Anogenital condylomatosis
Anogenital condylomatosis is a pathological condition characterized by the spread of genital warts in the anal area and on the mucous membranes of the genitals. The occurrence of this kind of outgrowth is provoked by human papillomavirus (or HPV), infection of which occurs sexually.
The content of the article:
Causes of anogenital condylomatosis
Symptoms and clinical course
Diagnosis of anogenital condylomatosis
Complications of anogenital condylomatosis
Treatment of anogenital condylomatosis
Forecast
Anogenital condylomatosis
When infected, the virus is activated, prompting epithelial cells to divide uncontrollably, which manifests itself in the form of mastoid thickenings on the skin that have a gray or pinkish hue, causing itching, discomfort and periodic bleeding. The formation of genital warts around the anus in most cases is accompanied by damage to the anal canal, which leads to difficulty defecating and pain. Sometimes there is a fusion of genital warts into a single giant Bushke-Levenstein tumor.
If this disease is affected in a mild form, treatment is carried out by chemical cauterization with special drugs. In other cases, surgical intervention is necessary. Since the probability of recurrence of condylomatosis is high, treatment carried out by surgical removal of condyloma is combined with the use of immunopreparations.
In rare cases, this form of HPV can cause cancerous tumors. HPV vaccination is recommended as a prevention of condylomatosis.
Causes of anogenital condylomatosis
The formation of genital warts in the anus and mucous genitals is a consequence of infection with the papilloma virus, which occurs as a result of sexual contact, with direct contact of the mucous membrane of the genital organ or anus with the carrier’s condyloma.
There are about forty types of virus that lead to this pathological formation, but the main types are E6 and E11. The human papillomavirus can stay in the inner layers of the skin or in the mucous membranes of the genitals for a long time in a latent, asymptomatic state and manifest itself as condylomatosis only if immunity is weakened as a result of stress, various infectious diseases or pregnancy. Factors favorable for the development of condylomatosis are also heat, maceration and sweating of the skin.
Despite the high prevalence of papillomavirus diseases among the population, condylomatous formations occur only in 2% of all cases of infection. The most common types of infection leading to this complication — the sixth and eleventh — are oncogenic.
Most often, papillomas grow in the genital area, however, the occurrence of such formations in the anus is not uncommon, especially among homosexuals.
Symptoms and clinical course
In most cases, anogenital condylomatosis proceeds without any complications, delivering only discomfort, manifested as a sensation of a foreign body in the anal-genital area, as well as itching, sweating and bleeding when the condyloma is damaged. However, in a particularly neglected state, the effects of intoxication may manifest themselves, such as weakness, headache and fever.
The period of asymptomatic development of condylomatosis is about three months, after which acanthosis occurs — single villi-like outgrowths of a pinkish hue appear on the skin, which gradually grow into pineal seals. Over time, warts acquire a bright red color, deform under the influence of maceration and erosion.
Diagnosis of anogenital condylomatosis
Usually, formations such as pointed condylomas in the form of seals with mastoid outgrowths or Buschke-Levenstein condylomas are easily detected by visual examination of the perianal region and the external genitalia of the patient. However, it is not uncommon for foci of this disease to develop in areas that are difficult to access for examination, such as the urethra, anal canal or vagina. Therefore, if anogenital condylomatosis is suspected, as a rule, an examination of the cervix and the inner part of the anus is carried out.
How is the diagnosis carried out
Examination of the perianal area is combined with an anoscopic examination or palpation of the walls of the anal canal in order to detect small dense formations. The presence of anogenital candylomas in the inner walls is confirmed in 78% of cases.
When examining the vagina, a colposcopy is performed with the extraction of a biopsy for cytological and histological analyses.
When examining male genitals, first of all attention is paid to the head of the penis, the frenulum of the foreskin and the scrotum.
In cases where, for some reason, the patient’s immunity is significantly weakened, pointed papillomas can coalesce into a giant bundle – the Bushke—Levenstein condyloma. Under these circumstances, there is a serious risk of further development of this formation into a cancerous tumor, which requires additional oncological studies.
Differential diagnosis
In fact, the detection of the disease in question occurs during the direct diagnosis of human papillomavirus infection, which is the cause of its occurrence.
Thus, the diagnostic task is to determine the type of HPV infectious disease that led to the development of warty growths. In addition, it is mandatory to conduct a blood test for HIV, syphilis and other sexually transmitted diseases, often associated with the papilloma virus.
Colposcopy
When a papillomavirus is detected in the cervix, a colposcopy is performed together with an acetic Acid Test. The use of Lugol’s iodine solution leads to the staining of epithelial areas affected by HPV in a whitish color.
Biopsy
Clarification of the diagnosis is carried out by biopsy. A biopsy of a genital wart is subjected to various histological and cytological studies. With the help of these methods, the presence of special signs is established that allow differentiating anogenital condylomatosis from similar syphilitic formations, spinocellular epitheloma or vegetative pemphigus.
Histological examination reveals acanthosis, parakeratosis and papillomatosis of the stratum corneum. In addition, to clarify the diagnosis, the presence of coilocytes with pronounced perinuclear vacuolization and hyperchromic nuclei in the deep layers of the epithelium should be established.
Polymerase Chain Reaction
The most effective method in the differential diagnosis of condylomatosis is PCR or Polymerase Chain Reaction. The essence of this method is to increase the concentrations of certain fragments of deoxyribonucleic acid in relation to the total content of the biopsy.
DNA amplification
The DNA amplification method allows not only to differentiate genital warts from other similar growths, but also to most accurately determine the type of HPV that provoked anogenital condylomatosis. However, since outbreaks of papillomavirus cell damage are usually short-lived and completely suppressed by the immune system of the subject, there is a 20% chance of receiving false positive tests.
Digene test
Digene test is used to determine the level of highly oncogenic types of papilloma virus in cells. It is carried out by collecting, with the help of a special brush, epithelial cells from the walls of the cervix. The samples are placed in a special solution for further study. The data obtained allow us to determine the type of HPV, the risk of developing cancer, as well as its stage.
Complications of anogenital condylomatosis
In rare cases, with sufficiently weakened immunity (such as in people suffering from HIV infection), anogenital condylomas are combined into one large formation — the Bushke-Levenstein condyloma, whose dimensions can reach up to 30 cm in diameter.
Giant-sized condyloma usually forms in the area of the coronal furrow, on the head of the penis or in the inner fold of the foreskin. However, there are cases when the tumor grows around the anal canal or on the mucous membranes of the female genital organs. In especially rare cases, localization is possible in the urethra, on the face or in the axillary fold, as well as in the oral cavity.
Bushke-Levenstein tumor formation
The Buschke-Levenstein tumor is a conglomerate of contiguous warts fused together, has a wide base, and the surface is covered with villi-like processes and vegetations separated by pronounced grooves. Gradually, the surface of the formation is covered with epithelial scales, maceration occurs, and secretions that exude a bad smell accumulate between the papules. The secretions are easily infected, which leads to suppuration. This formation is also characterized by a steady invasive progression — penetration into the cavernous bodies, accompanied by destruction of foreskin cells, followed by fusion and formation of fistulas. Removal of warts in this case inevitably leads to recurrent overgrowth.
The end result of the progression of giant Buschke-Levenstein condyloma may be the formation of a cancerous tumor.
Treatment of anogenital condylomatosis
Since this disease can be called one of the manifestations of papillomavirus, there are reasons why a complete cure is impossible. However, there are methods for preventing the development of the disease and preventing infection, as well as removing the affected areas.
For the prevention of anogenital condylomatosis caused by oncogenic HPV types 6 and 11, vaccination with Gardasil is used. Vaccination is indicated for men and women aged 9 to 17 years. This method allows you to prevent infection, but it is useless for the treatment of patients already infected with the virus.
Removal of pathological formations of genital warts is carried out mainly by the following methods: chemical cauterization, by surgical excision with a scalpel or using a laser.
Moxibustion
The method of cauterization with special chemicals is used only for mild forms of condylomatosis, namely in cases where the area of distribution of condylomas is no more than 1 cm in diameter. Otherwise, it is necessary to make sure that the disease has not affected the lower layers of the skin. The substance is applied directly to the areas affected by the disease. The group of similar drugs for external use includes condylin (podophyllotoxin), solkoderm and liquid nitrogen.
Condilin is developed on the basis of podophyllotoxin, an organic substance that is part of podophyllin. The drug is applied to warts 2 times a day. Three-day courses alternate with four-day breaks. The duration of treatment is about five weeks. The use of this remedy is contraindicated during pregnancy, lactation, as well as with hypersensitivity of the skin.
Solkoderm is a substance for external topical use, which includes nitric, acetic and oxalic acid. Before applying the drug, the condylomatous area is treated with ethyl alcohol. The application procedure is repeated until the skin of the affected area is discolored. In the future, the treated areas should be lubricated with 70% alcohol 2-3 times a day until the final hardening of the deformed lesion area.
Since these substances are very caustic and, if they get on healthy skin, can cause acid burns, their use requires extreme caution.
Surgical excision
If the patient has overgrown volumetric condylomatous conglomerates, the method of surgical excision is used, and the use of a hydrocarbon laser is very effective for removing formations in hard-to-reach areas. Such operations are considered low-traumatic and are therefore performed under local anesthesia.
By itself, the surgical method is not effective, because when excising the affected area, there are factors that lead to the re-proliferation of genital warts:
The virus that provokes the occurrence of condylomatosis persists in unaffected tissues.
The appearance of large condylomatous formations is possible only with weakened immunity. Weakened immune defenses also contribute to relapse.
In order to reduce the susceptibility of cells to HPV and thereby reduce the likelihood of recurrent manifestations, immunotherapy is used together with surgical removal. Interferon inducers — various ointments, injectable solutions and powders (kipferon, viferon, gepon, cycloferon, ridostin, imiquimod) are used as means that increase the patient’s immunity and reduce the risk of oncological complications both external and internal use.
Since anogenital condylomatosis is a consequence of venereal disease, both sexual partners should undergo treatment. The period of treatment of anogenital condylomatosis requires sexual abstinence for six months.
Forecast
Anogenital condylomatosis, as one of the consequences of infection with the human papillomavirus, is a chronic disease and therefore a complete cure is impossible. However, timely treatment of genital warts at an early stage not only prevents their further spread, but also eliminates the possibility of complications, among which the most dangerous is the development of a cancerous tumor. After removal of condylomatous formations, continuous monitoring of the state of immunity is required in order to avoid recurrent manifestations of the disease.
