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Condyloma acuminatum is a sexually transmitted disease caused by human papillomavirus (HPV) infection, with proliferative damage to the anal genital area as the main manifestation. Most occur in young people aged 18 to 50. Onset takes about half a month to 8 months, with an average incubation period of 3 months. The disease is more common and is transmitted mainly through sexual contact.

Basic Information

nickname
STD warts, anal genital warts, genital warts
English name
pointed condyloma
Visiting department
dermatology
Multiple groups
18 to 50 years old
Common locations
External genitalia, perianal
Contagious
Have
way for spreading
Sexual contact, indirect contact, mother and child

Causes and transmission of genital warts

HPV has different subtypes. The most common HPV that causes genital warts are 6, 11 and so on. HPV is easy to survive and reproduce under the warm and humid conditions of the human body, so the external genitalia and perianal area are the most prone to infection. There are several ways of spreading:
Sexual contact
Is the most important route of transmission. Therefore, the disease is prone to occur in people with sexual relations disorders.
2. Indirect contact infection
A small number of patients can be infected by articles that have been used by patients, such as underwear, underwear, bath towels, bathtubs, and toilet circles.
3. Mother-to-child transmission
Laryngeal papillomatosis of the baby occurs during delivery through the birth canal.

Clinical manifestations of genital warts

The incubation period is 1 to 8 months, with an average of 3 months. It mainly occurs in sexually active people.
1. Typical Condyloma Acuminatum
Genitals and perianal are the most common sites. Men are more common in the foreskin, lacing, coronary sulcus, glans, urethral opening, penis, perianal, intrarectal, and scrotum. Women are more common in the labia majora, posterior union, vestibule, clitoris, and cervix And perianal. Occasionally can be found outside the genitals and perianal areas, such as the armpits, umbilical fossa, mouth, breasts and between the toes. Vaginitis in women and excessively long foreskin in men are contributing factors to the occurrence of genital warts.
The damage was small and reddish pimples at the beginning, and gradually increased and increased later, distributed individually or in clusters, moist and soft, with uneven surfaces, showing nipple-like, crow-like, or cauliflower-like protrusions. Red or stained gray. Roots often have pedicles, and are prone to erosion and exudate, which is easy to bleed when touched. Purulent secretions often stagnate between skin fissures, causing a foul odor, and can cause secondary infections due to scratching. The disease is often unconscious, and some patients may experience foreign body sensation, pain, itching, or pain during intercourse. Condyloma acuminatum in the rectum can cause pain, blood in the stool, and severe sensations after anxiety.
2. HPV subclinical infection
Means that HPV infection is not identifiable to the naked eye clinically, but evidence of HPV infection can be found by acetic acid white test (spotting with whiteness after 5% acetic acid solution or wet application), histopathology, or nucleic acid detection technology.
3. Relationship with tumors
A large number of epidemiological data indicate that HPV infection (mainly high-risk HPV, such as HPV-16, type 18) is closely related to the occurrence of genital cancer, such as cervical cancer and penile cancer.
The prognosis is generally good after treatment. Regardless of the method of treatment, it may recur.

Condyloma acuminatum

Acetic acid white experiment
With 3% to 5% acetic acid solution, topical external application or wet application for 5 to 10 minutes can cause whitening in the HPV infected area, the so-called "acetic acid phenomenon". However, the specificity is not high, and some chronic inflammations, such as candida vulvitis, genital trauma, and non-specific inflammation can appear false positive.
2. Cytological examination
Vaginal or cervical wart tissue smears and Pap staining show that two types of cells, namely vacuolated cells and keratinocytes, are present at the same time, which is of diagnostic value for condyloma acuminatum.
3. Histopathological examination
The emergence of vacuolated cells above the spinous layer and granular layer is important evidence for the diagnosis of HPV infection.
4. Immunological test
Antibodies against HPV proteins were used to detect HPV antigens in diseased tissues. The sensitivity of this method is not high, and the detection rate is only about 50%.
5. Nucleic acid hybridization test
It is an important method for detecting HPV infection, including dot blot hybridization, tissue in situ hybridization, and nucleic acid blotting (Southern blot hybridization). These methods have high specificity and sensitivity, and are sensitive and reliable methods for diagnosing HPV infection. However, the technical operation is cumbersome and it has not been generally carried out clinically.
6. Polymerase chain reaction (PCR)
It is the most sensitive method for detecting HPV infection at present, and can be used for type specificity analysis. It has the characteristics of high sensitivity, simple and rapid method. It has been widely used clinically.

Condyloma acuminatum diagnosis

1. Typical skin lesions are pimples on wet parts such as the genitals or perianum, nipple-shaped, cauliflower-like, or chicken crown-shaped fleshy neoplasms, and the surface is rough and keratinized.
2. Auxiliary inspection: Positive white acetate test, HPV-DNA related sequences can be detected by nucleic acid hybridization, and specific HPV-DNA amplification bands can be detected by PCR.
3. Patients often have a history of unclean sex life or a spouse's infection. A few genital warts are infected through contact with contaminated equipment, and newborns can also be infected through the birth canal. The incubation period ranges from 1 to 8 months, with an average of 3 months.

Condyloma acuminatum treatment

The treatment of condyloma acuminatum must be combined.
1. Treatment incentives (excessive foreskin, vaginitis, balanitis, gonorrhea, etc.).
2. Improve body immunity.
3. Chemotherapy
(1) 0.5% podophyllotoxin tincture (or 0.15% cream) is suitable for the treatment of genital warts with a diameter of 10 mm or less, and the clinical cure rate can reach about 90%. The total area of warts used should not exceed 10 cm 2 , and the total amount of daily medication should not exceed 0.5 ml. The topical medicine should be allowed to dry naturally after application. The main side effects are local irritation, which can include itching, burning, swelling, erosion and necrosis. In addition, this medicine has teratogenic effects, and pregnant women are contraindicated.
(2) 5% imiquimod cream For the treatment of condyloma acuminatum, the average clearance rate of warts is 56%. The advantage of this therapy is the low recurrence rate, which is about 13%. The appearance of erythema is not an indication to stop the drug. If there is erosion or damage, the drug should be discontinued and revisited. The doctor will treat the wound and decide whether to continue the medication. The side effects are mainly local irritation, which may include itching, burning, erythema, and erosion. The safety of imiquimod during pregnancy has not been established and is contraindicated in pregnant women.
(3) 80% 90% trichloroacetic acid or dichloroacetic acid should be treated by a doctor. When using, apply a small amount of liquid medicine on the wart damage and wait for it to dry. At this time, a layer of white frost is formed on the surface. During treatment, care should be taken to protect the surrounding normal skin and mucous membranes. If the amount of external medicine is excessive, you can apply talc, or sodium bicarbonate (soda powder) or liquid soap to neutralize excess, unreacted acid. This medicine cannot be used for hyperkeratosis or large, multiple, and large warts. Adverse reactions were local irritation, swelling, and erosion.
4. Cryotherapy
Utilizing liquid nitrogen with a low temperature of -196 ° C, the condyloma acuminatum is treated by compression freezing to promote necrosis and shedding of the wart tissue. The operation is simple, efficient, and easy for patients to tolerate. This method is suitable for genital warts with small quantity and small area. It can be treated once or twice, with an interval of one week.
5. Laser treatment
CO 2 laser is usually used to treat condyloma acuminatum by cautery. Single or small multiple warts can be treated at once, and multiple or large warts can be treated 2 to 3 times at intervals of one week.
6. Electrocautery treatment
Use high-frequency electric needle or electric knife to remove genital warts. This therapy is suitable for genital warts with small quantity and small area.
7. Aminoketovaleric acid photodynamic therapy (ALA-PDT therapy)
This method can selectively kill proliferative and prosperous cells. It not only has a destructive effect on the condyloma acuminatum visible to the naked eye, but also removes subclinical damage and latently infected tissues. It has the advantages of high cure rate, low recurrence rate, few and mild adverse reactions, and good patient compliance.
8. Surgical treatment
It is suitable for huge condyloma acuminata, to remove the wart body in whole or in batches.
9. Immunotherapy
It is not recommended to be used alone, it can be used as adjuvant treatment and prevent recurrence. Interferon can be injected intramuscularly, subcutaneously, and damaged base, interleukin-2 is injected subcutaneously or intramuscularly, and intramuscular injection of polymyocytes is available.

Condyloma acuminatum prevention

1. Resolutely put an end to sexual disorder
In patients with genital warts, infection is mainly through sexual contact. One of the family members became ill from the society, transmitted to their spouse through sexual life, and passed on to their family members through close living contact, which brought both physical pain and family discord. Therefore, improving sexual ethics and preventing extramarital sex are important aspects of preventing genital warts. Make sure your sex partner is also getting treatment.
2. Prevent contact infection and pay attention to personal hygiene
Do not use other people's underwear, swimwear and bathtubs; do not wash tub baths in public baths, promote showers, do not sit directly on the bath chair after bathing; use squat toilets in public toilets; wash hands with soap before and after using the toilet. [1-3]

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