Condylomas (peaked condylomas) - a kind of the viral warts representing soft sosochkovidny educations on a leg, inclined to merge. Merging, form colonies, resembling a species of a cauliflower superficially. Arise in anogenitalny area more often. Bring discomfort in genitals, psychological inconveniences, sexual problems. Travmatization of condylomas leads to their infection and is followed by allocations with an unpleasant smell, an itch and pain. Can recur, . The virus is transmitted sexually. Treatment consists at a distance condylomas (the laser, liquid nitrogen, radionozhy, a usual scalpel) against the background of system antiviral therapy.
The virus of papilloma of the person – the filtering virus causing emergence on skin and mucous membranes of the person small is more often than multiple, opukholevidny formations of good-quality character. It is shown in the form of viral warts or peaked condylomas. The chronic recidivous current, wide circulation, a high susceptibility is characteristic of the virus of papilloma of the person (VPP). Human papillomavirus infections of a genital tract make risk group on emergence of malignant new growths of genitals and development of bleedings.
The peaked condylomas which are often called by sexual warts represent new growths of skin and mucous genitals, caused by the virus of papilloma of the person (VPP). It is one of the most frequent displays of a human papillomavirus infection which is characterized by long, chronic, recidivous character of a current. Usually, condylomas represent the nipples of corporal color having a lobular structure and a leg, but can also expand before massive educations which type reminds a cauliflower.
Condylomas more often on genitals settle down (at women – on vulvar lips, a vagina, a uterus neck; at men – on a head of a penis, extreme flesh), also in an anus and a crotch, is more rare in a mouth.
Peaked condylomas concern to group of infections from sexually transfer (STD) therefore the venereology is engaged in their diagnostics and treatment generally. However women, as a rule, come with this problem to consultation of the gynecologist and are treated at him. Men address the urologist. And the proctologist most often faces condylomas of anal area.
The main spread of the VPCh-infection usually happens at vaginal, oral, or anal sexual contacts with the infected partner. Peaked condylomas usually develop in the places which are exposed to traumatizing at sexual contact. VPCh can be transferred to time of sexual intercourse with the scales peeling from condylomas, and at women also to get into a vagina and a neck of a uterus from genitalia at application of hygienic tampons during periods.
Also pre-natal transfer of a virus from the infected mother to a fruit, and infection of the child in labor in the presence of active VPCh or condylomas on mucous genitals of the pregnant woman is possible.
Risk factors of infection with peaked condylomas
The virus of papilloma of the person is widespread and possesses high degree of contageousness. More than a half of the people having sex is infected with one or several strains of VPCh. In a human body of VPCh changes the nature of growth of fabrics that leads to diseases of skin and mucous (peaked condylomas, warts, papillomas, a dysplasia and a carcinoma of a neck of a uterus). There are more than 100 strains of VPCh, and different strains cause various diseases, including precancer. Strains of VPCh (6 and 11) strike mainly urogenital path and cause development of peaked anogenitalny condylomas.
Emergence of a human papillomavirus infection and its further development is caused by easing of immunity of the person. The asymptomatic current is characteristic of this infection, at many infected people it is not shown in any way. Most of people – carriers of the corresponding strains of VPCh, do not get sick with peaked condylomas. Treat the factors increasing risk of infection with peaked condylomas:
- the postponed STD (clamidiosis, gonorrhea, trichomoniasis, herpes, candidiasis, etc.);
- free sexual behavior (at frequent change of sexual partners, through the partner who had earlier sexual contact with the VPCh carrier);
- internal factors of an organism (the reduced immunity, lack of vitamins, susceptibility to stresses);
- vagina dysbacteriosis.
Ways of development of an infection of VPCh (peaked condylomas)
Development of an infection of VPCh is defined by a condition of immune reactions of an organism, depending on it, the most possible options of development of a human papillomavirus infection (including, condylomas) are:
- self-healing, regress of condylomas, (in particular, appeared during pregnancy);
- lack of any dynamics during the long period of time;
- gradual or rapid growth of condylomas (increase in the size, quantity);
- malignant regeneration of condylomas.
On degree of risk of development of oncological process allocate several groups of strains of VPCh:
- low degree of risk
- average degree of risk
- high risk
Strains of VPCh of average and a high risk (mainly, 16, 18, 31, 33 and 35) cause development of a dysplasia of a neck of a uterus and increase risk of a disease of uterus neck cancer, but do not cause development of peaked condylomas. Strains of VPCh of low risk (first of all, 6 and 11) provoke emergence of peaked condylomas, however do not cause a uterus neck dysplasia. The women infected with VPCh of a high risk have to undergo regularly inspection (onkotsitologiya) for timely detection of a dysplasia of a neck of a uterus.
At the complicated option of development of anogenitalny condylomas there can be their traumatizing and infection, to be observed bleeding. Besides, condylomas of genital area interfere with normal sexual life and normal childbirth, cause feeling of psychological discomfort because of existence of cosmetic defect.
Pathogenesis and displays of peaked condylomas
Papillomavirusny an infection is transmitted from the person to the person, and it is at the same time possible to catch several types of a papillomavirus. VPCh lives in cells of skin and mucous membranes. The long time a human papillomavirus infection can proceed is reserved (latentno). In cages enough a virus that there were clinical symptoms of a human papillomavirus infection has to collect. Reproduction of VPCh and its quantity in an organism depend on the level of immune protection. Under the influence of various factors reducing local and general immunity there is an activation of a virus, its reproduction and development of skin manifestations.
Having got to an organism, VPCh strikes epitelialny cages (especially, a zone of transition of a multilayered flat epithelium to cylindrical). In the infected cage the virus can be in two forms: episomalny (out of cellular chromosomes - a good-quality form) and introsomalny – integrated (as a part of a cellular genome – a malignant form).
At the latent course of an infection of VPCh exists in an episomalny form, without leading to pathological changes in cages and without causing clinical manifestations.
Having bred in a large number, VPCh changes growth and development of epitelialny cages. They begin to share strenuously and uncontrolledly, there is a growth of the site of an integument or mucous and formation of a peaked condyloma. Them there can be several pieces, and sometimes and several tens. Anogenitalny condylomas often arise in one stage, is more rare within several days.
At men peaked condylomas most often are on a penis head (a coronal furrow) and extreme flesh (a bridle and an internal leaf), is more rare - a penis body, a scrotum, about an anus and an opening of an urethra. Emergence of condylomas in an urethra causes unpleasant feelings, the complicated urination, spraying of a stream of urine.
At women of a condyloma most often appear in small vulvar lips (a bridle, a clitoris), crotches and openings of an urethra are more rare in a vagina, on big vulvar lips, on a uterus neck, in the field of an anus. Peaked condylomas of a vagina and neck of a uterus can be found only during gynecologic survey.
Extremely seldom peaked condylomas develop in a mouth. At constant mechanical damage of a condyloma about 3-5 cm in the diameter can increase.
Except anogenitalny, also other kinds of peaked condylomas meet:
- Papular warts - dark red color, have the dome-shaped form and a smooth surface, are on completely horny epithelium.
- Keratotichesky warts – resemble a cauliflower superficially, usually settle down on a penis trunk, a scrotum, vulvar lips.
- The huge condyloma - develops at pregnancy, at patients with the reduced immunity.
- Endourethral condylomas – are localized in an urethra, occur generally at men.
- Uterus neck condylomas:
- ekzofitny (external) condylomas - practically do not differ from anogenitalny condylomas
- endofitny (internal) flat condylomas - settle down in the thickness of tissues of a vagina and neck of a uterus of an epithelium, they cannot be found at usual survey. Come to light at a kolposkopiya, are often combined with a dysplasia and sometimes with a preinvazivny carcinoma of a neck of a uterus, ozlokachestvleniye constitute danger
- warty epidermodisplaziya - multiple polymorphic flat papules - red color with a warty surface.
Diagnosis of an infection of VPCh (peaked condylomas)
Diagnosis of a human papillomavirus infection includes:
- clinical examination
In the presence of typical forms of peaked condylomas definition of a strain of VPCh is not obligatory. At men peaked condylomas quite often confuse to a papular necklace of a penis (norm option). At women sometimes take for peaked condylomas vulvar lips (norm option). At suspicion of peaked condylomas it is necessary to exclude other diseases (a contagious mollusk, wide condylomas at syphilis).
- carrying out an expanded kolposkopiya, uretroskopiya (at suspicion of endourethral condylomas);
- cytologic research of dab from the tservikalny channel on atypical cages for a uterus neck dysplasia exception;
- histologic research;
- PTsR – diagnostics (definition and typing of VPCh);
- immunological research (existence in blood of antibodies to VPCh).
Methods of treatment of peaked condylomas
Unfortunately, it is not possible to any of modern methods of treatment to get rid of VPCh completely, also as it is impossible to guarantee also lack of a recurrence of developing of condylomas. It is impossible to exclude also self-spread of condylomas, emergence all of the new centers on other sites of skin or mucous.
On VPCh resistant immunity is not developed, it is possible to catch and ache with condylomas repeatedly if the sexual partner was not treated or rules of safe sex were not followed.
In the main way of treatment there is a removal of condylomas by various methods, each of which has indications, restrictions, contraindications. Treatment of condylomas is carried out under local anesthesia and almost without serious consequences.
When carrying out a lazerokoagulyation (the neodymium or carbonic laser) fabric of a condyloma evaporates with education on its place of a dry crust - a scab. The radio wave method or a radio knife quickly and almost without serious consequences deletes condylomas. Cryodestruction (liquid nitrogen) "freezes" a condyloma, however this method is not recommended to be applied at not giving birth women. Electrothermic coagulation is based on impact on condylomas by means of an electrode (electroknife) passing high-frequency current.
To destruction and removal of condylomas also locally apply chemicals - cytotoxic medicines – , , , , ftoruratsit.
The risk of a recurrence of a human papillomavirus infection is high (30%) at any way of treatment as the virus remains in other cells of skin and mucous. Therefore include protivoretsedivny (antiviral) therapy of VPCh in a complex of treatment of anogenitalny condylomas. Apply the medicines increasing immunity (a meglyumin , , , immunomax.). Domestic antiviral medicine on the basis of an alloferon (in injections) is developed for treatment of herpes and a human papillomavirus infection.
It is necessary to carry out virologic control of an izlechennost of condylomas. Annual histologic inspection is recommended to women with peaked condylomas.
Prevention of an infection of VPCh (peaked condylomas)
Measures of prevention of a human papillomavirus infection (peaked condylomas, in particular) include: