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Genital warts of the anogenital region: how to deal with them?

Benign skin neoplasms are called anogenital warts, or genital warts, the reason for which is the infection of the body with human papillomavirus (HPV), mainly types 16, 18, 31, 39.

Genital warts have a characteristic cone shape, a height of 1 to 5 mm and can be either single or multiple. Often, neoplasms merge into “inflorescences”, visually resembling a cockscomb, have signs of keratinization and cause discomfort not only during sexual intercourse, but even when walking and wearing underwear. Often the development of genital warts is accompanied by hyperemia and the appearance of painful bleeding cracks on the skin of the anogenital region.

Human papillomavirus is a highly contagious virus. Genital warts in 9 out of 10 cases are sexually transmitted by unprotected contacts, in which case the virus invades the healthy mucous membranes of the genitals and the perianal epithelium. Rarely, infection with the human papillomavirus is possible using common hygiene items (washcloth, towel) and underwear common with the virus carrier, even less often the virus is able to cross the placental barrier and be transmitted to the fetus.
Infection with HPV types 16, 18, 31 and 39 does not always lead to the appearance of genital warts on the surface of the skin and mucous membranes; for a long time, the disease can occur in the form of asymptomatic carriage of the virus. As a rule, the disease begins to manifest itself in cases of decreased immunity:

during pregnancy
with exacerbations of various chronic diseases,
with inflammatory processes in the pelvic organs,
when infected with other types of viruses,
with a sharp change in the climate zone,
with serious stress.
The peculiarity of the course of the disease is that it is impossible to completely get rid of the human papillomavirus at this stage of the development of medicine, and even after successful treatment, relapses are possible. Another danger of genital warts lies in the risks of malignant degeneration of neoplasms and in increasing the likelihood of dysplasia and oncological pathologies of the external genital organs and genital tract.

With the appearance of visible symptoms, genital warts are localized in men in the prepuce area, capturing the glans penis, frenulum, coronary sulcus and foreskin. More rarely, anogenital warts affect the scrotum, groin, perineum and perianal region, as well as the external opening of the urethra. When a woman is infected with HPV, genital warts can be localized not only in the clitoris, labia minora, the labia minora, the perianal region, but also in the vagina, on the cervix, in the external opening of the urethra.

Specialists resort to several treatment options, which can be either conservative or surgical.
Operational techniques for combating genital warts include: electrocoagulation and thermocoagulation, laser removal and cauterization with liquid nitrogen.

Electrocoagulation / thermocoagulation. In this case, the destruction of the neoplasm occurs under the point influence of high temperatures or electric current. Protein denaturation and the death of genital warts are observed. Electrocoagulation / thermocoagulation is used to remove neoplasms both on the surface of the skin and on the mucous membrane of the external genitalia.

Laser removal. When using a laser, genital warts are excised with a high-precision laser beam. It is possible to use the capabilities of the laser to remove neoplasms on the internal genital organs.

Cauterization with liquid nitrogen – cryodestruction. To remove genital warts from the external genitalia, liquid nitrogen with a temperature of -1960 can be used.

As a rule, to reduce the likelihood of relapse after removal of neoplasms, systemic antiviral therapy is performed using interferon synthesis inhibitors (drugs that activate the production of immune system proteins – interferons in the human body).

As an alternative to mechanical removal and another means of relapse prevention, local application of ointments and creams to the affected area containing local immunomodulator imimimod (Imiquimod) is gaining popularity. Various agents with this active substance are actively used in the practical treatment of genital warts in the USA, Germany, France, England, Italy, Japan and other countries, and more recently in Russia. The application of ointments and creams with imihimodom relieves symptoms, reduces the number of neoplasms and reduces the area of ​​damage until the disappearance of anogenital warts. Clinical trials show that it is the agents with imichimod that provide the minimum frequency of relapse of the disease today.

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