Anogenital warts or genital warts

The appearance of cone-shaped flesh-colored growths in the genital area is a cause of concern, which is completely justified, 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 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 quite natural.

Reasons for appearance

The cause of papilloma warts is the human papilloma virus. This virus contains a certain DNA set 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 papillomavirus is coded B97. 7. Anogenital warts of a venereal nature are assigned 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, location 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 genital organs, oral cavity, etc.

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

Most often, several different strains are present within the body of an infected person at the same time.

Routes of infection and risk factors

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

• "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 infection occurs in the prenatal period or directly during childbirth, but it is undesirable to perform a cesarean section on a mother with papillomavirus. Caesarean section is chosen only in the case of bleeding papillomas inside the birth canal.
• Sexual path.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 does make its transmission less likely.
• Household 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, from the toilet rim or in a bathhouse.

The method 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 came from the mother, and for older children, through contact and household contact. From the age of 17, in most cases, sexual transmission occurs.

According to statistics, human papillomavirus is present in the bodies 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 at young ages from 17 to 25 years. This is due to maximum sexual activity and high susceptibility of the epithelium on 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;
• therapy with cytostatic or glucocorticosteroid drugs;
• excess weight;
• disruption of the thyroid gland and disruption of insulin production;
• hypovitaminosis.

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

After introduction, the virus spreads throughout the body through the bloodstream, attaches to cells, penetrates their structure and integrates its DNA into the DNA of the cell. The affected cells then begin to actively grow and divide, due to which condylomas appear.

Development ways

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. During this stage, the carrier is not aware 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 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 when 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);
• sluggish course and lack of growth of skin outgrowths;
• 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 condylomas

There are several conventional types of condyloma papillomas:

• exophytic- protruding above the surface of the skin or mucous membrane with preferential growth outward;
• endophytic- with a predominant growth deep into the skin structures, therefore little noticeable during visual inspection;
• Buschke-Levenshtein education- characterized by rapid growth rates, large sizes and frequent relapses after a course of treatment. With this form, both external growth and damage to the deep internal layers of tissue occur.

Genital warts can have a thin or wide base in shape. If the stem is thin, the tip may be sharp or club-like. Papillomas with a wide base are quite rare. The color of all such outgrowths 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 singly or in groups resembling nodules. Sometimes such multiple groups reach sizes of 1. 5 cm. When several groups merge, formations appear that resemble cauliflower inflorescences or a rooster's comb. These growths make it easy to identify the disease upon examination.

Single 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 soaked, bleed, and worsen due to a secondary infection that takes root in the affected areas.

Symptoms

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

The occurrence of condylomas 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;
• the tubercles gradually increase to 1-1. 5 centimeters in length;
• New rashes appear nearby, which also 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;
• on the cervix;
• on the epithelium in the mouth (on the buccal surfaces, tongue and 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 object in the perineal area;
• humidity in the area of neoplasms;
• unpleasant odor from the area where condylomas are located.

With physical activity, long walking or running, 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, coronary groove. When localized near the urethra, papillomas acquire a pronounced red color, and this location often causes bifurcation or splashing of the stream when urinating.

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

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

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

Manifestations in women

The most common places for papillomas to occur in women are the perianal zones, where humidity and temperature are constantly increased: the epithelium of the clitoris, labia, vaginal outlet and 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. While walking, irritation and severe discomfort are observed.

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

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 for starting treatment at a later date compared to men.

Often women experience embarrassment 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 abstinence from pregnancy is lengthened if the woman took antiviral drugs during therapy. After successful treatment and a maintained interval, you can safely become pregnant.

If the disease is discovered already during pregnancy, then it is recommended to wait for treatment until all the baby’s organs are already 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 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 discomfort, then the question of treatment can be postponed until the child is born. But in case of rapid growth, increase in size and severe pain in 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.

This disease, as a rule, does not affect the formation 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 prematurity.

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, after which the tissue is sent for histology in order to verify its benign nature.

The use of traditional medicine methods to get rid of condylomas during pregnancy is unacceptable, since this not only may not have a positive result, but can 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 within several months after childbirth as the woman’s hormonal balance normalizes.

Diagnostics

If a patient notices symptoms reminiscent of human papillomavirus, then he needs to contact a gynecologist, urologist or venereologist.

First of all, 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 until you see a doctor.

After this, a clinical examination is carried out, during which the specialist determines the location, intensity, size and condition of the outgrowths. 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 prescribes the following additional tests:

• PCR diagnostics, 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 microscopic study of tissue structure;
• antibody titer detectionto this virus;
• smearfrom the cervical canal and cervix for microscopic oncocytology.

If necessary, consultations with a dermatologist or proctologist are scheduled. If the diagnosis is carried out 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 for therapy and complete relief from the disease.

Treatment

Often, with condylomatosis, people avoid going to medical institutions and choose therapy themselves, giving preference to local drugs that can remove visible manifestations, but do not cure the body of the infection, transferring it to a latent stage. Such treatment almost always leads to relapse. Therefore, for a final cure, an integrated approach is required, 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 medicinal.

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 excisionformations 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, so recently surgical removal has 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 are no scars or scars left at the treatment site.
• Laser removal.Despite the safety and high efficiency, the method requires anesthesia and is characterized by high cost, so it is prescribed if 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 within a few days leads to its necrosis and the scab disappears. Scars often remain after laser removal.
• Electrocoagulation.The method is affordable, but is very painful, so it requires local anesthesia. The genital outgrowths are exposed to high temperatures, during which the papillomas are cauterized. The scabs fall off on their own after a few days, leaving behind scars.
• Radiosurgery.At the moment, this is the most high-tech, fast and effective method, which determines its high cost. Using high-frequency radio waves, genital warts are painlessly removed 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 strong substances are used, which leads to the death of growth cells. These products are based on high concentration acids or alkalis that cause local chemical burns.

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

Drug therapy

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

• Pharmacy productsfor necrosis of warts, acceptable for home use. For several days, this product should be applied pointwise to condylomas. If the drug gets on healthy tissue near the growth, a deep chemical burn will form, so you need to apply the medicine very carefully. After daily applications, take a short break of several days. If the shoot does not fall off, then the course is repeated. Pharmaceutical products that cause necrosis of outgrowths include solutions and ointments.
• Antiviral agents.They can be for local or systemic use.
• Immunomodulatorsto improve immunity.

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

Immunity to condylomatosis is not developed 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:

• The attachment of a bacterial infection to damaged condylomatous papillomas, which leads to purulent formations, balanoposthitis and ulceration in the perianal area.
• When growths grow in the urethra, viral-bacterial urethritis can develop, leading to urination problems, urine retention 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 him to refuse sexual intercourse. All this often leads to depression and psychological problems.
• Women may develop cervical erosion and dysplasia.
• The greatest danger is the risk of degeneration of benign tumors 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 successfully combat the most dangerous of them, which cause cervical cancer. Vaccination is carried out from the age of 11 and is repeated three times.

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

• use of barrier contraceptives;
• personal hygiene at the proper level;
• regular sexual partner;
• regular examination by a gynecologist or andrologist;
• timely treatment of diseases of the pelvic organs;
• giving up 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, improved health, and proper sleep patterns will help prevent the appearance of genital warts.