The healing process, recovery and consequences of condyloma removal

Condylomas (a type of human papillomavirus infection) affect the skin and mucous membranes of the genital organs of men and women. Genital warts can be localized in the pubic area, labia majora and minora, vaginal opening, perineum, perianal zone, glans, foreskin and shaft of the penis, external opening of the urethra.

When the human papillomavirus (HPV) affects the cervix, the formation of cervical dysplasia with subsequent malignancy is possible.

Genital warts are a disease that is sexually transmitted. Infection through household items is also possible if personal hygiene rules are not observed (through razors, towels, washcloths).

Preparing to remove condylomas with nitrogen

Before cryodestruction of genital warts, the following is necessary:

• Examination by a doctor detailing complaints, the duration of the expected infection and assessing the number, size, and location of condylomas in a particular patient. For this purpose, women are examined in a gynecological chair.
• Research for the full range of sexually transmitted infections. To do this, a smear is taken from the urethra, cervix and vagina for women, and from the urethra for men, followed by laboratory testing. Laboratory diagnosis of scrapings and genital discharge is performed using microscopy and PCR.
• A smear test for oncocytology is performed for women with any manifestations of HPV to exclude dysplasia and cervical cancer.
• Blood tests for syphilis, HIV, viral hepatitis.

Simultaneous examination and treatment of the sexual partner is advisable.

Treatment methods for vaginal condylomas

To remove tumors, the following destructive treatment methods are available:

· cryodestruction;

· laser removal, the most optimal destructive method;

Argon plasma ablation;

· radio wave (high frequency) removal, preferably with argon-enhanced coagulation.

Destructive methods of influence do not guarantee relapse of the disease, which is why the use of antiviral drugs is practiced in our country. Immunotherapy is not always justifiably used; more often it is prescribed blindly, without appropriate examination. This method sometimes gives side effects in the presence of condylomas, and as monotherapy it is ineffective, but in some cases it can give a good result, but this is impossible to predict. The best effect is achieved in a combination of destructive and conservative treatment.

Key points:

Treatment of condylomas of the external genitalia and vagina produces positive results in most patients within 1 to 6 months. At the same time, the virus can remain and be detected in 30% of women, without clinical manifestations, which no longer requires treatment, but observation.

It is important to note that condylomas that appear on new areas of the skin or mucous membrane during treatment or after completion of treatment do not require a change in treatment method. The appearance of new formations in the area where the treatment was carried out requires a change in the treatment method.

Patients should be informed about maintaining sexual rest during treatment and undergo examinations until the condylomas completely disappear.

Sexual partners should be examined and treated only if there are condylomas on the penis.

Contraindications for cryodestruction of condylomas

Contraindications for removing condylomas with liquid nitrogen:

• The presence of other sexually transmitted infections (gonorrhea, trichomoniasis, chlamydia, urogenital mycoplasmosis, syphilis, genital herpes). Before cryodestruction of condylomas in these cases, preliminary sanitation of these infections is required.
• The presence of individual intolerance to cold. This may be indicated by the appearance of any itchy rash when exposed to cold (usually like urticaria). To perform a cold test, applying an ice cube to the skin can be used, followed by assessing the patient's condition.
• Feverish conditions accompanying ARVI, exacerbations of chronic diseases.
• Decompensation of diabetes mellitus, cardiac activity.

Treatment of cervical condylomas

Removal of condylomas on the cervix is ​​a mandatory procedure in terms of the spread of infection and the prevention of cervical cancer.

Cervical condylomas can be removed in the following ways:

· laser vaporization is an effective technique with a low relapse rate and does not affect the reproductive function of nulliparous patients;

· argon plasma ablation – a good effect, especially in nulliparous patients;

· radio wave removal - a technique that allows a histological examination to be carried out after removal;

· cryodestruction is a popular method, but it is effective for small lesions;

· Solkovagin – cauterization of single genital warts using a chemical preparation.

Each of the listed methods has its own advantages and disadvantages. In each specific case, the choice of treatment remains with the doctor and depends on the availability of equipment and the qualifications of the specialist.

Using destructive treatment methods, part of the affected cervical tissue that is visible or detectable by colposcopy is removed, but not the virus itself. Therefore, along with removal, gynecologists recommend antiviral or immunomodulatory drugs of local or general action to prevent relapse and fight the virus. We cannot predict the effect of this treatment, but in some cases there is a positive result. It is incorrect to believe that antiviral drugs are the main ones in the fight against HPV. These medications activate the immune system, and it already resists viral aggression. In the practice of treating condylomas of any location, these drugs have their own niche of use. Clear evidence of the effectiveness of these dosage forms has not been obtained, so they are practically not used in world practice.

Vulvar condylomas during pregnancy

Pregnancy can provoke the development of exophytic condylomas (visible), which previously did not bother and did not make themselves felt. Condylomatosis is the result of the presence of the human papillomavirus in the body. This virus, having entered a woman’s body, may not manifest itself in any way if the immune system is strong. However, during pregnancy there is a temporary decrease in immunity due to the presence of a fetus, which half consists of foreign genetic material (protein) belonging to the husband. The papilloma virus, if present and in an inactive state, may begin to manifest itself in the form of neoplasms on the external and internal genital organs of a woman, in the perineum, and in the vicinity of the anus.

Condylomas during pregnancy must be removed due to their active growth and the sooner this is done, the better.

Treatment of condylomas during pregnancy should be carried out by an obstetrician-gynecologist who is fluent in removal techniques. Treatment of exophytic condylomas is preferable using the most effective modern laser and radio wave equipment with argon-enhanced coagulation. These operations are usually performed in a hospital under intravenous or epidural anesthesia. With extensive condylomatosis, removal is sometimes carried out in several stages. Epithelization of the wound surface in pregnant women occurs quite quickly, due to increased blood circulation in the genital area. Therefore, removal of condylomas can be carried out from early pregnancy up to 36 weeks of pregnancy. Before the planned removal of condylomas, it is necessary to conduct an examination to exclude possible complications occurring during pregnancy (for example, the threat of miscarriage, gestosis, etc.). Carry out sanitation in case of an inflammatory reaction in the genital area.

During pregnancy, only external condylomas should be removed. It is better not to touch condylomas in the vagina and cervix, as this is associated with an increased risk of bleeding and the threat of miscarriage. As practice shows, condylomas regress on their own after childbirth, especially in the vagina.

In pregnant women with condylomas, only local immunotherapy is performed. Virus carriage, without clinical manifestations (presence of visible condylomas), is not a basis for therapy. It is better to start treatment before removal and continue after surgery. The goal is to reduce the risk of recurrence of condylomas.

To ensure that you are not burdened by treatment for condylomas during pregnancy, it is preferable to undergo testing for the presence of HPV before planning a pregnancy. If this virus is detected, it is necessary to first improve the body’s defenses and only then plan a pregnancy. If this is not done, then there is a chance that you will develop condylomas during pregnancy.

It is not possible to guarantee that a woman will be cured of the virus before a planned pregnancy using modern medications. Treatment of the identified inflammatory process of the reproductive tract, before a planned pregnancy, is a sufficient measure to prevent exacerbation of HPV.

It should be emphasized that carriage of HPV of any type, without clinical manifestations (presence of exophytic condylomas), is not a contraindication to pregnancy.

Stages of cryodestruction of condylomas

The procedure for removing condylomas with liquid nitrogen is as follows:

• After examining the doctor and conducting the necessary research, eliminating contraindications, the patient takes a comfortable position on the couch or gynecological chair, exposing the affected area from clothing.
• Preliminary anesthesia is not required, since the freezing procedure is short-term (10 to 30 seconds) and tolerable. A tingling sensation and slight burning sensation may be present.
• Liquid nitrogen is applied to the areas of condylomas using a cotton swab attached to a wooden stick or tweezers, after immersing them in a container of liquid nitrogen. It is also possible to apply non-contact liquid nitrogen in the form of an aerosol through a special apparatus - a cryodestructor. The time and area of ​​exposure to liquid nitrogen and the frequency of cooling are determined individually depending on the size of condylomas and their location.

After the cryodestruction procedure, the patient is able to work, but minimal restrictions are recommended.

Preventive measures

After cauterization of the growths, it is worth consolidating the positive result with the help of conservative therapy and lifestyle changes. It is necessary to give up bad habits (smoking, alcohol), watch your diet (it must be balanced), and play sports (run, go to the gym, play volleyball and basketball).

The patient should isolate himself from stressful situations as much as possible and not overexert himself. It is recommended to periodically visit a doctor and take immunomodulatory and antiviral drugs of local and general action twice a year.

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Advantages of cryodestruction of condylomas

Among the advantages of removing condylomas with liquid nitrogen:

• no anesthesia is required, which is important if some patients are intolerant to local anesthetics;
• there is no violation of the integrity of the skin and mucous membranes, no bleeding occurs, the risks of secondary infection are reduced;
• no scars form after removal;
• the low temperature of liquid nitrogen has a detrimental effect on the human papillomavirus;
• If there is metal in the body and a fresh tan, cryodestruction is preferable, since hardware methods are impossible in these cases.

Surgery to remove growths

The traditional method of removing warts is cryodestruction. The procedure is carried out using gas, which at a temperature of -196 degrees cools and becomes liquid. Next comes the temperature effect on the growths.

Liquid nitrogen is applied to the affected area of ​​the body, which helps to freeze the water in the space between the cells and inside the cells themselves. As a result of freezing of water in the intercellular space, the cell “dies”, thus tissue necrosis occurs. Cells that are subject to pathological changes die, then the process of regeneration of the epidermis begins under the destroyed tissue.

The manipulation takes place without any particular discomfort, and therefore most often does not require pain relief. The exception is people who have a very low sensitivity threshold. Such patients are given local anesthesia with lidocaine or novocaine. One of the advantages of the operation is the complete absence of bleeding, because the influence of the low temperature completely blocks the damaged vessels.

The nitrogen method of genital wart removal allows you to destroy single growths and their overgrown neoplasms measuring 10 millimeters up to 20 pieces in just one procedure. The disadvantage of the manipulation is that it is impossible to control the depth of exposure to nitrogen, so the wart may not be completely destroyed and at least 1 more procedure will be required.

Recommendations for the patient after cryodestruction of genital warts

After removing condylomas with nitrogen, it is important:

• To prevent relapses, examination and treatment of the sexual partner is necessary.
• Limit intimacy until complete sanitation and restoration of the skin after removal of condylomas.
• Change your underwear daily and monitor the hygiene of your intimate areas. If a “wound” forms at the site of condyloma rejection, it is necessary to treat the skin defect with antiseptic agents (a solution of chlorhexidine, miramistin, aniline dyes, manganese).
• Replace household items (washcloths and razors) with new ones or thoroughly disinfect them. It is enough to wash towels and bed linen at maximum temperature and iron them with a hot iron.
• Refuse to visit swimming pools, baths and public bodies of water for a period of 1 month after cryodestruction.

Even if there are no complaints, you need to come for a follow-up examination to the doctor within the recommended time frame.

What to do after cryotherapy?

After surgery, you cannot pierce the bladder, cut or rip it off yourself. You should refrain from sexual intercourse until the wound has completely healed if a condyloma in the genital area was removed.

If a growth in the anus has been removed, then after each trip to the toilet you should adhere to the rules of hygiene (it is advisable to wash with warm water). If the bladder is damaged, it is necessary to disinfect the wound with chlorhexidine or miramistin, then seal it with a sterile plaster.

If you feel pain after cryosurgery, the patient should take medications with an analgesic effect. If discharge or itching appears after surgery, you should immediately consult a doctor. Severe pain may indicate an inflammatory process or other negative factors, for example, incomplete destruction of the wart.

Cost of cryodestruction of tumors

Procedure execution algorithm

Laser removal of condylomas is one of the safest and most effective procedures. Before surgery, the doctor checks the growth to see if it is benign; for this, a biopsy is prescribed. After receiving the histology results, blood tests are prescribed in order to determine the pathogen and select a comprehensive and effective drug treatment. Only after all these manipulations and in the absence of contraindications, the patient begins to be prepared for laser surgery.

The area is anesthetized and disinfected before laser therapy. The doctor sets the power, depth of exposure and beam diameter to the device. The entire procedure takes on average 40 minutes, everything directly depends on the number and size of formations.

In order to remove condylomas on the genitals, 2 procedures are needed. The second procedure is carried out at least 14 days later.

After removal, wounds form that must be carefully treated. The skin will recover within approximately 14-20 days.

Rehabilitation

Complete recovery may take up to 3-4 weeks, but the results of treatment can be assessed after 3-4 days during a follow-up visit. During this period, sexual rest is necessary. It is important to accurately and correctly follow all the doctor’s recommendations - this will help prevent complications and achieve optimal results.

Remember that genital warts are only an external manifestation of the disease. To prevent relapse, it is necessary to assess the immune status, determine the type of infection, consult a virologist, immunologist, as well as basic treatment aimed at the virus itself.

IMPORTANT! Regardless of the presence of genital warts, examination of the sexual partner is required.

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Treatment of anal warts

Perianal condylomas require immediate treatment due to the many inconveniences they cause to the patient and the likely progression of the disease. Modern specialists, along with excision of formations using various methods, simultaneously influence the patient’s immune system.

Treatment of condyloma in the anal area will be effective if you contact a specialized specialist in a timely manner and strictly follow all his recommendations. Proper influence on the immune system of a patient with condylomatosis activates the body's defenses and directs all their efforts to fight the papilloma virus.

Factors of HPV progression are:

• acute and exacerbation of chronic inflammatory diseases of the genital organs (trichomoniasis, chlamydia, mycoplasma genitalium, herpes simplex virus, etc.);
• the presence and exacerbation of systemic diseases (diabetes mellitus, systemic lupus erythematosus, thyroid disease, etc.);
• immunosuppressive therapy (for example, after organ transplantation);
• hormonal disorders;
• contraception (taking COCs for >5 years);
• smoking;
• stressful situations.

Treatment of condylomatosis at home

The main disadvantage of various destructive treatment methods is the recurrence of the disease, which varies, depending on the technique, from 20 to 50% of cases.

Imiquimod cream, commercial name Aldara, is a highly effective remedy in the fight against genital warts. This cream, when applied topically to the skin, acts as an immunomodulator, stimulating the production of interferons. This leads to a decrease and then to the disappearance of condylomas and a decrease in the amount of HPV in the tissue.

Aldara cream, available in sachets (sachets) for one-time use, is applied to condylomas and the skin near them 3 times a week before bed, and the next morning the area of ​​application is cleaned with soap and water. Treatment continues until the condylomas disappear, on average 4 weeks, but not more than 16 weeks. When used, a local skin reaction in the form of redness (erythema) may occur. In this situation, you can pause until the reaction disappears and continue treatment. More details about the method of use are described in the instructions for the Aldara cream.

Numerous clinical studies show that imiquimod (Aldara cream) can achieve significant improvement within 8-10 weeks of use. There is a low relapse rate of 13%. Additionally, it should be noted that the drug stimulates the regeneration of the skin and improves its appearance in case of actinic (senile) keratosis.

Complications of condylomatosis

Given that both sexes are equally susceptible to condylomatosis, this disease poses a greater danger for women than for men. Benign anogenital warts (condylomas), in 90% of cases are caused by HPV types 6 and 11 and are benign. Patients with visible warts can also be infected with highly oncogenic HPV types 16 and 18, which may be flat and not visible during routine examination. These last 2 types can cause cancer of the lower reproductive organs (cervix, vagina and vulva).

Genital warts caused by HPV types 6 and 11 are benign growths. Such neoplasms are not dangerous and cannot lead to oncological degeneration. They cause a lot of inconvenience to humans and pose a danger to sexual partners due to the high probability of infection.

Experts consider flat lesions more dangerous due to the difficulty of their timely diagnosis. It is viral lesions of the flat type that can cause tissue degeneration.

Buschke-Levenshtein condyloma is a fairly rare disease. Medical science does not have accurate statistical data due to the external similarity of this formation with epidermoid cancer.

In the initial stages, giant Buschke-Levenshtein condyloma appears in the form of elements similar to papillomas, wart-like nodules and genital warts. All elements of the neoplasm grow quickly, merge together, and form a tumor with a specific wide base. The surface of such a giant condyloma is characterized by growths and vegetations. All surface elements are separated by grooves. As the tumor grows, individual parts become more pronounced, becoming superficially covered with horny scales.

This is a rare type of disease associated with HPV types 6 and 11, characterized by aggressive growth.

Giant condylomas are usually localized in the anogenital area.

Recovery period

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To ensure that there are no complications after the procedure, it is strictly forbidden to wet the wounds during the day. After a crust forms on the wounds, do not wet it or rip it off; the scab falls off naturally - its mechanical removal can provoke infection with further complications.

The skin is regularly treated with antiseptics; in addition, the doctor prescribes antibiotic and immunomodulatory therapy.

All medications must be prescribed by a doctor, and the patient strictly adheres to these recommendations and prescriptions.

Additional recommendations: avoid depilation of the treated area, avoid saunas, intimate relations (if condylomas were removed from the genitals), avoid exposure to ultraviolet rays and hypothermia. It is important to follow all recommendations for at least one month, after which you need to see a doctor for control.

If the patient notices redness, inflammation, pain, itching, tingling, purulent formations, bleeding or other signs, an urgent need to consult a doctor.

Contraindications to laser removal of genital warts

Removing genital warts with a laser has many advantages - this procedure does not cause pain and is performed in a short period of time. After healing, the formation of scars and scars is excluded. The laser beam acts precisely and does not injure surrounding tissues. No long-term rehabilitation is required.

Using the procedure, you can get rid of the discomfort caused by the tumor. Condyloma can become malignant; removing it reduces the risk of cancer. Traumatization of the growth leads to the fact that it becomes painful and inflammation appears.

Despite the effectiveness of laser removal of papillomas and condylomas, there are some limitations to the procedure. The doctor will be able to determine the possibility of performing the operation by conducting an examination, assessing the general health of the patient.

The procedure cannot be performed if the patient’s condition is serious, there is oncology or acute infectious diseases. Limitations may include the presence of autoimmune pathologies, blood clotting disorders, and various mental disorders. The advantage of using a laser is that growths are removed quickly and the likelihood of adverse reactions is minimal.

Dermatologists

• Ayvazyan Linda Volodyevna
  Experience: 5 years

  Dermatovenerologist, mycologist, trichologist

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• Osipova Daria Sergeevna

  Experience: 14 years

  Deputy chief physician for medical work. Dermatovenerologist

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The cryodestruction method is widely used in dermatology to remove various skin tumors. This is a modern, effective way to correct cosmetic defects and treat diseases. Cryodestruction can remove warts, moles, basal cell carcinomas, papillomas, condylomas, scars, old calluses and other undesirable phenomena from the skin. There are practically no traces left.

At the Kutuzovsky Children's Center, cryodestruction treatment is performed by experienced dermatologists. The procedure is performed on an outpatient basis in our clinic in Moscow. Prices for cryodestruction are indicated on the website.