Anogenital warts or genital warts

The appearance of cone-shaped 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 general physical and moral well-being of the person.

These wart formations cause discomfort, interfere with normal sexual life, and can also cause more serious health problems. If the integrity of the condylomas is disrupted, 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.

Causes of appearance

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

Human papillomavirus B97 according to the international classification of diseases ICD-10. It is coded as 7. A63 for anogenital warts of a venereal nature. Code 0 is assigned.

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, location of manifestation and severity of complications.

Strains are divided into two main types:

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

In addition, papillomavirus types differ depending on the risk of oncogenic, moderately oncogenic and non-oncogenic degeneration in an oncogenic process.

Often, several different types are present in the body of an infected person at the same time.

Infection routes and risk factors

There are several ways for the pathogen to enter the body:

• "Vertical" transmission. It is the name given to the transmission of an infectious agent from mother to child during pregnancy. It is currently unknown whether the infection occurs during the prenatal period or directly during birth, but a cesarean section is undesirable for a mother with papillomavirus. Caesarean section is chosen only in case of bleeding papillomas inside the birth canal.
• Sexual way.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 reduces the possibility of transmission.
• Home road.This disease transmission mechanism is extremely rare. Infection can occur through contact with the patient's personal belongings. Since the virus is found in saliva and urine, it is possible to become infected by using someone else's dishes, shared towels, personal hygiene items, from the toilet or in the Turkish bath.

The method of infection is determined mainly by the age of the person: in infants, it can be established with a high degree of confidence that the infection comes from the mother, and for 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 form and is present in a transport form.

The peak of the disease occurs at young ages, between 17 and 25 years old. This is due to maximum sexual activity and high sensitivity of the epithelium in the organs of the genitourinary 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 disease;
• endometriosis;
• treatment with cytostatic or glucocorticosteroid drugs;
• excess weight;
• disruption of the thyroid gland and impaired insulin production;
• hypovitaminosis.

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

Once in the body, 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 which condylomas appear.

Development paths

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

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

• Secret period. At this stage, the carrier is unaware of the presence of an infectious pathogen because there are no clinical symptoms. However, at this stage the person is already contagious and can infect his 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 sufficiently in the body or the protective mechanisms of the immune system decrease. During this period, the first symptoms appear.
• Active development with increasing symptoms.

The further course of events is developing in one of the directions:

• self-healing with complete disappearance of papilloma warts (most often observed after the end of pregnancy);
• slow course and failure of skin growths to grow;
• active dynamics of papillomas, their shape, size, number and association of closely located groups;
• degeneration of benign growths into malignant ones.

Types of condyloma

There are several traditional types of condyloma papillomas:

• exophytic- protruding above the surface of the skin or mucosa, preferably with outward growth;
• endophytic- with a predominant growth deep into the skin structures, so it is barely noticeable during visual inspection;
• Buschke-Levenshtein training- characterized by rapid growth rates, large sizes and frequent relapses after a course of treatment. With this form, damage occurs to both the external growth and the deep internal tissue layers.

Genital warts may be thin or broad-based. If the stem is thin, the tip may be sharp or stick-like. Broad-based papillomas are extremely 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 may appear singly or in groups that resemble nodules. Sometimes such multiple groups reach a size of 1. 5 cm. When several groups merge, formations resembling cauliflower bunches or a rooster's comb appear. These growths make it easier to detect the disease after examination.

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

Large growths are more problematic: They can become wet, bleed, and worsen due to a secondary infection taking root in the affected areas.

symptoms

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

The formation of condylomata occurs as follows:

• a slight rash appears on the skin, which begins to itch;
• rashes in the form of blisters or small bumps appear on the skin or mucous surface;
• the length of the tubercles gradually increases to 1-1. 5 centimeters;
• New rashes appear nearby, which soon 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;
• on the epithelium of the mouth (on the buccal surfaces, tongue and inner lips).

The clinical picture may differ in each case depending on the person's health status. Small warts may not show any other symptoms.

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

• itching or burning at the rash site;
• sensation of a foreign body in the perineal area;
• moisture in the area of neoplasms;
• An unpleasant odor from the area where condylomas are located.

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

In severe cases, fatigue, weakness, symptoms of poisoning, prolonged headache, fever and high fever are observed.

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

Symptoms in men

In men, condylomas most often affect the scrotum, groin, pubis and various structural parts of the penis: head, trunk, frenulum and foreskin, coronary groove. Papillomas acquire a distinctive red color when localized near the urethra, and this location often causes the discharge to split or splash during urination.

If the rash is located at the anal outlet, severe pain may occur during bowel movements and blood may be present in the stool. Therefore, a reflexive fear of defecation often occurs, which causes periodic constipation and sometimes hemorrhoids.

There is often a vague pain in the lower abdomen; There is also a burning sensation and pain during sex, as well as during urination.

The long-term presence of the infection reduces a person's immunity, making him more vulnerable to respiratory diseases that are harder to treat than usual.

Symptoms in women

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

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

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

In some cases, all growths are located on the mucosa of the internal genital organs of the woman, so she does not notice them until a planned visit to the gynecologist. This is why treatment is often started later than men.

Often women feel embarrassed by the presence of formations in intimate places, which forces them to refuse sex.

Papillomas rarely occur in the mouth and, in very rare cases, on the pubis, thighs, neck or face.

Features of condylomatosis during pregnancy

If condylomatosis has been treated, pregnancy should not be planned earlier than a few months. If the woman takes antiviral medications during treatment, the period of abstinence from pregnancy is extended. After successful treatment and a well-maintained interval, you can safely become pregnant.

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

The reasons for the appearance of condylomatous warts in pregnant women include a standard decrease in immunity, increased stress on the body and significant hormonal fluctuations.

If the papillomas are located on the outer parts of the genital organs or in the perianal area and do not cause discomfort, the treatment problem can be postponed until the child is born. However, in case of rapid growth, increase in size and severe pain in the growths, you should immediately consult a doctor. Sometimes, as the formations progress at a high rate, their loosening is observed, which can lead to vaginal tearing.

This disease usually does not affect the formation of the fetus, but its effect extends to the condition of the mother and the birth process. There is often a risk of prematurity if other infections are present.

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 and the tissue is then sent for histology to confirm that it is benign.

It is unacceptable to use traditional medicine methods to get rid of condylomas during pregnancy, as this not only does not give a positive result, but can also lead to the degeneration of benign cells into malignant cells.

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

Diagnosis

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

The specialist first conducts a survey to clarify the following points:

• time when the first symptoms were detected by the patient;
• possible causes of infection;
• Dynamics and development of the disease until consulting a doctor.

After this, a clinical examination is carried out, in which the specialist determines the location, density, size and condition of the growths. For women, an additional colposcopy (examination of individual genital organs with magnification) or extended colposcopy (a similar procedure using a solution of acetic acid) is performed.

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

• PCR diagnosisallows you to detect and quantify the pathogen in scrapings taken from the epithelium of affected areas (also allows you to determine the type of virus);
• anoscopy- visual examination of the area near the anus with magnification;
• cytology and histologyformation fragments to identify atypical cells or tissues;
• growth biopsyfrom epithelial tissues for microscopic examination of tissue structure;
• antibody titer detectionto this virus;
• stainingFrom the cervical canal and cervix for microscopic oncocytology.

Consultations with a dermatologist or proctologist are planned if necessary. If the diagnosis is made to a pregnant woman, it is necessary to consult an obstetrician-gynecologist.

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

Treatment

Most often, with condylomatosis, people avoid going to medical institutions and choose treatment themselves, preferring local remedies that can eliminate visible symptoms, 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, an integrated approach is required for final treatment, which can only be determined by a specialist.

Treatment is carried out in the following areas:

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

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

radical methods

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

To remove it, the following methods are used:

• surgical excisionformations using a scalpel under local or general anesthesia. The cut area is stitched with surgical thread. Although this method is considered classical, surgical intervention is used less and less lately, as it often causes postoperative bleeding and long-term rehabilitation in the hospital.
• 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 and fall off. After a few weeks, there will be no wound or scar in the treatment area.
• Laser removal.Despite safety and high efficiency, the method requires anesthesia and is characterized by high cost, so it is prescribed in cases where other methods cannot be used. When exposed to laser beam, the structure of the growth 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 economical but very painful, so it requires local anesthesia. Genital growths are exposed to high temperatures, which cauterize papillomas. The crusts fall off on their own after a few days, leaving scars behind.
• Radiosurgery.It is currently the most technologically advanced, fast and effective method, which determines its high cost. Using high-frequency radio waves, genital warts are painlessly eliminated within 15-30 minutes. After removal in this way, there is no bleeding, healing occurs within a day, and there is no scar left on the skin afterwards.
• Destruction with chemicals.This technique is only suitable for small formations without multiple fusions. Special powerful substances are used that lead to the death of growth 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, recurrence of condylomata will occur in all three cases.

Medication

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

• Pharmacy productsacceptable for home use for wart necrosis. This product should be applied pointwise to the condyles for a few days. If the medication gets into healthy tissue near the growth, a deep chemical burn will occur, so you need to apply the medication very carefully. Take a short break for a few days after daily applications. If the shot does not fall, the course is repeated. Pharmaceutical products that cause necrosis of external growths include solutions and ointments.
• Antiviral agents. They may be for local or systemic use.
• immunomodulatorsto improve immunity.

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

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

Possible complications

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

• The addition of a bacterial infection to damaged condylomatous papillomas, which leads to purulent formations in the perianal area, balanoposthitis and ulceration.
• When growths grow in the urethra, viral-bacterial urethritis can develop, which can lead to urination problems, urine retention, and urinary tract infection.
• Hemorrhoidal bleeding and paraproctitis occur when large formations are localized in the anus.
• Genital warts can affect a person's sexual life and cause them to refuse sexual intercourse. All this often leads to depression and psychological problems.
• Cervical erosion and dysplasia may develop in women.
• The biggest danger is the risk of benign tumors turning 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 human papillomavirus, but they do successfully combat the most dangerous of them, the virus that causes cervical cancer. Vaccination is done starting from the age of 11 and is repeated three times.

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

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

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