Content

Introduction

Condylomas are small benign growths that appear mainly in the external genital organs, around the anus, in the mouth and throat (or pharynx).

They are caused by some types of human papilloma virus (HPV type 6, 11 or others) and are the most commonly found sexually transmitted disease in Italy, especially in men between the ages of 15 and 40.

Condylomas are extremely contagious and transmission generally occurs sexually during penetrative, oral-genital, oral-anal intercourse or following simple contact between the mucous membranes or the skin of the anogenital area.

Generally they do not cause disturbances but tend to increase in number and extend into the surrounding areas, and for this reason they must be eliminated quickly.

Warts do not usually cause serious health consequences, but tend to return over time and, in less common cases, are caused by types of HPV that have the potential to cause malignant tumors.

For these reasons it is important that they are adequately prevented through HPV vaccination and the protection of sexual intercourse.

Symptoms

Condylomas appear as small pink or brownish growths of elongated shape, single or multiple, that appear on the skin or mucous membrane of the genital organs (penis and scrotum in men, large, small labia and vagina in women), in the region around the anus and rarely in the mouth and throat (oropharynx).

They usually do not cause disturbances and can occur weeks and sometimes months after the viral infection.

If left untreated, warts can persist for a long time, increasing in number and extending into the surrounding areas.

Condylomas do not generally cause significant damage to the organs involved but can recur even months or years after their elimination, making new interventions necessary to remove them.

Causes

The virus responsible for the appearance of warts (HPV) is acquired mainly by direct contact with the skin or mucous membranes of people who have an active and evident lesion. Condylomas can therefore develop following unprotected vaginal, anal, oral-genital and oral-anal sex.

The appearance of warts usually occurs a few weeks and in some cases even a few months after intercourse.

In the presence of warts, the virus can spread to surrounding areas even in the course of intimate hygiene practices.

Since HPV tends to remain nested in the site where the infection occurred, the warts can re-form months / years after their eventual removal.

A pregnant woman can theoretically pass the virus to her baby during natural birth or Caesarean delivery.

Diagnosis

The assessment (diagnosis) of warts usually takes place through their direct observation during a specialist medical examination.No instrumental laboratory investigations are required, unless they are present in areas not easily observable from the outside such as, for example, in the cervico-vaginal canal, in the pharynx or in the larynx.

In these cases it is necessary to use colposcopy or laryngoscopy, respectively.

In cases where the lesions do not have the characteristic shape and suggest the presence of a tumor, it may be necessary to perform a biopsy, or scraping, to ascertain, by so-called techniques of genetic amplification, the presence of the virus, characterize its type and exclude tumor alterations of the tissue.

Therapy

The type of treatment for warts depends on their number and location.

The external forms can be removed by cryotherapy (burn with cold liquid nitrogen), laser therapy, diathermocoagulation (burn with heat), surgical removal or by local application of drugs with immunomodulating (imiquimod, interferon) or cytotoxic (podophylline) function .

Condylomas in non-external areas (vagina, oropharynx) may require removal by local surgery under instrumental guidance (colposcope, laryngoscope).

To be decisive, the treatment must completely eliminate the virus in order to prevent the warts from reappearing in the following months. In any case, even if the lesions are completely removed, the virus can remain nested in the tissue without causing disturbances and lead over time (months, years) to the reappearance of the warts.

Prevention

Infection with the types of HPV associated with the appearance of warts can be prevented by using a male or female condom and a dental dam (latex membrane, a “condom” for practicing oral sex) during sexual intercourse.

However, protection only concerns the skin or mucous areas covered by these barriers since the skin of the scrotum and the region around the anus can be the site of contagion.

Several vaccines against HPV are available today: tetra-valent (types 6, 11, 16 and 18) and latest generation nona-valent (types 6, 11, 16, 18, 31, 33, 45, 52 and 58) , able to prevent infection with the types of HPV most associated with the onset of warts and tumors.

Preventive vaccination, recommended since 2008 for girls at the age of 12, mainly to protect them from cervical cancer (cervical cancer), is now recommended for boys of both sexes for the prevention of warts and malignant tumors. affecting the urogenital system, the anus and the oropharynx.

It is also recommended for women, from 25 years of age, to carry out a pap test which allows you to analyze the cells taken from the cervix with a spatula and to identify HPV, if present.

Similarly in men, the presence of suspicious lesions at the level of the external genitalia or the anal region requires a specialist medical examination for adequate assessment.

Complications

Genital warts, not adequately eliminated or treated, can persist for a long time or increase in number and size, creating significant disturbances to sexual function, urinary function and defecation.

The presence of warts is also associated with an increased possibility of contracting other sexually transmitted infections.

An "incomplete removal of the lesions can facilitate, after months or years, the reappearance of the warts (relapse) following the permanence of the virus in a latent form.

Condylomas are generally caused by viral types with a low degree of malignancy, but some viral types (types 16, 18, others) can over time cause the appearance of malignant carcinoma of the cervix (cervix), penis, of the anus and the oropharynx.

Living with

Condylomas at the genital, anal or oral-pharyngeal level do not cause significant disturbances, but can limit sexual and urinary function, persist for a long time, increasing in number and extending into the surrounding areas and recurring months / years later.

The presence of warts often causes psychological discomfort and increases the risk of sexually transmitted infections as well as the possibility of contagion for the sexual partner.

For these reasons, in the event of the appearance of warts, it is essential to refer to a specialist doctor for effective treatment and elimination of the lesions.

Any sexual partners must also undergo a "thorough specialist medical examination.

Since warts can return months or years later, it is necessary, in the period following their removal, to use a condom (male or female) or dental dam during sexual intercourse and to carry out regular medical checks.

Bibliography

United Against AIDS (ISS). HIV and other sexually transmitted infections

Ministry of Health. Human papillomavirus (infection with)

Ministry of Health. National Vaccine Prevention Plan, PNPV 2017-2019

WHO Media center. Human papillomavirus (HPV) and cervical cancer (English)

World Health Organization (WHO). Human papillomavirus vaccines: WHO position paper, October 2014. Weekly epidemiological record. 2014; 89: 465

Salfa MC et al. Sexually Transmitted Infections: update of the data of the two sentinel surveillance systems active in Italy at 31 December 2014. Newsletter of the Higher Health Institute. 2016; 29: 3

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