Anogenitalny is a growth of peaked condylomas in an anus and a crotch. It is shown by feelings of discomfort and a foreign matter in the field of an anus, an anal itch, feeling of humidity, morbidity at defecation. Pathology becomes a source of psychological and sexual problems. There is a risk of traumatizing educations with bleeding and the subsequent infection. Perhaps malignant regeneration. The diagnosis is exposed on the basis of the given survey, laboratory and tool researches. Treatment includes removal of condylomas, purpose of means for immunity stimulation.
Anogenitalny – the disease which is characterized by emergence in the field of back pass and genitals of peaked condylomas which can expand to the huge sizes and closes an anus. The congestion of peaked condylomas reminds by the form a cauliflower. The huge condyloma is called still Bushke-Levenstein's tumor (the scientists who for the first time described such phenomenon in 1925).
Reasons and risk factors
Anogenitalny results from infection with a virus of papilloma of the person of 6 and 11 types. This virus is very widespread, causes different diseases of integuments and mucous membranes. Today more than 100 kinds of a virus provoking various pathologies (diverse types of warts, condylomas, papillomas) are revealed.
The virus of papilloma of the person is carried to one of the most widespread infections, sexually transmitted. More than a half of the people leading sex life are carriers of this virus (often several of its types). In most cases virus infection carrier state proceeds asymptomatically. Developing of condylomas is observed no more than in 1-2% of cases of virus infection carrier state of the corresponding type. It is supposed that emergence of peaked condylomas in the people infected with VPCh 6 or 11 of types requires also general and local weakening of immune protection.
The statistics shows the high frequency of incidence of perianalny condylomas among homosexuals, however localization of peaked condylomas in the field of an anus at all not necessarily is result of anal sexual contact. At infection the virus gets into quite extensive zone of skin and mucous covers in genitals, and the perianalny area is located as to genitals of men, and women in close proximity.
The virus of papilloma of the person settles down in cages of deep layers of skin and mucous membranes sexual, without getting into a blood-groove. In process of updating of integumentary fabrics and advance of deep layers to a surface together with cages also the virus which having reached the surface of skin migrates, causes development of clinical symptoms. The virus which left to a surface becomes capable to infection. Infection with the virus causing peaked condylomas happens in the contact way. Most often infection occurs at sexual contacts (vaginal, anal, is much more rare – oral). Infection with a household image, probably, is possible, but for the statement of probability of such way of transfer there are not enough sufficient evidential data.
From infection with a virus before emergence and growth of peaked condylomas can pass as several weeks, and several years. The virus develops in deep layers at this time and does not come to a surface. Such asymptomatic carriage is usually poorly infectious. Localization of peaked condylomas most often in genitals (at men on a penis head, at women on small and big vulvar lips), but it is frequent both at women, and at men of a condyloma expand in an anus. Such condylomas also call perianalny.
Symptoms of an anogenitalny kondilomatoz
The disease is shown by emergence and growth in the field of an anus of sosochkovidny educations, feeling of discomfort, presence of a foreign matter at a crotch zone. Often in the field of back pass maceration (moknuty) skin takes place. Big condylomas can mechanically be damaged, morbidity and bloody separated results.
Big condylomas are capable to sekretirovat liquid with an unpleasant smell, in the thickness of huge growths the svishcheobrazny courses can appear. Accession of an inflammation promotes development of symptoms of the general intoxication (fever, weakness, a headache). Perianalny condylomas can grow with quite high speed, however the expressed morbidity is not characteristic of this disease. If intensive pains in the field of an anus take place, it is necessary to assume any accompanying pathology (hemorrhoids, an anal crack, paraproktit, etc.).
Perianalny condylomas have tendency to development of a recurrence, both in case of performing conservative treatment, and after surgical removal of growths. In cases of formation of huge condylomas and emergence of growths in the anal channel is some probability of development of planocellular cancer therefore remote condylomas are exposed to a histologic research, and patients with Bushke-Levenstein's tumors (huge condylomas) are subject to careful survey and inspection.
Besides, large condylomas can be damaged and bleed, the area struck kondilomatozy is inclined to development of inflammatory process. Owing to long existence of growths in the field of an anus long maceration of skin promotes her irritation and development of perianalny dermatitis.
Diagnostics and difdiagnostika
The clinical picture of an anogenitalny kondilomatoz is rather characteristic, the diagnosis is made on the basis of given survey and detection of peaked perianalny condylomas. Besides, make careful survey of genitals as there can also be growths.
For the purpose of detection of condylomas in the anal channel the doctor-proctologist makes a manual research. The indication to it is detection even of small educations in perianalny area. At inspection of the anal channel peaked condylomas are probed as small small knots of a dense consistence. Huge perianalny condylomas quite often are followed by damage of a mucous membrane of the anal channel. With the same purpose (detection of peaked condylomas in the anal channel) make an anoskopiya.
At HIV-positive persons with the developing syndrome of an immunodeficiency of a condyloma are inclined to expand quickly to the huge sizes, forming the congestions reminding a cauliflower (Bushke-Levenstein's tumor). Such tumors are risk factor of development of planocellular cancer, in particular at patients with HIV infection. The histologic research can reveal invasive components of cancer in large knots of this tumor. At patients with suspicion on a malignant new growth the rektoromanoskopiya is surely made. Often during this research note hyperaemia (sometimes granularity) a mucous rectum. In the rectum (above the anorektalny line) peaked condylomas are not noted.
At identification of an anogenitalny kondilomatoz all patients are exposed to a research for detection of HIV and syphilis (RPR test). Confirmation of the diagnosis is made on the basis of a cytologic and histologic research of bioptat of condylomas. Besides, in blood by IFA method antibodies to a virus of papilloma of the person can be found. Also release of DNA of a virus from cells of the struck fabric is carried out by PTsR-diagnostics method.
Differentiate peaked condylomas generally with condylomas syphilitic and a contagious mollusk. The contagious mollusk is usually shown by whitish growths in the form of not merging plaques with a damp flat surface. Syphilitic condylomas suspect of a case of identification of positive reaction of Wasserman. Final diagnostics is made after obtaining results of the serological analysis. identifications of these or those antibodies and after the conclusion of the venereologist. At detection of peaked condylomas inspection concerning HIV and other infections, sexually transmitted is made. In differential diagnostics of a kondilomatoz and malignant new growths the main role is played by a cytologic research.
Treatment of an anogenitalny kondilomatoz
The modern medicine does not know ways of final destruction of a virus of papilloma of the person therefore treatment is directed to disposal of symptoms and the prevention of development of a recurrence of complications. Expeditious removal of condylomas does not exclude the subsequent transfer of a virus to the partner as the patient remains a virus carrier, and at a superficial arrangement in skin of the infected cages can be an infection source. Development of a recurrence after treatment of perianalny condylomas happens at 30% of patients.
Tactics of treatment is chosen individually depending on the sizes, by quantities, localizations of peaked condylomas, the accompanying urogenital infections and the general condition of an organism. The small perianalny condylomas which are not merging in conglomerates are subject to conservative treatment. Condylomas cauterize by means of solution of a podofillotoksin (applying it on the affected skin with the special stick going complete with medicine). It is necessary to avoid hit of medicine on not affected areas of skin. For the purpose of suppression of reproduction of a virus and prevention of a recurrence appoint local antiviral means (, ). Means of local action combine with the general immunostimulating therapy.
The most radical technique of disposal of perianalny condylomas is their surgical removal. Growths excise within not changed fabrics, delete by means of the hydrocarbonic laser, apply methods of chemical cytodestruction (the concentrated solutions of caustic acids, cytotoxic medicines). However techniques of removal of condylomas in most cases do not conduct to the prevention of their repeated development as the virus of papilloma of the person continues to develop in deep layers of surrounding fabrics. Besides, cauterization by chemical reagents of condylomas in the anal channel is inexpedient as insufficiently effectively and leads to development of complications (a local inflammation, an itch, a moknutiya and an erozirovaniye of mucous).
Regular courses of the general therapy by means of interferon and its inductors, other immunostimulators promote the prevention of development of perianalny condylomas again, after their removal. At once upon termination of a medical course of the combined immunotherapy the number of patients with positive DNA test on VPCh decreases by one and a half-two times. Especially It should be noted a positive role of an immunotherapy in prevention of an ozlokachestvleniye of growths with high cancerogenic risk. The risk of an onkogennost at the patients who received immunotherapeutic treatment also decreases almost twice.
Treatment of anogenitalny condylomas is appointed as directly addressed person, and his sexual partner. For the period of treatment it is recommended to refuse sexual contacts. The combined therapy combining methods of cytodestruction of the available growths with purpose of immunoexcitants of the general action represents the most effective scheme of treatment promoting improvement of quality of life and decrease in probability of repeated development of clinical displays of a disease.
Expeditious removal of perianalny condylomas is, as a rule, carried out under local anesthesia and belongs to low-traumatic interventions. The general anesthesia and long postoperative observation is required in need of removal of extensive growths. At numerous condylomas, and also at huge growths, their surgical removal in several stages is possible. One-stage excision of big condylomas is not recommended as the formed extensive defects of fabrics hardly begin to live and can lead to deformations of perianalny area.
Forecast and prevention
Regardless of a technique of removal of condylomas, the probability of a recurrence in all cases is almost identical. Prevention of a retsidivirovaniye of an anogenitalny kondilomatoz is complex treatment with application of antiviral means and immune therapy, and also immunity maintenance, regular carrying out courses of therapy under control of the expert. At identification in morphological structure of condylomas of malignant cages the forecast adverse.