Anogenital warts or genital warts

The presence of cone-shaped flesh-colored growths in the genital area is cause for concern, which is entirely reasonable because the health of the genital area is an important point in a person's overall physical and mental health.The growth of these warts can cause discomfort, interfere with normal sex life, and can lead to more serious health problems. If the integrity of genital warts is compromised, infection may occur and may transform into malignant formation. Therefore, the desire to get rid of this performance is understandable and natural.

Reason for occurrence

The cause of papillary warts is the human papilloma virus. The virus contains a certain set of DNA that successfully integrates into human cells and causes them to change their developmental cycle, shape and structure.

According to the International Classification of Diseases ICD-10, the human papillomavirus code is B97. 7. The code for anogenital warts of a venereal nature is A63. 0.

There are many different strains of this virus, and each strain causes specific verrucous papillomas. The type of virus determines the pathological process, symptoms, site of manifestation and severity of complications.Strains are mainly divided into two types:

• Skin, mainly in the dermis;
• Mucous membrane appears on the mucosal epithelium of reproductive organs, oral cavity, etc.

Furthermore, types of papillomaviruses differ based on the risk of denaturation into carcinogenic processes, carcinogenic, moderately carcinogenic, and non-carcinogenic.Most commonly, an infected person has several different strains present at the same time.

Infection routes and risk factors

Pathogens enter the human body in the following ways:

• "vertical" transmission. This is the name given to the spread of infectious agents from mother to child during pregnancy. It is unclear whether the infection occurred prenatally or directly during delivery, but it is not advisable to perform a caesarean section in a mother infected with papillomavirus. Cesarean section is chosen only if there is bleeding from papillomas in the birth canal.
• The path to sex.Infections can enter the body during vaginal, oral or anal sex. The pathogen is also spread through saliva during kissing. Using a condom during sex does not guarantee protection from the virus, but it does reduce the likelihood of spreading it.
• Home style.This mechanism of disease transmission is quite rare. Infection may result from contact with a patient's personal belongings. Since the virus is present in saliva and urine, it is possible to become infected by using other people's utensils, shared towels, personal hygiene items, toilet rims, or bathrooms.

The route of infection mainly depends on the age of the person: in infants, the infection can be determined with a high degree of certainty from the mother, while in older children, it can be determined through contact and household contact. Sexual transmission occurs in most cases starting at age 17.

According to statistics, human papillomavirus exists in the body of more than half of sexually mature people, but in most cases it does not manifest itself in any way, but exists in a carried form.

The disease peaks in the young ages, 17 to 25 years old. This is due to maximum sexual activity and the high sensitivity of the epithelial cells of the genitourinary system organs.Predisposing factors that increase the likelihood of illness include:

• Premature initiation of sexual activity;
• Frequently changing sexual partners;
• Be not more than 25 years old;
• Sexual contact with someone who has had human papillomavirus or other sexually transmitted diseases;
• Pregnant;
• Imbalance of vaginal flora;
• any chronic disease;
• Endometriosis;
• Treatment with cytostatic or glucocorticoid drugs;
• excess weight;
• disruption of the thyroid gland and disruption of insulin production;
• Vitamin deficiency.

Regular stress and failure to adhere to personal hygiene principles greatly increase the chance of an infection becoming active once it enters the body.After the virus enters the body, it spreads throughout the body through the bloodstream, attaches to cells, penetrates the cell structure, and integrates its DNA into the cell's DNA. The affected cells then begin to actively grow and divide, and genital warts appear.

Development methods

After the virus enters the human body, it will 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 the infectious agent because there are no clinical manifestations. However, at this stage, a person is already contagious and can infect his or her partner through sexual contact. This incubation period can last from 2-3 months to several years.
• Illness occurs when the virus has sufficiently multiplied in the body or when the immune system's protective mechanisms decline. During this period, the first symptoms appear.
• With active development, symptoms increase.

The further development of the situation is heading in one of the following directions:

• Self-healing, complete disappearance of papillary warts (most often observed after the end of pregnancy);
• The disease progresses slowly and lacks growth of skin hyperplasia;
• Active dynamics of papillomas, increase in shape, size, number, and merging of adjacent groups;
• Benign growth degenerates into malignant growth.

Types of genital warts

There are several general types of genital wart papilloma:

• exogenous- Protruding from the skin or mucous membrane surface, preferentially growing outward;
• endogenous- Mainly grows deep within the skin structure and is therefore barely noticeable on visual inspection;
• Buschke-Lewenstein Education- Characterized by fast growth, large size, and frequent recurrence after a course of treatment. In this form, both external growth of tissue and damage to the deep inner layers occur.

The base shape of genital warts can be thin or wide. If the stem is thin, the tip may be sharp or club-shaped. Papillomas with a broad base are very rare. The color of all these growths is close to that of the skin: from flesh-colored to pink. The surface can be soft or covered with a layer of keratin.Warts can appear singly or in clusters like nodules. Sometimes the size of such multiple groups can reach 1. 5 cm. When multiple groups merge, structures similar to cauliflower inflorescences or rooster combs emerge. These growths make it easy to identify the disease on examination.Individual growths usually don't cause as much discomfort as larger elements. In rare cases, they can rupture and bleed slightly.Large formations are even more problematic: They can become soggy, bleed, and worsen due to secondary infections that take root in the affected area.

symptom

The first symptoms appear after the incubation period, which can last at least a few weeks.Genital warts occur in the following situations:

• The skin becomes slightly red and begins to itch;
• Rash in the form of blisters or small bumps on the surface of the skin or mucous membranes;
• The nodule gradually increases to 1-1. 5 cm long;
• A new rash appeared nearby, which also turned into genital wart papules.

Localization depends on the specific strain and where the pathogen enters the body:

• external genitalia;
• anal area (anogenital papilloma);
• In the urethra;
• on the cervix;
• Oral epithelium (buccal surface, tongue and inside of lips).

The clinical presentation of each specific case may vary based on the individual's health status. With small warts, no other symptoms may be observed.If the course of the disease is more severe, the following accompanying symptoms are observed:

• Itching or burning sensation at the rash site;
• A foreign body sensation in the perineum;
• Humidity in the tumor area;
• The area where genital warts are located has a bad odor.

All of the above symptoms are exacerbated with physical activity, prolonged walking or running.In severe cases, fatigue, weakness, symptoms of poisoning, prolonged headache, fever, and high temperature may occur.There are some differences in symptoms in men and women. This is due to anatomical differences and sexual behavior characteristics.

Manifestations in men

Genital warts in men most commonly affect the scrotum, groin, pubic bone, and various structural parts of the penis: head, body, frenulum and foreskin, and coronal sulcus. Papillomas appear distinctly red when located near the urethra, and the location often causes the urine stream to diverge or splash during urination.If the rash is located at the anal opening, you may experience severe pain during bowel movements and there may be blood in your stool. Because of this, a reflex fear of having a bowel movement often occurs, leading to periodic constipation and sometimes hemorrhoids.There is often a dull pain in the lower abdomen; burning and pain during intercourse and during urination.Long-term infection can lower a man's immunity, making him more susceptible to respiratory illnesses that are more difficult to treat than usual.

manifestations in women

The most common sites for female papillomas are the perianal area where humidity and temperature are increasing: the epithelium of the clitoris, labia, vaginal outlet, and urethral meatus. If an infection occurs during anal sex, a ring of growth may appear around the anus.Large growths often become secondary to infection, causing a strong odor, bleeding, ulcers, and severe pain when touched. When walking, irritation and severe discomfort are observed.

50% of women who develop a white substance on their cervix during a routine colposcopy are treated with an acidic antiseptic to enhance the white color of their genital warts.

In some cases, all the growths are located on the mucous membranes of a woman's internal reproductive organs, so she doesn't notice them until she makes an appointment to see her gynecologist. This is often a reason to start treatment later than in men.Women often feel embarrassed by the presence of foreign objects in their private parts, forcing them to refuse sex.Papillomas rarely occur in the mouth and, rarely, on the pubic bone, thighs, neck, or face.

Characteristics of genital warts during pregnancy

If genital warts have been treated, you should plan a pregnancy within a few months. The period of abstinence during pregnancy may be prolonged if a woman takes antiviral medications during treatment. With successful treatment and maintaining intervals, you can have a safe pregnancy.If the disease is discovered during pregnancy, it is recommended to wait until all the baby's organs have formed before treatment. Treatment after 28 weeks will not cause abnormalities in fetal development.Causes of genital warts in pregnant women include lowered immunity standards, increased stress on the body, and significant hormonal fluctuations.If the papilloma is located on the outside of the reproductive organs or in the perianal area and does not cause discomfort, then treatment of the problem can be postponed until the child is born. However, if the growth rate is too fast, the size is large, and the pain is severe, you should seek medical treatment immediately. Sometimes, with the rapid progression of the morphology, their loosening is observed, which can lead to vaginal rupture.

Typically, the disease does not affect the formation of the fetus, but its effects extend to the mother's condition and the delivery process. If other infections are present, there is often a risk of premature delivery.

When genital warts damage the fetus as it passes through the birth canal, it often leads to infection in the baby, as well as laryngeal genital warts in the neonatal or chest period. Therefore, the presence of obvious papilloma in the birth canal is a direct indication for cesarean section.If necessary, the growth is removed during pregnancy and the tissue is sent for histology to verify its benignity.It is unacceptable to use traditional medical methods to remove genital warts during pregnancy because not only may this not produce a positive result, but it may cause benign cells to degenerate into malignant cells.The formation, which causes no discomfort during pregnancy, usually resolves on its own within a few months after delivery as the woman's hormonal balance returns to normal, without the need for treatment.

diagnosis

If a patient notices symptoms that resemble those of human papillomavirus, then he needs to contact a gynecologist, urologist or venereologist. First, experts conducted a survey and clarified the following points:

• The time when the patient first experienced symptoms;
• Possible causes of infection;
• The dynamics and progression of the disease until you see your doctor.

After this, a clinical examination is performed, during which the specialist determines the location, intensity, size and condition of the growth. In women, an additional colposcopy (magnifying examination of a single reproductive organ) or an extended colposcopy (a similar procedure using an acetic acid solution) is performed.For a more accurate diagnosis, your doctor will perform the following additional tests:

• PCR diagnosis, allows you to detect pathogens in epithelial scrapings of the affected area and determine their quantity (also allows you to determine the virus strain);
• Anoscopy- Visually inspect the area near the anus using a magnifying glass;
• Cytology and HistologyStructural fragments used to identify atypical cells or tissues;
• growth biopsyFrom epithelial tissue for microscopic study of tissue structure;
• Antibody titer testingFor this virus;
• smearMicroscopic tumor cytology is performed from the endocervical canal and cervix.

If necessary, a consultation with a dermatologist or proctologist will be arranged. If a diagnosis is made in a pregnant woman, it is necessary to contact an obstetrician-gynecologist.After receiving all necessary data, experts can choose an individualized treatment strategy and achieve complete remission of the disease.

treat

Often, people with genital warts avoid going to medical institutions and opt for treatment on their own, preferring instead topical medications that eliminate obvious symptoms but do not cure the infected body, allowing it to enter the latent stage. This treatment almost always results in relapse. Therefore, final cure requires a comprehensive approach, which can only be determined by experts.Treatment is carried out in the following areas:

• remove growth;
• Fight viruses;
• Enhance the patient's immunity.

All methods used to combat genital warts are divided into radical and medical methods.

radical approach

This type of method can be chosen if urgent elimination of external manifestations is required or when genital warts are located on the female cervix. Removal methods include the following:

• SurgeryThe shaping is performed using a scalpel under local or general anesthesia. The incision site is sutured with surgical sutures. Although this approach is considered classic, it often results in postoperative bleeding and long hospital stays, so surgical resection has become less common recently.
• Destroyed by freezing with liquid nitrogen.This method is relatively cheap and safe, and does not require anesthesia or anesthesia. After freezing, the proteins in the formation are destroyed and the nodules dry out and fall off. After a few weeks, there will be no scarring or scarring at the treated area.
• Laser removal.Although this method is safe and efficient, it requires anesthesia and is costly, so it is only used when other methods cannot be used. When exposed to the laser beam, the structure of the growing stem is destroyed. After cauterization, genital warts lose nutrients and become necrotic within a few days, and the scabs disappear. Laser removal often leaves scars.
• Electrocoagulation.This method is affordable but very painful and requires local anesthesia. The 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 a scar.
• Radiosurgery.This is currently the most technical, fast and effective method, which determines its high cost. Using high-frequency radio waves, genital warts can be painlessly removed in 15-30 minutes. It does not bleed upon removal, heals within a day, and leaves no trace on the skin afterwards.
• Chemical damage.This technique is only suitable for small formations and not suitable for multiple fusions. Special powerful substances are used that cause the death of growing cells. These products are based on high concentrations of acids or bases and can cause localized chemical burns.

If we only use an aggressive approach to combat genital warts, genital warts will return in one-third of cases.

medical treatement

A comprehensive approach includes eliminating benign formations, clearing viruses from the body, and improving immune status. Therefore, pharmacotherapy includes the use of such drugs:

• medical productsFor wart necrosis, suitable for home use. The product should be applied to genital warts point by point for several days. Deep chemical burns can form if the medication comes into contact with healthy tissue near the growth site, so you need to be very careful with the medication. After daily application, take a short break for a few days. If the buds do not fall off, repeat the process. Medications that cause necrosis of growths include solutions and ointments.
• Antiviral agents.They can be used locally or systemically.
• immunomodulatorImprove immunity.

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

Immunity to genital warts does not develop after treatment, so it is possible to be infected again by a previous sexual partner.

possible complications

If left untreated for a long time, genital warts can lead to the following complications:

• Bacterial infection attaches to damaged genital wart papilloma, causing suppuration, balanoposthitis, and ulceration in the perianal area.
• Viral bacterial urethritis occurs when the urethra grows, causing urinary problems, urinary retention, and urinary tract infections.
• Hemorrhoidal bleeding and pararectitis occur when large structures develop within the anus.
• Genital warts can affect a person's sex life, causing him to refuse sexual intercourse. All of this often leads to depression and psychological problems.
• Women may experience cervical erosion and dysplasia.
• The greatest danger is the risk of benign tumors degenerating into cancer (cancer of the glans penis or cervix).

Precaution

The prevention of genital warts is divided into specific and general.Specific preventive measures include vaccination with the new quadrivalent vaccine. These vaccines do not work against all strains of papillomavirus, but they are successful against the most dangerous of them all, the one that causes cervical cancer. Vaccination begins at 11 years of age and is repeated three times.Non-specific prevention is similar to the measures inherent in many sexually transmitted diseases:

• Use barrier contraceptives;
• maintain an appropriate level of personal hygiene;
• regular sexual partner;
• Regular examinations by a gynecologist or andrologist;
• Prompt treatment of pelvic organ diseases;
• Quit drinking and smoking.

Also avoid stress, physical fatigue, hypothermia, and anything that weakens your immune system. A healthy diet, improved health, and proper sleep patterns will help prevent the appearance of genital warts.