Домой Бородавки Папилломы в паху у мужчин и женщин

Папилломы в паху у мужчин и женщин

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Папилломы в паху

Папилломы в паху (остроконечные кондиломы, половые бородавки) у взрослых людей наблюдаются достаточно часто. Они представляют собой одну из разновидностей вирусных бородавок и имеют вид сосочковидных мягких образований на небольшой ножке, склонных к слиянию между собой. В результате слияния образуются колонии, поверхность которых внешне напоминает соцветие цветной капусты (см. на фото).

Новообразования в паховой области вызывают у пациентов дискомфорт, создают проблемы в интимной жизни, поэтому при их появлении следует обязательно обращаться к врачу.

Почему появляются кондиломы?

Причиной появления наростов в паховой области является инфицирование человека вирусом папилломы человека (ВПЧ).

Восприимчивость к заражению высокая. Течение инфекции хроническое, с периодическими рецидивами, которые чаще возникают на фоне ослабления общего или местного иммунитета.

Половые бородавки у женщин могут локализоваться на половых губах, слизистой оболочке влагалища и шейки матки, а у мужчин на коже крайней плоти, головке полового члена, вокруг анального отверстия.

Заражение ВПЧ-инфекцией происходит обычно при незащищенных сексуальных контактах (оральных, вагинальных, анальных) с инфицированным партнером.

Беременные женщины с папилломами в паху могут передать инфекцию плоду еще на этапе его внутриутробного развития или инфицировать его в момент родового акта.

Вирус папилломы человека распространен достаточно широко. Им инфицировано свыше 50% взрослых людей, ведущих половую жизнь. В литературе описано около 100 штаммов этого вируса. Некоторые из них обладают высокими онкогенными свойствами, то есть могут провоцировать развитие в организме инфицированного человека предраковых и злокачественных новообразований.

У многих зараженных людей инфекция клинически не проявляется, и остроконечные кондиломы появляются только при условии значительного снижения иммунитета.

Факторы риска

К факторам, которые повышают риск заражения папилловирусной инфекцией, относятся:

  • заболевания, передающиеся половым путем (генитальный герпес, кандидоз, трихомониаз, гонорея, хламидиоз);
  • влагалищный дисбактериоз;
  • наличие многих половых партнеров;
  • снижение иммунитета, связанное с различными факторами (сильные стрессы, инфекционные заболевания, нерациональное питание, злоупотребление алкоголем);
  • беременность.

Варианты развития папиллом в паху

В зависимости от особенностей иммунных реакций организма человека могут наблюдаться различные пути развития папилломовирусной инфекции:

  • регресс половых бородавок вплоть до полного их исчезновения (чаще наблюдается у женщин в послеродовом периоде);
  • отсутствие динамики заболевания на протяжении достаточно длительного отрезка времени;
  • рост и появление новых новообразований;
  • злокачественная трансформация наростов.

В зависимости от риска возникновения злокачественных опухолей штаммы ВПЧ подразделяются на несколько групп:

  • высокой онкогенности;
  • средней онкогенности;
  • низкой онкогенности;
  • неонкогенные.

Женщины, у которых выявлена инфекция ВПЧ с высокой онкогенностью, должны находиться на диспансерном учете у гинеколога и регулярно подвергаться онкоцитологическому исследованию с целью ранней диагностики дисплазии шейки матки, являющейся предраковым заболеванием.

Патогенез и симптомы заболевания

ВПЧ-инфекция передается от человека к человеку. Нередко выявляется одновременное инфицирование сразу несколькими штаммами вируса. Папилломовирус проникает в организм через повреждения кожи или слизистых оболочек. Длительное время он может находиться в эпителиальных клетках и никак не проявлять себя клинически. Под влиянием различных провоцирующих факторов, приводящих к снижению защитных сил организма, вирус начинает активно размножаться. После того как в клетках эпителия накапливается достаточно большое количество вирусных копий, начинается развитие кожных проявлений заболевания.

При латентном течении инфекции ВПЧ находится в эписомальной форме, то есть располагается вне хромосомного аппарата клеток. Размножившись в большом количестве вирус переходит в интрасомальную форму, характеризующуюся встраиванием вирусной ДНК в хромосомы пораженных клеток. Это приводит к их бесконтрольному и быстрому делению, росту. В результате и появляются остроконечные кондиломы. Половые бородавки обычно возникают одномоментно, реже их образование занимает несколько дней.

Папилломы в паху у мужчин обычно располагаются в области венечной борозды, уздечки и внутреннем листе крайней плоти. Реже местом их локализации становятся мошонка, тело полового члена, отверстие уретры или область вокруг анального отверстия.

Образование половой бородавки в области наружного отверстия уретры сопровождается появлением дизурических симптомов, разбрызгиванием струи мочи.

Излюбленной локализацией папиллом в паху у женщин являются малые половые губы. Несколько реже наросты появляются на больших половых губах, в перианальной области, во влагалище, на шейке матки или в области отверстия мочеиспускательного канала. Половые бородавки влагалища и шейки матки обнаруживаются обычно только при проведении гинекологического осмотра пациентки.

В большинстве случаев размер папиллом в паховой области не превышает 2-3 см. Однако у пациентов с иммунодефицитом или у беременных женщин новообразования могут достигать значительно большего размера, становиться гигантскими.

Осложнения

Половые бородавки нередко травмируются, что может стать причиной их инфицирования и кровоточивости. Помимо этого, они вызывают у пациентов чувство психологического дискомфорта, связанного с косметическим дефектом, могут препятствовать нормальной сексуальной жизни.

Гигантские кондиломы в области анального или мочеиспускательного отверстия приводят к затруднению дефекации и мочеиспускания соответственно.

Диагностика

При обнаружении в паховой области образований, подобных по описанию кондиломам, пациенту следует обращаться к врачу (гинекологу, урологу или венерологу).

Половые бородавки требуют проведения дифференциальной диагностики с рядом физиологических состояний и заболеваний:

  • микропапилломатоз половых губ;
  • папулезное ожерелье полового члена;
  • широкие кондиломы при сифилисе;
  • контагиозный моллюск.

Для уточнения диагноза используются следующие методы исследований:

  • кольпоскопия;
  • уретроскопия;
  • мазок на цитологию с шейки матки;
  • гистологическое исследование ткани новообразования;
  • ПЦР-диагностика;
  • иммунологический анализ на наличие в крови антител к вирусу папилломы человека.

При выявлении папиллом в паху пациент обязательно должен быть обследован на заболевания, передающиеся половым путем и ВИЧ-инфекцию.

Лечение

Основным способом лечения половых бородавок является их удаление, которое может производиться разными методами под местной анестезией и в амбулаторных условиях. У каждого из них есть свои показания и противопоказания. Рассмотрим основные методы хирургического лечения папиллом в паху:

Проводится при помощи углекислого или неодимового лазера. Луч лазера послойно испаряет ткани кондиломы. На месте образования остается сухая черная корочка (струп). После ее отпадения на 7-12 сутки на месте ранки остается неизмененная слизистая оболочка

Разрушение ткани опухоли происходит под воздействием радиоволн определенной частоты. Процедура практически безболезненная, но не позволяет произвести забор ткани для гистологического исследования

Новообразование подвергают глубокой заморозке жидким азотом. У нерожавших женщин удалять папилломы в паху этим методом не рекомендуется

Папилломы удаляют при помощи электрода, на который подается ток высокой частоты. Преимуществами метода являются возможность забора материала для гистологического анализа, низкий риск послеоперационных осложнений

Проводится при помощи цитотоксических препаратов (фторурацил, ферезол, имиквидом, подофиллин, подофиллинотоксин)

Вне зависимости от способа удаления риск рецидива половых бородавок достаточно высок – достигает 30%. Это связано с тем, что вирус на протяжении многих лет сохраняется в клетках эпителия. Поэтому после хирургического лечения пациентам рекомендуется прохождение противовирусной и иммуномодулирующей терапии.

Не следует пытаться избавляться от папиллом в паху самостоятельно в домашних условиях. Подобные попытки сопряжены с высоким риском развития осложнений, таких как инфицирование, усиление роста, малигнизация.

Прогноз

Современные методы лечения не позволяют полностью избавить человека от ВПЧ-инфекции. В результате всегда существует достаточно высокий риск рецидива заболевания.

Вирус папилломы человека обладает слабо выраженными антигенными свойствами. Это является причиной недостаточно активного ответа на инфицирование иммунной системы. В связи с этим существует вероятность повторного заражения, если половой партнер не получил необходимого лечения.

Женщинам с папилломами в паху рекомендуется ежегодное проведение кольпоскопии и исследование мазка с шейки матки на онкоцитологию.

Профилактика

С целью профилактики заражения папилломавирусной инфекцией необходимо:

  • использовать барьерные методы контрацепции (презервативы);
  • вакцинировать девочек от ВПЧ высокой онкогенности;
  • повышать защитные силы организма (правильное питание, занятия спортом, отказ от вредных привычек, полноценный отдых).

Видео

Предлагаем к просмотру видеоролик по теме статьи.

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