Pathology is at the discretion of venereologists, but her relief is also involved and other specialists: surgeons doing surgical treatment of the disease, the therapists corrected arose through condylomatous sexual problems, and psychologists engaged in the restoration of disturbed psychological comfort of such patients.
Genital warts appear as a result of infection with human papillomavirus (HPV) 6 and 11. The pathogen is characterized by a high prevalence and can cause a number of diseases of the skin and mucous membranes. At the moment there are more than 100 variations of human papilloma virus that provoke the emergence of different types:
It is important
The human papillomavirus is one of the most “popular” infections that are sexually transmitted and most often lead the patient into the study of venereal diseases.
It is believed that more than half of people who live a sexual life with different degrees of activity, are carriers of this pathogen, what they may not realize for a long time, the virus did not become active in the body (usually, the virus passes without any clinical symptoms). In most cases the carriage of the several types of the human papillomavirus.
Genital warts appear in no more than 1-2% of all clinical cases of virusological. For the occurrence of warts in people infected with human papillomavirus, the necessary weakening of the immune defense of the body (General and local). Warts also can occur when the normal immune system, but in the case of weakening of the organism as a whole. This happens in such clinical circumstances, such as:
- condition after suffering a serious hours-long surgery, especially after operations on the abdominal and thoracic cavity;
- a long rehabilitation period after serious injury;
- lingering chronic diseases – particularly diseases of the cardiovascular system, severe endocrine pathology (diabetes), blood disorder;
- a number of infectious diseases – marked tuberculous lesions of different localization, syphilis, malaria;
- the carriage of other pathogens infectious diseases;
- weak and exhaustion due to social factors (starvation, living in inadequate social conditions).
The development of the disease
Morphologically manifested condylomata anogenital genital warts in the anus and external genitalia. Characteristics of warts:
- the form – in the form of tumor-like growths on the skin, or clusters in the form of pink fused papillae. At a mass gathering such growths resemble a cauliflower;
- color – pink with gray tint;
- in size from small, 0.3-0.5 mm in cross-section, to giant (larger sizes) warts, which with progressive growth can close the anal opening.
Giant condylomas are also called tumor Bushke-Lowenstein – in honor of the scientists who described it in the early 20th century.
The human papilloma virus is localized in the deep layers:
- mucous membranes.
However, he does not enters the bloodstream.
Skin and mucous membranes are constantly updated (there is a desquamation of old cells, and on their place appear new ones), and their deep layers are gradually migrating from the inside becoming outside – together with the moved cell and the virus. Clinical signs appear in that case when it reaches the surface of the skin and mucous membranes.
If a virus were on the surface, it means that he is able to infection. Viruses 6 and 11 types that provoke the development of anogenital condylomatosis, passes by contact – most often through sexual relations:
Other kinds of contacts theoretically can also lead to infection – in particular:
- domestic way (through hygiene items, linens, towels);
- during medical procedures which are carried out without proper protection (gloves, glasses).
But for confirming the route of infection is currently an insufficient evidence base (that is, cases where patients did not engage in sexual contact but infected HPV).
The incubation period – the time from infection to the appearance of genital warts is quite variable and can range from several weeks to several years. During this time the virus multiplies and develops in the deeper layers of tissue, so the media is a little contagious.
Genital warts develop:
- often in the area of the external genitalia (for small and large labia in women, the head of the penis and the scrotum in men);
- somewhat less – around the anus. Such warts are also called perianal.
Perianal warts very often appear in gay – however, their occurrence anal sex are not required. Once in the tissue, the human papillomavirus captures the penetration extensive area of the skin and mucous membranes – including, and in the perianal region which is very close to the outer sexual organs of both men and women.
In HIV-infected patients in the development of immunodeficiency syndrome warts grow to giant size very quickly (this feature is one of the most important diagnostic signs of the disease). Are accumulated that its bumpy like cauliflower. Such education is a risk factor for the development of squamous cell carcinoma (by the way, not only in HIV-infected patients).
Signs allowing to diagnose anogenital condylomatosis is:
- education and growth in the perianal region of papillary formations;
- feeling of discomfort;
- the constant feeling that the perineum is the foreign body;
A feeling of discomfort in the perianal region may occur:
- in a state of tranquility;
- through sexual contact;
- during a bowel movement;
- when riding a Bicycle or on horseback;
- during the sports.
Themselves warts if they are not irritated, does not cause pronounced pain. If severe pain in the region of spread of the warts are observed in a state of relative calm, then you should suspect the presence of comorbidity, for which the pain syndrome is characteristic (it is the uncomplicated and complicated hemorrhoids, fissure the anal canal, acute abscess, etc.).
But often the pain occurs after mechanical damage to the larger warts:
- when wearing too tight underwear;
- during hygienic procedures;
- with the active daily activities during Cycling
and so on.
The same goes for bleeding – genital warts bleed due to mechanical irritation. Blood exuding from the damaged warts minor, bleeding is not dangerous, but the allocation of dirty underwear and scaring very impressionable patients who think that the blood is from the anus or genitals because of a severe illness.
If you’re having large warts, that on the surface may be formed of a transparent (sometimes unclear) serous fluid exuding an unpleasant smell.
In a giant condyloma tissue can spontaneously without exposure to an external factor, Microtiterwells – in the thick of these growths are formed by fistulous passages with discharge of necrotic tissue. As the perianal region is one of the most polluted in the human body, very soon joins nonspecific inflammatory-infectious process that is capable of quickly progress. While there may be signs of General intoxication:
- constant headaches;
- fever and hyperthermia (increased temperature) and chills. Hyperthermia can achieve 38,0-38,5 degrees Celsius.
You must keep in mind the following clinical feature of the warts – they are prone to quite rapid growth.
It should also be remembered that the presence of warts causes problems:
Sexual problems in the anogenital condylomatosis the following:
- the reduction or complete disappearance of sexual desire;
- deterioration of potency in men and sexual activity in women;
- the lack of a sense of satisfaction from sexual intercourse;
- in giant warts – lack the technical ability to have sex (genital warts will not interfere with a full sexual intercourse).
Psychological manifestations due mainly to the following factors:
- people are complex due to the fact that his crotch for something to grow;
- develops suspicion towards his sexual partner “He/she was cheating on me so sick and made me sick/and”.
There are psychological abnormalities:
- sometimes tearfulness;
- depression or the opposite – a mild form of aggressiveness;
- the fear to engage in sexual relationship even after successful treatment.
The diagnosis of anogenital condylomatosis to put difficult, since the clinical picture is quite characteristic. Medical verdict pronounced on the basis of:
- complaints of the patient;
- data inspection. While visiting not only the perianal region, but the external genitals, as there can be formed condylomatous growths;
- instrumental methods of diagnostics;
- laboratory methods of examination.
On examination revealed:
- characteristic growths;
- often maceration (superficial erosion of the skin due to high humidity).
In addition to external inspection, conduct digital rectal exam for the presence of warts in the anal canal. The indication for the study are even a slight condylomatous growths around the anus. Characteristics of genital warts, which are found in the rectum:
- in the form of nodules;
- dense consistency.
Instrumental methods of examination, which are used in the diagnosis of anogenital condylomatosis is:
- anoscopy in the rectum administered rectally mirror, which expands the anus, followed by visual inspection of its mucosa;
- sigmoidoscopy – deeper than anoscope, study direct and primary departments of the sigmoid colon. It is performed in patients with suspected occurrence of malignant neoplasms in the place of genital warts. Performed sigmoidoscopy – endoscopic apparatus with mounted optics and lighting. During a sigmoidoscopy, you can see the redness (often – granular structure) of the mucous membrane of the rectum. When carrying out this method, biopsy – sampling of the changed tissues of the intestine and their subsequent study under a microscope.
Laboratory diagnostic methods that are used in the diagnosis of anorectal condylomatosis is:
- General blood test – elevated white cell count and erythrocyte sedimentation rate indicates the accession of inflammatory process (especially with the defeat of the giant condyloma);
- RPR-test – study to identify HIV and syphilis, which in recent years actively engaged in identifying anogenital condylomatosis. In order examine the fragments of the tissues of genital warts;
- histological examination of the tumor tissues Buske-Levenshtein in major nodes reveal cancer cells;
- the method of enzyme immunoassay (ELISA) with blood examined for the presence of specific antibodies (immunoglobulins class A, M and G) to antigens of an infectious agent that provokes or other infectious diseases. In the presence of anogenital condylomata blood detects antibodies to the human papillomavirus;
- PCR diagnostics (polymerase chain reaction) – using samples of biological material are determined by the DNA of pathogens. In the presence of anogenital condylomatosis detect DNA of human papillomavirus.
Differential diagnosis of
Differential diagnosis of anorectal condylomatosis often carried out with:
- syphilitic warts – for confirmation of their syphilitic nature of the use of the Wassermann reaction, which, when syphilis is positive ;
- contagious molluscum – it is defined in the form of a whitish growths in the form of plaques, which do not merge and have a wet flattened surface;
- malignant tumors of the anogenital region – to confirm the cancer diagnosis is carried out a histological study of biopsy material.
The most frequent complications that occur with anorectal condylomata is:
- the development of squamous cell carcinoma – in the formation of giant condyloma and the growth in the anal canal;
- inflammation of the warts;
- fistulas large warts;
- perianal dermatitis is an inflammation of the skin in the perianal region, which occurs because of wet skin irritation. Occurs if the prolonged anogenital condylomatosis.
Modern medicine yet unknown ways to the complete destruction of the human papillomavirus. Treatment is aimed at:
- relief of clinical symptoms;
- the prevention of complications;
- prevention of recurrence of the disease.
Tactics of treatment depends on such characteristics of genital warts, as they are:
- accompanying urogenital infections (infections of the genitourinary system);
- concomitant somatic pathology;
- overall health and the degree of weakening due to various reasons.
For small warts nalivayka the purpose of the following:
- treatment of warts solution of podophyllotoxin, which has a cauterizing effect. Thus it is necessary to ensure that the drug did not get on unaffected areas of the skin;
- local antivirals, which are used in order to suppress the reproduction and development of the virus and also prevent the recurrence of anogenital condylomatosis. For this purpose, use podofillotoksin, bromination and other drugs;
- General immunostimulatory therapy.
Common features of conservative treatment of the following:
- treatment for genital warts is prescribed to the patient, but also his sexual partner;
- during treatment should refrain from any sexual contact.
The most radical method to get rid of perianal warts is their removal. It is carried out using operative and non-operative methods such as:
- surgical excision within healthy tissue;
- the removal using a hydrocarbon laser;
- chemical cytodestructive for its use of concentrated solutions of acids and cytotoxic drugs.
Removal of warts – it is actually a palliative method (i.e., one that is struggling with the consequences of the disease but cannot eliminate the disease itself). When the papilloma virus remains in the tissues of the infected person, and when the surface location is capable of infecting a new “victim”.
In addition, warts can occur again after treatment, relapses occur in 30% of all clinical cases.
Also, be aware that the cauterization of the warts in the anal canal chemical compounds is impractical because on the one hand sufficiently effective, on the other – leads to the complications:
- inflammatory lesions;
- the formation of erosions (small defects) of the mucous membrane of the rectum.
Features of surgical removal of perianal genital warts following:
- it is less traumatic operation;
- often done under local anesthesia.
If the growth is solid, it requires:
- operation under General anesthesia;
- sometimes the removal of multiple or giant growths in several stages;
- prolonged postoperative observation.
The most effective method of relieve the patient’s anogenital condylomatosis is combined treatment is removal of warts and the use of immunostimulatory drugs of General validity. This scheme not only cures the patient, but also allows to reduce the likelihood of recurrence of anogenital condylomatosis.
The most reliable ways to prevent anogenital condylomatosis this:
- sex life with one partner, who also passed preventive examination at venereologist;
- refusal of casual sex;
- observance of personal hygiene.
Prevention of recurrence of anogenital condylomatosis is a complex treatment with the use of antiviral agents and immune therapy, and immune support.
Prevention of recurrence of genital warts after the surgical treatment is:
As immune therapy is prescribed:
- its inducers (substances which, in contact with cells and tissues induce the production of interferon).
The positive role of immunotherapy it is also noted in the prevention of malignant transformation (turning into a malignant tumor) condylomatous growths that there is a high risk of degeneration. Also after completing the treatment course of combined immunological treatment number of patients who had positive DNA test for HPV is reduced in two times.
Forecast favorable for life (warts people do not die), health is different. Perianal condylomas have a tendency to relapses, as in the case of a conservative treatment and after surgical removal of the growths probability of recurrence in both cases is almost identical.
If the tissues of the warts revealed malignant cells, the prognosis is poor and requires actions on the part of oncologists.
Kovtonyuk O. V., medical columnist, surgeon, consultant physician