What are Genital Warts?

Genital warts, also known as genital warts or venereal warts, are a type of perianal proliferative damage caused by human papilloma virus (HPV). Occurs in young people aged 18 to 35. The disease is mainly transmitted through sexual contact, and can also be transmitted vertically and indirectly.

Basic Information

nickname

Condyloma acuminatum

English name

genital warts

Visiting department

dermatology

Common locations

External genitalia, perianal

Common causes

Human papillomavirus (HPV) infection

Common symptoms

The initial appearance is a pale red pimples and wart protrusions, small and pointed, gradually increasing, forming a cauliflower-like surface after fusion.

Contagious

Have

way for spreading

Sexual contact

Causes of genital warts

The pathogen of the disease is HPV. HPV belongs to the genus Papilloma vacuolar virus A. It is a group of small DNA viruses with a diameter of 55 nm and a lipoprotein-free envelope. It is a symmetrical icosahedron composed of 72 virus capsids. Contains 7.9kb and molecular weight of 50,000kD. HPV has been classified into more than 100 subtypes using modern molecular methods. Different types of HPV can cause different types of damage in different parts, such as condyloma acuminatum, flat warts, common warts, Bowen's disease, and so on. Thirty-four types have been found to be associated with the disease, the most common being HPV 6, 11, 16, and 18 types. The human body is the only natural host of HPV. HPV only reproduces in the living tissue cells of the human body by replication, cannot survive in tissue cells and cultured cells in vitro, and cannot be inoculated and grown in experimental animals. In addition to causing proliferative damage, HPV is also carcinogenic. Many evidences indicate that HPV is related to the occurrence of cervical cancer.

HPV is most susceptible to reproduction under warm and humid conditions, so it easily occurs in the external genitalia and perianal area. Genital warts can be transmitted through sexual contact, indirect contact, and vertical transmission from mother to child.

Clinical manifestations of genital warts

The incubation period of the disease is 1 to 8 months, with an average of 3 months. It mainly occurs in sexually active populations. Young people aged 18 to 35 years old, accounting for more than 80%.

External genitalia and perianal are the most common sites of the disease. Female vaginitis and male foreskin are too long as co-factors for the occurrence and growth of the disease. Males are more common in the coronary sulcus, glans, foreskin, lacing, penis, perianal and scrotum. Females are more common in the labia majora, posterior union, vestibular, cervical and perianal. Occasionally occurs outside the vulva and perianal area, and generally occurs in the armpits, umbilicus, mouth, breasts, and between the toes.

The skin lesions are small and reddish pimples at the beginning, and gradually increase in the future. The surface is uneven and rough, and there is usually no special feeling. Later, it gradually grows into wartlike protrusions and spreads outward. The surface of the wart is often moist, white, red, or dirty gray. Occasionally foreign body sensation, itchiness, and pain during intercourse can cause ulceration, bleeding, exudation or infection.

Genital Warts Diagnosis

According to the history of extramarital sexual intercourse or history of sexual partner infection or indirect contact infection, pimples, papillary, cauliflower-like or chicken coronal fleshy neoplasms appear on wet parts such as genitals or perianal area, and the surface is rough and keratinized. A positive white acetate test is not difficult to diagnose. When necessary, the diagnosis can be confirmed with pathological examination and nucleic acid hybridization.

Differential diagnosis of genital warts

This disease should be differentiated from other proliferative diseases of the external genital and perianal areas, skin diseases, and normal physiological structures, such as pearly papules of the penis, villous labia minora, flat genital warts, Bowen-like papules, squamous cell carcinoma, Sebaceous gland hyperplasia and other identification.

Genital Warts Treatment

Treatment principle

Remove visible warts as much as possible to reduce recurrence. Regardless of the treatment method, relapse is unavoidable, only the recurrence rate is high, and retreatment is still effective.

Treatment

The choice of treatment is based on the size, distribution, number, shape, cost of treatment, convenience of the patient, and the experience of the doctor.

(1) Topical drug treatments currently used are 5% podophyllotoxin tincture, 25% podophyllotoxin tincture, 50% trichloroacetic acid, 5% imiquimod, 5% phthalimidine tincture, 5% Fluorouracil ointment and so on. When treating with topical drugs, pay attention to the local adverse reactions and stimulating effects of the drugs, and protect the surrounding normal tissues.

(2) Local physical treatment The physical treatment of genital warts mainly includes laser treatment, liquid nitrogen cryotherapy, electrocautery treatment and surgical resection.

(3) Amino-ketovaleric acid photodynamic therapy (ALA-PDT therapy) This method can selectively kill proliferative and proliferative cells, which not only has a destructive effect on the condyloma acuminatum visible to the naked eye, but also can clear subclinical infections and latency lesions. It has the advantages of high cure rate, low recurrence rate, few and mild adverse reactions, and good patient compliance.

(4) Immunotherapy The effect of this therapy alone is not obvious and expensive, and some patients also have adverse reactions. Generally, it is used as an adjunct to the above treatment. Commonly used immunotherapy is mainly interferon, interleukin-2, polymyocyte and so on.

3. Choice of treatment

(1) Warts of moderate to below size can be seen in the external genital area of both sexes (single wart diameter <0.5cm, wart mass diameter <1cm, number of warts <15), and are usually treated with topical drugs.

(2) Warts in the urethra and perianum of men, women's vestibules, urethral openings, vaginal walls and cervical openings; or warts of both sexes that exceed the above standards, physical treatment is recommended.

(3) After a small amount of wart remains after physical therapy, it can be treated with topical drugs.

(4) Whether it is drug therapy or physical therapy, an acetic acid white test must be performed to try to remove damage including subclinical infections to reduce recurrence.

(5) Treatment of genital warts in pregnant women. Early pregnancy should be treated as early as possible; those with skin lesions near delivery, such as obstruction of the birth canal, or vaginal delivery can cause severe bleeding, cesarean section should be considered; podophyllotoxin (podophyllotoxin), podophyllate, Fluorouracil has teratogenic effects and is contraindicated in pregnant women; the safety of imiquimod in pregnant women has not been determined. Pregnant women can choose topical 50% trichloroacetic acid solution, laser treatment, cryotherapy or surgical treatment. Condyloma acuminatum is not an indication of termination of pregnancy. Caesarean section should be considered when the wart is large, obstructs the birth canal, or causes severe bleeding.