Anogenital warts or genital warts

According to statistics, human papillomavirus is present in 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 transport.

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 of 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 cytostatics or glucocorticosteroid drugs;
• excess weight;
• disruption of the thyroid gland and disruption of insulin production;
• hypovitaminosis.

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

After introduction, the virus spreads throughout the body through the bloodstream, binds 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.

Ways of development

After entering the human body, the virus causes no 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 not aware of the presence of an infectious pathogen, as there are no clinical manifestations. But 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 decline. During this period the first symptoms appear.
• Active development with increasing symptoms.

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

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

Types of condylomas

There are several conventional types of condylomas papillomas:

• exophytic- protrudes beyond the surface of the skin or mucous membrane with preferential growth outwards;
• 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 inner 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 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 singly or in groups that look like nodules. Sometimes such multiple groups reach sizes of 1. 5 cm. When several groups merge, formations appear that look like cauliflower florets or a cock's comb. These growths make it easy to identify the disease on examination.

Single growths usually do not cause as much discomfort as large elements. In rare cases, they break and bleed a little.

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

Symptoms

The first symptoms appear after the end 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;
• rash appears on the skin or mucous membrane 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 load 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 of the mouth (on the buccal surfaces, the tongue and the inside of the lips).

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

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

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

During physical activity, long walks or runs, all 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 during urination.

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

There are often vague pains in the 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 where papillomas occur in women are the perianal zones, where humidity and temperature constantly increase: clitoral epithelium, 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, sores and severe pain when touched. While walking, irritation and severe discomfort are observed.

In 50% of women, whitish elements form on the cervix in the uterus, which are discovered during a routine colposcopy, after 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 genitals, so she does not notice them until a scheduled visit to the gynecologist. This is often the reason why treatment is started at a later stage compared to men.

Often, women experience embarrassment due to the presence of formations in intimate places, forcing 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 in a few months at the earliest. The period of abstinence from pregnancy is extended if the woman took antiviral drugs during treatment. After successful treatment and a maintained interval, you can safely become pregnant.

If the disease is detected already during pregnancy, it is recommended to wait for treatment until all the baby's organs have 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 genitals 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 solution 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 birth process. 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 child and laryngeal condylomatosis in the neonatal 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, after which the tissue is sent for histology to verify its benign nature.

The use of traditional medicine methods to get rid of condylomas during pregnancy is unacceptable, as this can not only 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 birth, as the woman's hormonal balance normalizes.

Diagnostics

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

First of all, the specialist carries out an examination to clarify the following points:

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

A clinical examination is then carried out, where the specialist determines the location, intensity, size and condition of the growths. For women, an additional colposcopy (examination of individual genitals 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 amount (also allows you to determine the virus strain);
• 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 tissue to microscopic examination of tissue structure;
• antibody titer detectionto this virus;
• lubricatefrom the cervical canal and cervix to microscopic oncocytology.

If necessary, consultations with a dermatologist or proctologist are scheduled. If the diagnosis is carried out on a pregnant woman, it is necessary to contact an obstetrician-gynecologist.

After receiving all the necessary data, the specialist can choose individual tactics for therapy and complete relief of the disease.

Treatment

Often, with condylomatosis, people avoid going to medical institutions and choose therapy themselves, preferring local drugs that can remove visible manifestations, but not cure the body of the infection and transfer 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.

The treatment is carried out in the following areas:

• removal of growths;
• fight 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 quickly 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 incision site is sutured with surgical thread. Despite the fact that this method is considered classical, 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 cheap and safe and requires neither anesthesia nor 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 costs, so it is prescribed if other methods cannot be used. When exposed to a laser beam, the growth stem's structure 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 growths are exposed to high temperatures, where the papillomas are cauterized. The scabs fall off on their own after a few days, leaving scars.
• Radiosurgery.Currently, this is the most high-tech, fast and effective 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 of chemicals.This technique is only suitable for small formations without multiple fusions. Special strong substances are used which lead to the death of growth cells. These products are based on highly concentrated acids or bases that cause local chemical burns.

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

Drug therapy

An integrated approach involves 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. For several days, this product must be applied point by point on condylomas. If the medicine gets on healthy tissue near the growth, a deep chemical burn will form, so you must apply the medicine very carefully. After daily applications, take a short break of several days. If the shot does not fall off, the process is repeated. Pharmaceutical products that cause necrosis of growths include solutions and ointments.
• Antiviral agents.They can be for local or systemic use.
• Immunomodulatorsto improve immunity.

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

Immunity against 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, urinary retention in the body, and urinary tract infection.
• When large formations are located in the anus, hemorrhoidal bleeding and paraproctitis occur.
• Genital warts can affect a person's sex life, causing him to refuse intercourse. All this often leads to depression and psychological problems.
• Women can 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 measurements

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 fight the most dangerous of them, which cause cervical cancer. Vaccination is carried out from the age of 11 and is repeated three times.

Non-specific prevention corresponds to 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;
• give 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.