination is then carried out in which the specialist determines the location, intensity, size and condition of the growths. In women, colposcopy (examination of individual genital organs with magnification) or extended colposcopy (a similar procedure using an acetic acid solution) is also performed.

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

• PCR diagnostics, allows you to detect the pathogen in smears of 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 for identifying atypical cells or tissues;
• Biopsy of growthsfrom epithelial tissue for microscopic examination of tissue structure;
• Detection of antibody titerabout this virus;
• smearfrom the cervical canal and the cervix for microscopic oncocytology.

If necessary, consultations with a dermatologist or proctologist are arranged. 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 therapeutic tactics and complete relief of the disease.

Treatment

With condylomatosis, people often avoid going to medical facilities and choose therapy themselves. They prefer local drugs that can eliminate visible manifestations, but do not cure the body of the infection and transfer it to a latent stage. Such treatment almost always leads to a relapse. Therefore, for a definitive cure, an integrated approach is required, which can only be determined by a specialist.

Treatment takes place in the following areas:

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

All methods of combating genital warts are divided into radical and medical methods.

Radical methods

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

The following methods are used for removal:

• Surgical excisionFormations with a scalpel under local or general anesthesia. The incision site is sutured with surgical thread. Although this method is considered classic, it often leads to postoperative bleeding and long rehabilitation in the hospital, which is why surgical removal has recently been used less and less.
• 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 will no longer be any scars or scars at the treatment site.
• Laser removal.Despite the safety and high efficiency, the method requires anesthesia and is associated with high costs. Therefore, 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 is deprived of nutrition, which leads to its necrosis within a few days and the scab disappears. Scars often remain after laser removal.
• Electrocoagulation.The method is affordable but very painful and therefore requires local anesthesia. The genital outgrowths are exposed to high temperatures, at which the papillomas are cauterized. The scab falls off on its own after a few days and leaves scars.
• Radiosurgery.This is currently the most modern, 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 a removal there is no bleeding, healing occurs within a day, after which no traces remain on the skin.
• Chemical destruction.This technique is only suitable for small formations without multiple fusions. Particularly strong substances are used that cause growth cells to die. These products are based on highly concentrated acids or alkalis that cause local burns.

If we limit ourselves only to radical methods of combating condylomatosis, condylomas will recur in every third case.

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 such drugs:

• Pharmacy productsagainst wart necrosis, suitable for home use. This product should be applied selectively to condylomas for several days. If the drug gets on healthy tissue near the growth, a deep chemical burn occurs. Therefore, you must use the medication very carefully. After daily use, take a short break of several days. If the sprout does not fall off, the process is repeated. Pharmaceutical products that cause necrosis of outgrowths include solutions and ointments.
• Antiviral agents.They can be intended for local or systemic use.
• 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.

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

Possible complications

If condylomatosis remains untreated for a long time, the following complications arise:

• The attachment of a bacterial infection to damaged condylomatous papillomas, leading to purulent formations, balanoposthitis and ulcerations in the perianal area.
• When growths form in the urethra, viral-bacterial urethritis may develop, causing problems with urination, retention of urine 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 and cause them to refuse sexual intercourse. All of this often leads to depression and psychological problems.
• In women, cervical erosion and dysplasia may occur.
• The greatest danger is the risk of benign tumors turning into cancer (penile head or cervical cancer).

Precautions

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, which cause cervical cancer. The vaccination takes place from the age of 11 and is repeated three times.

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

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

In addition, it is necessary to avoid stress, physical fatigue, hypothermia and all factors that weaken the immune system. A healthy diet, improved health, and an appropriate sleep schedule can help prevent the appearance of genital warts.