Condyloma are a type of viral warts, which are soft papillary formations on the leg, prone to fusion. Merging, they form colonies, outwardly resembling the appearance of cauliflower. They occur more often in the anogenital region. They cause discomfort in the genital area, psychological inconvenience, sexual problems. Traumatization of condyloma leads to their infection and is accompanied by discharge with an unpleasant odor, itching and pain. They may recur, become malignant. The virus is transmitted sexually. Treatment consists in the removal of warts (laser, liquid nitrogen, radionog, conventional scalpel) against the background of systemic antiviral therapy.
Human papillomavirus is a filtering virus that causes the appearance of small, often multiple, tumor–like formations of a benign nature on the skin and mucous membranes of a person. It manifests itself in the form of viral warts or genital warts. The human papillomavirus (HPV) is characterized by a chronic recurrent course, widespread, and high susceptibility. Papilomavirus infections of the genital tract constitute a risk group for the occurrence of malignant neoplasms of the genital organs and the development of bleeding.
Genital warts, often referred to as genital warts, are neoplasms of the skin and mucous membrane of the genital organs caused by the human papillomavirus (HPV). This is one of the most frequent manifestations of papillomavirus infection, characterized by a long, chronic, recurrent nature of the course. Usually, condyloma are flesh-colored papillae with a lobed structure and a leg, but they can also grow to massive formations, the appearance of which resembles cauliflower.
Condyloma are located more often on the genitals (in women – on the labia, vagina, cervix; in men – on the head of the penis, foreskin), also in the anal opening and perineum, less often in the mouth.
Genital warts belong to the group of sexually transmitted infections (STIs), so their diagnosis and treatment is mainly engaged in venereology. However, women, as a rule, come with this problem to a gynecologist’s consultation and are treated by him. Men turn to a urologist. And with condyloma of the anal area, the proctologist most often encounters.
The main spread of HPV infection usually occurs during vaginal, oral, or anal sexual contact with an infected partner. Genital warts usually appear in places that are traumatized by sexual contact. HPV can be transferred during sexual intercourse with scales exfoliating with warts, and in women it can also get into the vagina and cervix from the external genitals when using hygienic tampons during menstruation.
Intrauterine transmission of the virus from an infected mother to the fetus is also possible, and infection of the child in childbirth in the presence of active HPV or warts on the mucous membranes of the genitals of a pregnant woman.
The human papillomavirus is widespread and has a high degree of contagiousness. More than half of sexually active people are infected with one or more HPV strains. In the human body, HPV changes the nature of tissue growth, which leads to diseases of the skin and mucous membranes (genital warts, warts, papillomas, dysplasia and cervical carcinoma). There are more than 100 HPV strains, and different strains cause various diseases, including precancerous ones. HPV strains (6 and 11) mainly affect the urogenital tract and cause the development of acute anogenital condyloma.
The appearance of papillomavirus infection and its further development is caused by a weakening of human immunity. This infection is characterized by an asymptomatic course, in many infected people it does not manifest itself in any way. Most people who carry the corresponding HPV strains do not get genital warts. Factors that increase the risk of infection with genital warts include:
- transferred STDs (chlamydia, gonorrhea, trichomoniasis, herpes, candidiasis, etc.);
- free sexual behavior (with frequent change of sexual partners, through a partner who has previously had sexual contact with an HPV carrier);
- internal factors of the body (reduced immunity, lack of vitamins, susceptibility to stress);
- dysbiosis of the vagina.
Ways of developing HPV infection
The development of HPV infection is determined by the state of the immune reactions of the body, depending on this, the most possible options for the development of papillomavirus infection (including warts) are:
- self-healing, regression of warts, (in particular, those that appeared during pregnancy);
- the absence of any dynamics for a long period of time;
- gradual or rapid growth of warts (increase in size, quantity);
- malignant degeneration of condyloma.
According to the degree of risk of the development of the oncological process, several groups of HPV strains are distinguished:
- low-risk non-oncogenic
- medium risk
- high risk
Medium and high-risk HPV strains (mainly 16, 18, 31, 33 and 35) cause the development of cervical dysplasia and increase the risk of cervical cancer, but do not cause the development of genital warts. Low-risk HPV strains (primarily 6 and 11) provoke the appearance of genital warts, but do not cause cervical dysplasia. Women infected with high-risk HPV should undergo regular examination (oncocytology) for timely detection of cervical dysplasia.
With a complicated variant of the development of anogenital condyloma, their injury and infection may occur, bleeding may occur. In addition, genital warts interfere with normal sexual life and normal childbirth, cause a feeling of psychological discomfort due to the presence of a cosmetic defect.
Pathogenesis and manifestations
Papillomavirus infection is transmitted from person to person, and several types of papillomavirus can be infected at the same time. HPV lives in the cells of the skin and mucous membranes. For a long time, papillomavirus infection can occur covertly (latently). Enough virus must accumulate in the cells to cause clinical symptoms of papillomavirus infection. The reproduction of HPV and its amount in the body depend on the level of immune protection. Under the influence of various factors that reduce local and general immunity, the virus is activated, its reproduction and the development of skin manifestations.
Once in the body, HPV affects epithelial cells (especially, the transition zone of a multilayer flat epithelium into a cylindrical one). In an infected cell, the virus can be in two forms: episomal (benign form outside the cell chromosomes) and introsomal – integrated (malignant form within the cell genome).
In the latent course of infection, HPV exists in an episomal form, without leading to pathological changes in cells and without causing clinical manifestations.
Multiplying in large numbers, HPV alters the growth and development of epithelial cells. They begin to divide intensively and uncontrollably, there is a proliferation of a section of the skin or mucous membrane and the formation of a pointed condyloma. There may be several pieces of them, and sometimes several dozen. Anogenital warts often occur simultaneously, less often within a few days.
In men, genital warts are most often found on the head of the penis (coronal furrow) and the foreskin (frenulum and inner leaf), less often on the body of the penis, scrotum, near the anus and the opening of the urethra. The appearance of condyloma in the urethra causes unpleasant sensations, difficulty urinating, splashing of urine.
In women, condyloma most often appear in the area of the labia minora (frenulum, clitoris), less often in the vagina, on the labia majora, on the cervix, in the anus, perineum and urethral orifice. Genital warts of the vagina and cervix can only be detected during a gynecological examination.
Extremely rarely, genital warts develop in the oral cavity. With constant mechanical damage, warts can increase up to 3-5 cm in diameter.
In addition to anogenital, there are other varieties of genital warts:
- Papular warts are dark red in color, have a domed shape and a smooth surface, are located on a completely keratinized epithelium.
- Keratotic warts – outwardly resemble cauliflower, usually located on the trunk of the penis, scrotum, labia.
- Giant condyloma – develops during pregnancy, in patients with reduced immunity.
- Endourethral condyloma – localized in the urethra, occur mainly in men.
- Cervical condyloma:
- exophytic (external) condyloma – practically do not differ from anogenital condyloma
- endophytic (internal) flat condyloma are located in the thickness of the tissues of the vagina and cervix of the epithelium, they cannot be detected during a routine examination. They are detected by colposcopy, are often combined with dysplasia and sometimes with preinvasive cervical carcinoma, and pose a risk of malignancy
- warty epidermodysplasia is multiple polymorphic flat papules of pinkish – red color with a warty surface.
Diagnosis of HPV infection
Diagnosis of papillomovirus infection includes:
- clinical examination
In the presence of typical forms of genital warts, the definition of the HPV strain is not necessary. In men, genital warts are often confused with a papular necklace of the penis (a variant of the norm). In women, micro-papillomatosis of the labia is sometimes mistaken for genital warts (a variant of the norm). If acute warts are suspected, it is necessary to exclude other diseases (contagious mollusc, broad warts with syphilis).
- performing extended colposcopy, urethroscopy (if endourethral condyloma are suspected);
- cytological examination of a smear from the cervical canal on atypical cells to exclude cervical dysplasia;
- histological examination;
- PCR diagnostics (HPV detection and typing);
- immunological examination (presence of HPV antibodies in the blood).
Those infected with genital warts are necessarily examined for syphilis, HIV and other STIs.
Unfortunately, it is not possible to get rid of HPV completely by any of the modern methods of treatment, as well as it is impossible to guarantee the absence of relapses of warts. It is impossible to exclude the self-propagation of warts, the appearance of new foci on other areas of the skin or mucous membrane.
HPV does not produce a stable immunity, warts can be infected and get sick again if the sexual partner was not treated or the rules of safe sex were not followed.
The main method of treatment remains the removal of warts by various methods, each of which has its own indications, limitations, contraindications. The treatment of warts is carried out under local anesthesia and is practically painless.
During laser coagulation (neodymium or carbon dioxide laser), the condyloma tissue evaporates with the formation of a dry crust in its place – a scab. The radio wave method or radionog quickly and almost painlessly removes warts. Cryodestruction (with liquid nitrogen) “freezes” condyloma, however, this method is not recommended for use in nulliparous women. Electrocoagulation is based on the effect on condyloma using an electrode (electron knife) that passes a high-frequency current.
Chemicals – cytotoxic drugs – podophyllinotoxin, podophylline, imiquimod, ferezol, fluorouracil are also locally used for the destruction and removal of condyloma.
The risk of relapse of papillomavirus infection is high (30%) with any method of treatment, since the virus persists in other cells of the skin and mucosa. Therefore, the complex of treatment of anogenital condyloma includes anti-inflammatory (antiviral) HPV therapy. They use drugs that increase immunity (meglumine acridonacetate, lycopide, panavir, immunomax). A domestic antiviral drug based on alloferon (in injections) has been developed for the treatment of herpes and papillomavirus infection.
It is necessary to carry out virological control of the cure of warts. Annual histological examination is recommended for women with genital warts.
Prevention measures of papillomavirus infection (genital warts, in particular) include:
- use of barrier contraception (condoms);
- elimination of factors that cause a decrease in immunity (vitamin deficiency, hypothermia, smoking and alcohol abuse, stress and fatigue).
- vaccination against cervical cancer. Vaccination is carried out for girls from 11-12 years old, three times.