Condylomas: an intimate history... of the disease

“I’m in big trouble with women,” my friend sobbed into the phone. After fifteen minutes of conversation, it turned out that we were talking about genital warts - a manifestation of human papillomavirus infection.

The next day, the unfortunate woman went to see “her” gynecologist. The treatment lasted almost a month and cost a decent fur coat. It was uncomfortable for my friend to sit for more than a week, and she still doesn’t want to have sex - she’s afraid.

Some unfortunate warts cause so many troubles... To understand the problem, we talked with an obstetrician-gynecologist of the highest category, general director of the Women's Outpatient Clinic network of medical centers, Zukhra Shamilyevna Zhemoldinova.

- Is it true that human papillomavirus infection can be picked up in the pool, for example, through a shared washcloth or towel?

- Not true. The likelihood of household infection is almost zero. It is not for nothing that human papillomavirus infection is classified as a sexually transmitted disease. That is, if a person has warts in the genital or anal area, it means that he had unprotected sex with an infected partner.

- What do the statistics say? Is this a common disease or rather a rarity?

- In recent years, the number of patients with papillomavirus infection has increased sharply. According to our observations, young women under 30 years of age are especially often affected. Apparently, the whole point is that they change sexual partners more often and are prone to risky experiments in bed.

- What about men under 30?

- Hard to tell. It is possible that for various reasons they are less likely to seek help.

- Really, what difference does it make: there are warts or not? A cosmetic defect, nothing more...

- Don't tell me. A cosmetic defect in such an intimate place can ruin all the pleasure of sex. I'm not talking about oral sex. In addition, an infected person deliberately takes the risk of infecting his partner. This prospect is also not conducive to a fulfilling personal life. Next... Genital warts, of course, do not cause such pain as herpetic rashes, but they can cause itching and burning, which in itself is unpleasant, and can also be injured during sexual intercourse. And most importantly, this infection is dangerous for its complications: some serotypes of papillomaviruses (in particular, 16 and 18) belong to the group of high oncogenic risk - they are simply capable of triggering cancerous degeneration of cells. First of all, cervical cells.

- What a horror... So what should we do?

- No matter how trite it sounds - get treatment. And for this you need to detect the disease in time. Unfortunately, today there is a certain problem in diagnosing genital warts - the stereotype of examining a gynecologist. The doctor carefully examines the cervix, uterus, and appendages, but pays virtually no attention to the vestibule and vaginal walls. Meanwhile, this is where anogenital warts are predominantly localized. In men, they are usually located on the head of the penis and behind the foreskin. It turns out that if the patient himself does not find anything suspicious in himself or does not specifically ask to exclude papillomavirus infection, it will remain unrecognized.

- I heard that it can be diagnosed using PCR.

- Yes, polymerase chain reaction (PCR) is the most accurate and sensitive method for identifying the causative agent of the disease. When the doctor doubts whether he has genital warts or another growth of the mucous membrane, it is recommended to conduct PCR. However, if the picture is clear, then there is no point in this study. I believe that in this case it is a waste of the patient's time and money.

- So we come to the financial issue. Zukhra Shamilyevna, why is the treatment of genital warts so expensive?

- The fight against human papillomavirus infection includes several stages: removal of condylomas, impact on the causative agent of the disease and increasing immunity. If we talk about the high cost of treatment, then, on the one hand, it is justified. A virus is not a bacterium, it is located inside a cell and it is quite difficult to deactivate it; special and often expensive drugs are required. On the other hand, it does happen that medical centers deliberately inflate the cost of treatment. Take, for example, the removal of condylomas themselves - and it is imperative to get rid of them: you can charge money for removal individually or per square centimeter of the affected surface. What if the patient has so many condylomas that she can’t count them? Or are they isolated, but everywhere?

- Then she will go broke...

- Or refuse treatment. And both options, as you understand, are dead ends for her. Therefore, we took a different path. In our “Women's Outpatient Clinic”, condylomas are considered to be walls: two walls of the vestibule, four walls of the vagina. And for each fixed price, more than which no one has the right to demand.

- What about men? After all, as I understand it, both partners need treatment?

- No one is going to ruin them either. Not only does it make them feel more psychologically comfortable, the appointment is conducted by a male doctor.

- How are condylomas removed?

- Today there are several ways. Chemical - exposure to a mixture of organic acids - preparations such as Solcoderm. Physical – electrosurgical excision, diathermocoagulation, CO2 laser evaporation. In our experience, the latter method is the most preferable. Firstly, it allows you to control the depth of the effect - healthy tissues are not affected, and secondly, with its help you can remove all condylomas at one time.

- Is this a painful procedure?

- Quite sensitive, so proper anesthesia is needed. We work with modern drugs for local anesthesia, and for those who prefer to completely disconnect from what is happening, we offer general anesthesia.

- Everything is more or less clear with the treatment, now about the timing. Let's say a patient comes to you with condylomas, how long will it take to cure him?

- When it comes to human papillomavirus infection, using the word “cure” is not entirely correct. It is almost impossible to completely cleanse the body of the virus, but it is possible to get rid of the external manifestations of the disease and make the person no longer contagious. This takes on average several weeks.

- Did I understand correctly that after the end of treatment the disease will not return?

- Unfortunately, no one can give a 100% guarantee. It all depends on the state of the patient’s immune system, and, of course, on his sex life - there are known cases of re-infection.

- It’s the 21st century, and we can’t defeat the papillomavirus...

- To protect against papillomavirus (its oncogenic serotypes), scientists have developed a vaccine that has already passed all possible clinical trials. It's called Gardasil. You need to be immunized between the ages of 12 and 29 (of course, when the person has not yet gotten sick). When I found out about the appearance of this drug, I was delighted, I thought that there would be no end to those who wanted to insure themselves against such a serious infection. But in Russia, unlike, say, the USA and Great Britain, the demand for prevention is very low. In the old fashioned way, we prefer not to prevent disease, but to treat it.

- Returning to the story of my friend: she, of course, got rid of condylomas, but at what cost.

- Are you waiting for me to advise you on how to find a good gynecologist? I can recommend the specialists of the “Women’s Outpatient Clinic”; for us, providing care to patients is in the first place, and only in the second place is commercial interest. But generally speaking, there is no absolute recipe. See how long the clinic has been in existence, how many patients there are. Talk to your doctor: does he inspire confidence, does he explain all the stages of treatment, does he not overuse “horror stories”? Assess the average prices for similar services in Moscow and compare the price-quality ratio.

- At the end of the conversation, I really want to hear that condylomas are not a problem...

- Not certainly in that way. This is, of course, a problem, but it can be solved. And we need to decide.