Anogenital warts or genital warts

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

These wart growths cause discomfort, interfere with normal sex life, and can even cause more serious health problems. If the integrity of the warts is damaged, an infection may occur and the 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 set of DNA 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, human papillomavirus is coded B97. 7. Anogenital warts of venereal nature are assigned the code A63. 0.

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, place of manifestation and severity of complications.

Strains are divided into two main types:

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

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

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

Routes of infection and risk factors

There are several ways the pathogen can enter the body:

• "Vertical" transmission.. This 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 in the prenatal period or directly during childbirth, but it is undesirable to perform a cesarean section on a mother suffering from papillomavirus. Cesarean section is chosen only in case of bleeding papillomas inside the birth canal.
• Sexual journey.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 likelihood of transmission.
• Domestic 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 bathroom.

The mode of contagion is mainly determined by the age of the person: in newborns, with a high degree of certainty, it can be established that the infection came from the mother, and in older children, through contact and family 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 a carrier.

The peak of the disease occurs at a young age, from 17 to 25 years. This is due to the 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 drugs or glucocorticosteroids;
• excess weight;
• disruption of the thyroid gland and disruption of insulin production;
• hypovitaminosis.

Frequent stress and failure to comply with the principles of personal hygiene significantly 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 cell's DNA. The affected cells then begin to actively grow and divide, causing warts to appear.

Ways of development

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 phase 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 their partner through sexual contact. This latency 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);
• slow course and lack of growth of skin growths;
• active dynamics of papillomas with an increase in shape, size, number and fusion of closely localized groups;
• degeneration of benign growths into malignant ones.

Types of warts

There are several conventional types of condylomatic papillomas:

• exophytic- protruding above the surface of the skin or mucosa with preferential growth towards the outside;
• endophytic- with a predominant growth deep into the skin structures, therefore not very evident on visual examination;
• Buschke-Levenshtein education- characterized by rapid growth rates, large size and frequent relapses after a course of treatment. With this form, both external growth and damage to the deep internal layers of the tissue occur.

Genital warts can have a thin or broad base. If the stem is thin, the tip may be sharp or club-shaped. Broad-based papillomas are quite rare. The color of all these 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 lump-like groups. Sometimes these multiple groups reach sizes of 1. 5 cm. When several groups join together, formations appear that resemble cauliflower inflorescences or a rooster's comb. These growths make it easy to identify the disease on examination.

Single growths usually do not cause as much discomfort as large items. In rare cases they break and bleed slightly.

Large formations 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 completion of the latency period, which in the shortest case lasts several weeks.

The appearance of warts occurs as follows:

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

The 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 of the mouth (on the buccal surfaces, on the tongue and inside the lips).

The clinical picture may differ in each specific case depending on the person's state of health. 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 the warts are located.

With physical activity, long walking or running, all the symptoms listed above intensify.

In more severe cases, fatigue, weakness, signs of intoxication, prolonged headache, fever and high fever 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

Warts in men most often affect the scrotum, groin, pubis and various structural parts of the penis: head, body, frenulum and foreskin, coronary sulcus. When located near the urethra, papillomas acquire a pronounced red color, and this location often causes bifurcation or splashing of the flow during urination.

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. For this reason, a reflexive fear of defecation often appears, which causes periodic constipation and sometimes hemorrhoids.

Often a vague pain is felt in the lower part of the abdomen; during sexual intercourse a burning and painful sensation is felt, as well as during urination.

The prolonged presence of the infection reduces human immunity, making it more vulnerable to respiratory diseases, which are more difficult to treat than usual.

Manifestations in women

The most common places where papillomas develop in women are the perianal areas, 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 growths may concentrate around the anus.

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

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

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 the scheduled visit to the gynecologist. This is often the reason for starting treatment later than 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 abstinence period from pregnancy is lengthened if the woman takes antiviral drugs during therapy. After successful treatment and a maintained interval, you can get pregnant safely.

If the disease is discovered 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 of 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, the question of treatment can be postponed until the birth of the baby. 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 warts are damaged during the passage of the fetus through the birth canal, this often leads to infection of the baby and laryngeal warts 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 histological examination to verify its benign nature.

The use of traditional medicine methods to eliminate warts during pregnancy is unacceptable, since this may not only not have a positive result, but can provoke the degeneration of benign cells into malignant cells.

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

Diagnostics

If a patient notices symptoms resembling human papillomavirus, she should contact a gynecologist, urologist or venereologist.

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

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

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

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

• PCR diagnostics, allows you to detect the pathogen in scrapings of the epithelium of the affected areas and determine its quantity (it 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 the growthsfrom epithelial tissues for the microscopic study of tissue structure;
• detection of antibody titerto this virus;
• droolfrom the cervical canal and cervix for microscopic oncocytology.

If necessary, consultations with a dermatologist or proctologist are scheduled. If the diagnosis is made on a pregnant woman, 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 turning to medical institutions and choose therapy themselves, preferring local drugs that can remove visible manifestations, but not cure the body of the infection, transferring it to a latent stage. Such treatment almost always leads to relapse. Therefore, for a definitive cure, an integrated approach is needed, which can only be determined by a specialist.

Treatment is carried out in the following areas:

• removal of growths;
• fight against the virus;
• strengthen 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 warts 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 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, no scars or scars remain 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 it is not possible to use other methods. 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 disappearance of the crust. Scars often remain after laser removal.
• Electrocoagulation.The method is convenient, but it is very painful, so it requires local anesthesia. Genital growths are exposed to high temperatures, during which papillomas are cauterized. The scabs fall off on their own after a few days, leaving scars.
• Radiosurgery.At the moment, this is the most technological, 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 removal, no bleeding occurs, 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 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 warts occurs in every third case.

Pharmacological 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:

• Pharmaceutical productsfor necrosis of warts, acceptable for home use. For several days, this product must be applied punctually on the warts. If the drug comes into contact with 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, the course 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, to improve the body's defenses, the systematic intake of multivitamin complexes, a special diet and a healthy lifestyle are prescribed.

Immunity to condylomatosis does not develop after treatment, so reinfection 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, leading 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 infections.
• When large formations are localized in the anus, hemorrhoidal bleeding and paraproctitis occur.
• Genital warts can affect a person's sex life, causing them 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 the human papillomavirus, but they successfully fight the most dangerous ones, which cause cervical cancer. Vaccination is carried out from the age of 11 and is repeated three times.

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

• use of barrier 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;
• give up 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, better health and adequate sleep will help prevent the appearance of genital warts.