Diagnosis and treatment of genital warts perianal
PROCTOLOGY – 2009
Genital warts perianal – a sprawl of the anus in the form of papillae, gray-pink color, which are often located in separate clusters of islands. Between these clusters can be seen whole, unaffected skin warts. The number and size of genital warts can be different, they may merge into large conglomerates and close the anus. By their appearance they are genital warts look like cauliflower.
Causes of genital warts
Today, it is significantly ustavleno that the causative agent of genital warts is human papillomavirus (HPV) types 6 and 11. Infection can be sexually transmitted. Usually, if a person is infected with papilloma virus, no symptoms were observed. Clinical symptoms are manifested in the weakening of the immune system.
The manifestations of genital warts
The main complaint of patients with genital warts is the presence of perianal papillary growths on the anus, as well as foreign body sensation in the area. Sometimes you may feel a burning sensation, itching. It may also appear soak in the anus. If genital warts are many and large, patients may experience discharge of blood and pain. This is due to ongoing traumatization of genital warts during defecation, as well as the rubbing of clothing.
Large perianal warts may be accompanied by an unpleasant smelling discharge. Upon accession to the warts infection is marked inflammation, they become reddened, swollen and painful. With prolonged inflammation, which is marked by poor personal hygiene patient, warts appear fistulous passages. This leads to intoxication and the effect on its overall health.
Complications of perianal warts
The main complication of perianal warts is their ability to recur, as after conservative and surgical treatment.
Another, albeit rare complication of perianal warts is the ability to malignancy – that is, malignant degeneration. There are cases where genital warts degenerated into squamous cell carcinoma. This complication is most common in giant warts (also called Buschke-Lowenstein tumor, especially in the transition process kondilomatoznogo anal canal.
It is because of this, though rare, but terrible complications and should be carefully inspected patients with perianal genital warts, especially the giant size, both before and after surgery to remove them.
Diagnosis of genital warts
The diagnosis of genital warts perianal not cause difficulties for the doctor-proctologist. Already at the external examination of the anus can see the characteristic papillary growths in the form of cauliflower. It is important to note that warts can be simultaneously in the genital area.
In the diagnosis of perianal warts is also a digital rectal examination. This is due to the fact that warts can pass as the anal canal. The most common lesion encountered in the anal canal giant condylomas.
The next study, which is necessary to conduct a patient with perianal warts – a sigmoidoscopy. Usually, when this is revealed redness (hyperemia), rectal mucosa, and sometimes grain.
Be sure to study the patient for HIV and syphilis (with the possible route of infection), regardless of what method of treatment is assumed.
Differential diagnosis of genital warts
Genital warts perianal should usually be distinguished from warts in the area of another origin – syphilitic warts. Syphilitic genital warts are different from what they are flatter, and the color – lighter. In addition, the syphilitic warts are in the form of individual plaques, and the surface is wet. To clarify the diagnosis blood test for syphilis (blood RW), as well as consulting venereology.
It is also important to differentiate warts from malignant tumors. In this case, the value of a biopsy and cytology.
Treatment of genital warts perianal
When small amounts of genital warts, as between them there are clusters of healthy skin, is usually carried out medical treatment.
Conservative treatment of genital warts perianal usually used for small warts, when between individual growths there is a gap in groups of healthy skin.
For the conservative treatment of genital warts medication used Condyline, Used Condyline solution. The structure is Condyline podophyllotoxin (note that the drug is based on plant extracts). Its effect is that it has a cytotoxic effect on cells infected with papilloma virus.
Condyline applied to the warts with a special applicator, so that he did not get into areas of healthy skin. In case of contact of the drug on healthy skin may be a strong local irritation up to the ulceration. The drug is applied to the warts Condyline 2 times a day for three days. After a 4-day break, you can spend another three-day course of treatment.
Application Condyline contraindicated in pregnancy, lactation (breast milk feeding) for children under 12 years of age, as well as increased sensitivity to the drug.
Also Condyline for conservative treatment of genital warts and antiviral drugs are used. They are usually assigned in the form of ointments. This means such as podofilin, bonafton etc.
For large genital warts, as well as complications such as bleeding, surgical treatment.
Surgical treatment may include elektrodiatermokoagulyatsiyu, laser destruction, the use of high-frequency radio waves (unit Surgitron), cryosurgery, and excision of the classic scalpel.
Indications for surgical treatment of genital warts – their large size, as well as the process moves to the anal canal. In some cases, when a lot of warts, surgery may be performed in several stages, as the one-stage removal of large amounts of tissue can lead to deformation of the anus.
Surgery is performed under local anesthesia. Elektrodiatermokoagulyatsii method is excision of warts incandescent electric current loop, which "pounced" on the warts, and as it burns through it. Thus occurs at the same time and coagulation – stop bleeding. Moreover, there is no risk of separation of the virus to other tissues, as it always remains sterile. The same applies to laser coagulation, as well as the use of high-frequency radio waves.
Of course the surgical removal of warts, by whatever means it does not lead to complete elimination from the body of HPV. Therefore, there is always a risk of recurrence, and it is associated usually with the provoking factors, when there is a weakening of immunity.
Therefore, treatment of genital warts should be comprehensive and include both the surgical removal of warts, as well as conservative treatment – antiviral drugs, drugs that improve the immune system (immune stimulants). In malignant degeneration of condylomata unfavorable prognosis.
CENTER PROCTOLOGY Professor PROMA – GERMANY
SURGICAL DIVISION CB 6 RZD – MOSCOW
Examination and treatment in GERMANY – Institute "DIAGNOSTIX"
AID IN THE TREATMENT –
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