Anogenital warts or genital warts

The appearance of cone-shaped, flesh-colored growths in the area of the genitals is a cause for concern, which is completely justified, since the health of the genitals is an important aspect of a person's general physical and moral well-being.

These warts cause discomfort, interfere with normal sex life, and can 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 completely natural.

Reasons for 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 changes their development cycle, shape and structure.

According to the ICD-10 international classification of diseases, the human papillomavirus is B97. 7 coded. Anogenital warts of genital origin A63. They have 0 codes.

There are many different strains of this virus, each of which causes specific wart papillomas. The type of virus determines the course of the pathological process, the symptoms, the place of manifestation and the severity of the complications.

Strains can be divided into two main types:

• skin, appears predominantly on the skin layer;
• mucous membranes that appear on the mucous membrane of the genitals, oral cavity, etc.

In addition, the types of papillomavirus differ depending on the risk of degenerating into an oncogenic process as 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" gearbox. This is the name given to the transfer of an infectious agent from mother to child during pregnancy. Currently, it is not known whether the infection occurs in the prenatal period or directly during delivery, but it is not desirable to perform a caesarean section on a mother infected with papillomavirus. Caesarean section is chosen only for bleeding papillomas inside the birth canal.
• Sexual way.The pathogen can enter the body during vaginal, oral or anal sex. The pathogen is also spread with saliva during kissing. Using a condom during sexual intercourse does not guarantee protection against the virus, but it reduces its spread.
• Household mode.This disease transmission mechanism is quite rare. Infection can occur through contact with the patient's personal belongings. Since the virus is found in saliva and urine, you can get infected by using someone else's dishes, shared towels, personal hygiene items, from the toilet rim or in the bath.

The mode of infection is primarily determined by the person's age: in infants, it can be established with great certainty that the infection originated from the mother, and in older children through contact, through household contact. From the age of 17, sexual infection 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 it does not manifest itself in any way and is present in the form of carriage.

The peak of the disease occurs between the ages of 17 and 25. This is due to maximum sexual activity and the high sensitivity of the epithelium on the organs of the urogenital system.

Predisposing factors that increase the likelihood of the disease are the following:

• early onset of sexual activity;
• frequent change of sexual partners;
• age up to 25 years;
• sexual contact with people who have previously suffered from human papillomavirus or other sexually transmitted diseases;
• pregnancy;
• imbalance of intravaginal flora;
• any chronic disease;
• endometriosis;
• cytostatic or glucocorticosteroid medication;
• overweight;
• dysfunction of the thyroid gland and disruption of insulin production;
• hypovitaminosis.

Frequent stress and failure to observe the basic principles of personal hygiene greatly increase a person's chance that the infection will enter the active phase after entering the body.

After introduction, the virus spreads throughout the body via the bloodstream, binds to cells, penetrates their structure, and incorporates its DNA into the cell's DNA. The affected cells then begin to actively grow and divide, causing condylomas to appear.

Development methods

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:

• A hidden period. At this stage, the carrier does not know the presence of the infectious agent, since it does not have clinical manifestations. However, at this stage a person is already contagious and can infect their partner through sexual contact. This latent period can last from 2-3 months to several years.
• The disease begins when the virus multiplies sufficiently in the body or when the defense mechanisms of the immune system decrease. During this period, the first symptoms appear.
• Active development with increasing symptoms.

The further course of events develops in one direction:

• self-healing with the complete disappearance of papilloma 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 the shape, size, number and merging of closely located groups;
• the degeneration of benign growths into malignancy.

Types of condylomas

There are several traditional types of condyloma papillomas:

• exophytic- with beneficial growth rising above the surface of the skin or mucous membrane;
• endophytic- it is predominantly grown deep into the skin structures, so it is barely noticeable on visual inspection;
• Buschke-Levenshtein education- characterized by a fast growth rate, large sizes and frequent relapses after treatment. With this form, both external growth and damage to the deep inner layers of tissues occur.

The base of genital warts can be thin or wide. If the stem is thin, the tip may be sharp or stick-like. Papillomas with a wide base are quite rare. The color of all such growths is close to the color of the skin: from flesh to pink. The surface can be soft or covered with a layer of keratin.

Warts can appear individually or in groups resembling nodules. Sometimes the size of such groups reaches 1. 5 cm, when several groups merge, formations resembling cauliflower florets or rooster combs appear. These growths make it easier to identify the disease during the examination.

Individual 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 wet, bleed, and get worse as a result of a secondary infection taking root in the affected areas.

Symptoms

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

The occurrence of condylomas occurs as follows:

• slight redness appears on the skin, which begins to itch;
• rashes appear on the skin or mucous membranes in the form of blisters or small bumps;
• tubers gradually grow to 1-1. 5 centimeters;
• New rashes appear nearby, which also turn into condyloma papules.

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

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

The clinical picture may differ in individual cases depending on the person's state of health. Smaller warts do not show any other symptoms.

In case of a more severe course, the following accompanying symptoms can be observed:

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

All of the above symptoms intensify with physical activity, long walks or runs.

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

In men and women, the symptoms show certain differences. This is due to anatomical differences and characteristics of sexual behavior.

Manifestations in men

In men, condylomas most often affect the scrotum, groin, vulva and various structural parts of the penis: head, body, frenulum and foreskin, coronary artery. Localized near the urethra, papillomas acquire a pronounced red color, and this place often causes the stream to fork or splash during urination.

If the rash is located at the exit of the anus, severe pain may occur during defecation and blood may appear in the stool. Because of this, a reflexive fear of defecation often appears, which causes periodic constipation and sometimes hemorrhoids.

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

The long-term presence of the infection lowers the man's immunity, making him more vulnerable to respiratory diseases, which are more difficult to treat than usual.

Manifestations in women

In women, the most common places for papillomas are the perianal zones, where humidity and temperature are constantly rising: the epithelium of the clitoris, the labia, the anus and the urethral opening. If an infection occurs during anal sex, a growth ring may form around the anus.

Large growths often become secondarily infected, causing a strong odor, bleeding, ulcers, and severe pain to the touch. Irritation and severe discomfort are observed while walking.

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

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

Women often experience embarrassment due to 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 after a few months at the earliest. The period of abstinence from pregnancy is extended if the woman took antiviral drugs during the therapy. After the successful treatment and the maintained interval, you can become pregnant safely.

If the disease is already discovered 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.

Among the reasons for the appearance of condylomatous warts in pregnant women is the usual decrease in immunity, with 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 area 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, consult a doctor immediately. Sometimes, with the high rate of progression of formations, loosening is observed, which can lead to sheath rupture.

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

If condylomas are damaged during the passage of the fetus through the birth canal, this often leads to infection of the baby and condylomatosis of the larynx in the newborn 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, and then the tissue is sent for histological examination to confirm its benign nature.

The use of traditional medicine methods to get rid of condylomas during pregnancy is unacceptable, as this not only does not lead to positive results, but can also cause the degeneration of benign cells into malignancy.

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

Diagnostics

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

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

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

After that, a clinical examination takes place, during which the specialist determines the location, intensity, size and condition of the growths. In the case of women, an additional colposcopy (examination of the individual genitals with magnification) or extended colposcopy (a similar procedure with acetic acid solution) is performed.

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

• PCR diagnostics, enables detection of the pathogen in scrapings from the epithelium of the affected areas and determination of its quantity (also determination of 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 microscopic examination of the tissue structure;
• antibody titer detectionto this virus;
• smearfrom the cervical canal and cervix for microscopic oncocytology.

If necessary, a dermatologist or proctologist consultation is planned. If the diagnosis is made on a pregnant woman, an obstetrician-gynecologist should be contacted.

After obtaining all the necessary data, the specialist can choose an individual tactic of therapy and complete relief from the disease.

Treatment

In the case of condylomatosis, people often avoid entering medical institutions and choose therapy themselves, preferring local drugs that can remove visible manifestations, but do not cure the body of the infection, transferring it to the latent stage. Such treatment almost always leads to relapse. Therefore, the final recovery requires an integrated approach that can only be determined by a specialist.

The treatment is carried out in the following areas:

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

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

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 sutures. Despite the fact that this method is considered a classic, it often causes postoperative bleeding and long-term rehabilitation in the hospital, so recently surgical removal is 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 of the formations is destroyed, the nodules dry out and fall off. After a few weeks, there will be no scars or scars at the treatment site.
• Laser removal.Despite its safety and high efficiency, the method requires anesthesia and is characterized by high costs, so it is prescribed when no other method can be used. As a result of the laser beam, the structure of the growth stem is destroyed. After cauterization, the condyloma is deprived of food, which leads to death 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. Genital growths are exposed to high temperatures during which the papillomas are cauterized. The scab will fall off on its own after a few days, leaving behind scars.
• Radiosurgery.Currently, this is the most modern, fastest and most effective method, which determines its high costs. Using high-frequency radio waves, genital warts are painlessly removed in 15-30 minutes. After such removal, there is no bleeding, healing takes place within a day, and no traces remain on the skin afterwards.
• Destruction by chemicals.This technique is only suitable for small formations without multiple fusions. Special strong substances are used, which leads to the destruction of growth cells. These products are based on high concentrations of acids or alkalis that cause local chemical burns.

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

Drug therapy

The integrated approach includes the elimination of benign formations, getting rid of the virus in the body and increasing the immune status. Therefore, drug treatment includes the use of such drugs:

• Pharmacy productsfor necrosis of warts, acceptable for home use. This preparation should be applied topically to the condylomas for a few days. If the drug gets on healthy tissues near the growth, a deep chemical burn is formed, so the drug should be used very carefully. After daily application, take a short break of several days. If the shoot does not fall, the course is repeated. Pharmaceutical products that cause necrosis of growths include solutions and ointments.
• Antiviral drugs.They can be for local or systemic use.
• Immunomodulatorsto improve immunity.

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

Immunity against condylomatosis does not develop after treatment, so re-infection from a previous sexual partner is possible.

Possible complications

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

• Attachment of bacterial infection to damaged condylomatous papillomas, leading to purulent formations, balanoposthitis and ulceration in the perianal area.
• When growths grow in the urethra, viral-bacterial urethritis can develop, which can lead to problems urinating, urinary retention, and urinary tract infection.
• If large formations are localized in the anus, hemorrhoidal bleeding and paraproctitis occur.
• Genital warts can affect a person's sex life and make them refuse to have sex. All this often leads to depression and psychological problems.
• Cervical erosion and dysplasia may develop in women.
• 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 specific and general.

Special preventive measures include vaccination with the new quadrivalent vaccine. These vaccines do not work against all strains of human papillomavirus, but they successfully fight the most dangerous ones that cause cervical cancer. The vaccination is repeated three times from the age of 11.

Non-specific prevention is similar to measures for many sexually transmitted diseases:

• use of barrier-free 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;
• quitting alcohol and smoking.

In addition, stress, physical fatigue, hypothermia and all factors that weaken the immune system should be avoided. A healthy diet, better health and proper sleeping habits help prevent the appearance of genital warts.