Anogenital warts or genital warts

The appearance of conical flesh-colored shoots in the genital area causes 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 the warts is destroyed, infection and 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 specific set of DNA that successfully integrates into the cells of the human body and causes them to change their growth cycle, shape and structure.

According to the International Classification of Diseases ICD-10, human papillomavirus has code B97. 7. Anogenital warts of a genital nature are attributed with code A63. 0.

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

Stems are divided into two main types:

• cutaneous, with predominant appearance in the dermal layer.
• mucous membranes, appearing on the mucous epithelium of the genitals, oral cavity, etc.

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

Most of the time, 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 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 the infection occurs in the prenatal period or directly during labor, but it is not desirable to perform a caesarean section in a mother with papillomavirus. Cesarean section is chosen only in the case of bleeding papillae within the birth canal.
• Sexual route.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 sex does not guarantee protection against the virus, but it does make it less likely to be transmitted.
• Home way.This mechanism of disease transmission is quite rare. Infection can occur through contact with the patient's personal belongings. Since the virus is contained in saliva and urine, it is possible to get infected by using someone else's dishes, shared towels, personal hygiene items, from the toilet seat or in a bathroom.

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, the 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 exists in the form of transfer.

The peak of the disease occurs at young ages from 17 to 25 years. This is due to the maximum sexual activity and the high sensitivity of the epithelium in the organs of the genitourinary system.

Predisposing factors that increase the likelihood of the disease occurring 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 the vaginal flora.
• any chronic disease;
• endometriosis;
• treatment with cytostatic or glucocorticosteroid drugs.
• overweight?
• disorder of the thyroid gland and disorder of insulin production.
• hypovitaminosis.

Frequent stress and non-compliance with the principles of personal hygiene significantly increase the chances of a person, after entering the body, for the infection to enter the active phase.

After entry, the virus spreads throughout the body through the bloodstream, attaches to cells, penetrates their structure, and integrates its DNA into the cell's DNA. Then the affected cells begin to actively grow and divide, due to which warts 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. At this stage, the carrier is unaware of the presence of an infectious pathogen, as there are no 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 appearance of the disease occurs when the virus multiplies sufficiently in the body or when the protective mechanisms of the immune system are reduced. In this period the first symptoms appear.
• Active growth with increasing symptoms.

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

• self-treatment with complete disappearance of papillary warts (which are more often observed after the end of pregnancy).
• slow course and lack of development of skin waste.
• active dynamics of papillae with an increase in shape, size, number and fusion of nearby groups.
• degeneration of benign growths into malignant ones.

Types of warts

There are several conventional types of wart papillae:

• exotic- protrudes above the surface of the skin or mucous membrane with preferential growth outwards.
• endophytic- with dominant growth deep in the skin structures, therefore hardly noticeable during visual inspection.
• Buschke-Levenshtein training- characterized by rapid growth rates, large sizes and frequent relapses after a course of treatment. In this form, both external growth and damage to the deep inner layers of the tissue occur.

Genital warts can be thin-based or broad-based in shape. If the stem is thin, the tip may be sharp or club-like. 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 nodule-like groups. 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 detect the disease on examination.

Single deployments usually don't cause as much discomfort as large items. In rare cases they break and bleed slightly.

Large formations are more problematic: they can soak, bleed and worsen due to secondary infection that takes 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.

Warts appear 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 bubbles or small bumps.
• tubers gradually increase to 1-1. 5 cm in length.
• New rashes appear nearby, which also turn into wart papules.

Localization depends on the specific strain and the site of entry of the pathogen into the body:

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

The clinical picture may differ in each specific case depending on the health status of the individual. 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 perineum.
• moisture in the area of neoplasms.
• unpleasant odor from the area where the warts are located.

With physical activity, a lot of walking or running, 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.

Men's events

Warts in men most often affect the scrotum, groin, pubic cavity and various structural parts of the penis: head, body, groove and foreskin, coronal groove. When located near the urethra, the papillae become bright red in color and this location often causes the stream to split or splash during urination.

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

Often there is a vague pain in the lower abdomen, during sex there is a burning sensation and pain, as well as during urination.

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

Events for women

The most common places for papillomas in women are the perianal zones, where humidity and temperature are constantly increasing: the epithelium of the clitoris, the labia, the exit of the vagina and the opening of the urethra. If an infection occurs during anal sex, a ring of growths may gather around the anus.

Large growths often become secondarily infected, causing a strong odor, bleeding, ulceration, and severe pain when touched. When walking there is irritation and intense discomfort.

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

In some cases, all growths are located on the mucous membrane of the internal genital organs of the woman, 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 appear in the mouth, and in extremely rare cases - in the pubic area, thighs, neck or face.

Features of warts during pregnancy

If warts have been treated, pregnancy should be planned no earlier than a few months. The period of abstinence from pregnancy is extended if the woman received antiviral drugs during treatment. After successful treatment and a maintained interval, you can become pregnant safely.

If the disease is already discovered 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 warts appear in pregnant women include a typical 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 in growths, you should immediately consult a doctor. Sometimes, with a high rate of development of the formations, their relaxation is observed, which can lead to a rupture of the sinus.

This disease, as a rule, does not affect the formation of the fetus, but its effect extends to the state of the mother and the process of childbirth. If other infections are present, there is often a risk of prematurity.

When warts are destroyed 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 a 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 warts during pregnancy is unacceptable, as this may not only not have a positive effect, but may lead 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 should contact a gynecologist, urologist or venereologist.

First of all, the specialist conducts an investigation to clarify the following points:

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

After that, 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 genitals 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 diagnosis, allows you to detect the pathogen in scrapings from the epithelium of the affected areas and determine its amount (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 growthsfrom epithelial tissues for microscopic study of tissue structure.
• antibody titer detectionto this virus.
• blotfrom the cervical canal and cervix for microscopic oncocytosis.

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

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

Treatment

Often, with warts, people avoid going to medical institutions and choose the treatment 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, a comprehensive approach is required for a final treatment, which can only be determined by a specialist.

Treatment is carried out in the following areas:

• removal of increases;
• fight 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 warts are located on the cervix in women.

The following methods are used for removal:

• Surgical resectionformations using a scalpel under local or general anesthesia. The incision site is sutured with surgical suture. 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 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 up and fall off. After a few weeks, there are no scars or scars 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 structure of the growth stalk is destroyed. After cauterization, the condyle 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 it is very painful, so it requires local anesthesia. The genitals are exposed to high temperatures, during which the papillae 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.
• Chemical destruction.This technique is only suitable for small formations, without multiple mergers. Special strong substances are used, which lead to the death of growth cells. These products are based on highly concentrated acids or alkalis that cause localized chemical burns.

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

Pharmacotherapy

A comprehensive approach includes the elimination of 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 productsfor wart necrosis, acceptable for home use. For several days, this product should be applied topically to the warts. If the drug gets into healthy tissue near the growth, a deep chemical burn will form, so you need to apply the drug very carefully. After daily applications, take a short break of several days. If the shoot does not fall, then the course is repeated. Medicinal products that cause necrosis of the estuary 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, a systematic intake of multivitamin complexes, a special diet and a healthy lifestyle are prescribed.

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

Possible complications

If left untreated for a long time, warts cause the following complications:

• The attachment of bacterial infection to damaged warty papillomas, leading to purulent formations, balanoposthitis and ulceration in the perianal area.
• When growths develop in the urethra, viral-bacterial urethritis can develop, leading to problems urinating, retention of urine in the body, and urinary tract infection.
• When large formations are found in the anus, hemorrhoidal bleeding and paraproctitis occur.
• Genital warts can affect a person's sex life, causing them to refuse intercourse. All this often leads to depression and psychological problems.
• Women may develop cervical erosion and dysplasia.
• The biggest risk is the risk of benign tumors degenerating into cancer (cancer of the head of the penis or cervix).

Precautionary measures

The prevention of warts 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 of them, which cause cervical cancer. Vaccination takes place from the age of 11 and is repeated three times.

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

• use of barrier contraceptives.
• personal hygiene at an appropriate level;
• regular sexual partner.
• regular examination by a gynecologist or andrologist.
• timely treatment of diseases of the pelvic organs.
• stopping 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 genital warts.