There are usually two types: type I, which manifests as isolated or multiple cauliflower or cocklebur protuberances, mostly in the vulva, perianal area, etc.; and type II, which is a papillate, finger-like, or papular lesion, mostly distributed in the mucous membranes of the inner part of both labia minora, hymenal ring, vestibule, navicular fossa and so on.
Epidemiologic data show a close association between condyloma acuminatum and genital cancer. Using nucleic acid hybridization methods, human papillomavirus has been measured in different types of genital tumors, as well as in tissues of acromegaly lesions. Interstitial changes and progression to carcinoma in situ or invasive carcinoma have been reported in 5% to 10% of acromegaly of the vulva, cervix, and perianal area after a period of time. It has also been found that 15% of penile cancers and 5% of female vulvar cancers occur on the basis of primary condyloma acuminatum, especially cervical cancers, and those that develop malignant changes are particularly associated with HPV-16, 18, 31, and 33 types. Cancer can occur secondary to giant condyloma acuminatum. Many laboratory studies have further shown a causal relationship between HPV, condyloma acuminatum and genital cancer. Condyloma acuminatum of the vulva, penis or perianal area can transform into squamous cell carcinoma. This transformation usually takes 5-40 years. That's why it's important to treat warts aggressively to get rid of them. Seeking specialist treatment is the best choice, otherwise inappropriate treatment and irritation can accelerate the malignant transformation.
Clinical manifestations of warts
The clinical manifestations are varied. In the genitals of the lower temperature and dry parts of the damage is often manifested in small and flat, while in the warm, moist parts of the often filiform or papillomatous. At the beginning of a small reddish papules, and then gradually increase the number of fusion, the surface is uneven, moist and soft, papillomatous, corns, grass-like, myxomatous or cauliflower-like protrusions, red or dirty gray, the root of the root is often tibial, and prone to vesiculation and oozing, easy to hemorrhage. Between the cracks of the skin lesions often have pus secretion accumulation, resulting in a bad smell, conscious itch and scratching and secondary infection. Due to the constant effect of local moist and chronic stimulation, it tends to grow rapidly. Some female patients even from the vulva to the vagina, cervix and so on are full of a piece of hairy spines or a lot of small cauliflower-like protrusions, similar to the rose-colored thorns or cockles. The number of warts is less than a few, more than ten, dozens or even a hundred. A few patients due to untimely treatment, so that warts grow very large, become a huge warts, can be to the deep penetration, produce a lot of fistula to the urethra or after 5-40 years of malignant transformation into cancer. The warts that occur in the rectum can cause a sense of urgency and heaviness. When the hormone level of the body during pregnancy, the genital blood supply is rich, and the body's immune function has been reduced, so the volume of genital warts is also rapidly increased, even to the extent of obstructing the birth canal. The warts tend to rub and tear and bleed during labor and delivery, and because of the fragility of their tissues, it can be difficult to stitch and stop the bleeding. Some warts may shrink or even disappear at the end of pregnancy or after delivery. There are no obvious symptoms, but there is a sense of itching, dampness or friction. If there is secondary infection, it can be accompanied by pain, and when there is damage to the vagina and cervix, it can be manifested as increased leukorrhea or bleeding after sexual intercourse. A large rash may cause a localized foreign body sensation or pain due to friction. Symptoms may worsen during sexual intercourse.
Some cases are subclinical infections or HPV carriers with no meaty clinical manifestations. After a pregnant woman has warts, the human papilloma virus can be transmitted to her baby through the process of labor and delivery, causing her to develop laryngeal warts and causing papilloma of the larynx. Even if the mother is infected with no clinical symptoms, the virus can be transmitted to the fetus through the blood or placenta, so women with this disease in full-term pregnancy, to do a cesarean section operation is appropriate.
Histopathology
Insufficient keratinization, the echinocyte layer is highly hypertrophied, papillomatous hyperplasia, epidermal thickening and prolongation of pseudoepithelioma, the basal layer of the echinodermal cells can be seen in the majority of nuclear schizophrenia, quite similar to carcinoma, but the cells are arranged in a regular manner, dermis and epidermis clear boundary, the end of the granules and the echinodermal layer of the vacuolated cells, the cells are pale in color with a cytoplasm, and the center of the nucleus is y basophilic, large and rounded.
Dermal capillaries are dilated, and there is a dense chronic inflammatory cell infiltrate around the blood vessels.
Diagnosis
Condyloma acuminatum often needs to be differentiated from genital carcinoma, flat condyloma, pseudocondyloma, genital Bowen's papulosis, and pearly papulosis.
(1) genital area cancer The skin lesions are hard, the border is unclear, squamous epithelioma has obvious infiltration to the deep, often forming ulcers, sometimes should be pathohistological examination. Condyloma acuminatum is usually papillary growth, the lesion is superficial, rarely infiltrate the surface.
(2) flat warts For syphilis stage II rash. Flat warts occur in the perianal area and around the external genitalia, with a wide base, no tips, flat appearance, and a moist, smooth wart surface. Dark-field microscopy can find syphilis spirochetes, syphilis seropositivity. See the section on syphilis for more information.
(3) pseudocondyloma, also known as female villous labia minora, in adult women on the labia minora on the inner side of the fish-egg-shaped or tiny villous, regular arrangement of organisms, do not fuse with each other, long-term unchanged, acetic acid white test is negative.
(4) Genital Bowen-like papulosis This disease is rare, mainly associated with human papillomavirus type 16 infection. It is characterized by multiple brownish-red papules in the genital area, 2-10 mm in diameter. clinically it resembles warts, but histologically it is similar to the changes of Bowen's disease. A specialist is necessary to make this diagnosis.
(5) Pearly papulosis (pearly penile papulosis) occurs in the male glans, along the coronal groove of the glans there is a neat arrangement of pearl-like papules of uniform size. They are rice-grain sized, domed, and smooth, do not fuse with each other, and remain unchanged for a long time.
(6) Sebaceous ectasia: papules without overlapping growth in the mucosa, mostly yellowish.
(7) Molluscum contagiosum: a single non-fused skin-colored hemispherical papule with a smooth periphery and a central molluscum contagiosum extrudable.
(8) Soft chancre: skin lesions on the external genitalia in the form of irregularly shaped ulcers with painful stomatitis. A smear of the exudate from the ulcerated surface may detect Ducreyella.
The diagnosis of warts depends on the doctor's clinical experience, but because of the sexually transmitted diseases in our country for many years, the clinician's experience is limited, it is inevitable that there are errors of judgment, it is reported that some of the grassroots hospitals of the misdiagnosis of the rate of up to 50-80%; warts are located in the inner labia major and minor labia, the vaginal opening and anus, the lesion is light red, bright red or dark red. The warts are moist and soft, and can be single or multiple, sometimes in the form of cauliflower pattern typical skin lesions. The warts are similar to the warts, but there are also pseudo warts or velvet labia minora, the latter is mostly found in the inner and lower labia minora, spiny protruding and labia minora color similar to velvet, but the patient has no symptoms, only leukorrhea increase. Other easy to misdiagnose hymen flab, flat warts (syphilis rash), sebaceous gland hyperplasia and so on.
To accurately identify these different diseases, very practical and simple way is the vinegar white test, that is, with 5% glacial acetic acid liquid coated in the lesion, 3 minutes after the warts white warts, or else a different story. Or to soak 3-5% glacial acetic acid solution of gauze wrapped in the suspected lesions for 3-5 minutes, if the affected area becomes white, it is a subclinical infection.
You can also do the iodine yellow test, that is, 3 minutes after applying with Lugol's solution, the yellowing can be diagnosed as condyloma acuminatum. Of course a more reliable way is to do histopathological examination. In the past two years, there have been several reports in domestic magazines talking about the differential diagnosis of pseudo warts, especially mentioning the vinegar white test. However, the diagnosis of histopathological examination is not easy, and sometimes it is difficult to confirm the diagnosis, but still depends on the examiner's business level and experience. The definitive diagnosis of this disease depends on the establishment of an effective viral culture system, tissue immunochemistry and the development of molecular bioengineering technology DNA probe, then it will not be pseudo-warts expanded, misdiagnosed as condyloma acuminatum.
Warts occurring in the vagina or cervix may be less obvious and variable, and may be misdiagnosed by clinical examination alone, often requiring cytology, colposcopy, and histopathology.
a. Cytological examination: with vaginal or cervical warts tissue smear for Pap smear, if found poorly keratinized cells and vacuolated cells mixed presence, the diagnostic value of the disease.
b.Immunohistochemistry: The peroxidase-antiperoxidase antibody complex technique (PAP method) is an immunological method that uses antisera specific for HPV to show viral proteins, which proves the presence of viral antigens in the warts, and is more rapid and effective than conventional electron microscopy methods.
Pathologic examination helps in the diagnosis, and the presence of vacuolated cells in the upper layers of the transsphenoidal cells is most diagnostic.
Molecular biology techniques such as polymerase chain reaction (PCR) to detect HPV, this method can also be used as subtype determination. But most of the domestic medical institutions PCR experiment due to insufficient conditions, misdiagnosis phenomenon is too much, has been insufficient as a diagnostic tool. Now gopla is trying to use gene chip technology to diagnose warts, but because of the cost is still high, and rely on PCR to amplify the results, only applicable to laboratory research, in recent years is difficult to promote.
Treatment
Currently, the treatment of warts is mainly external treatment, supplemented by internal treatment. There are many methods of external treatment, including medication, cryotherapy, laser therapy, microwave therapy, electrocautery therapy, and surgery. Drug treatment is convenient and easy to operate, but generally need to be repeated several times, and some drugs, such as trichloroacetic acid, there is a possibility of burning the mucous membrane.
I. Medication. For smaller and lesser damage.
(1) 5% 5-Fu ointment 5-Fu is a commonly used antitumor drug, it can inhibit cell proliferation, the power is more mild, usually need to be treated for 2 to 3 weeks.
(2) warts enemy: with a single hole or porous plastic stick, will be 0.5% "warts enemy" solution drops on the warts, and make the liquid slowly penetrate into the wart base, the warts after the point of purple, to be self drying, pay attention to the point of the drug can not be too much, in order to avoid the flow of medicine to the normal tissue. The actual fact is that it's not a good idea to have a good deal of money to spend on the actual thing.
(3) acetic acid: trichloroacetic acid is a strong acid that can be used to cauterize warts and is generally used to treat type II lesions. Before applying a cotton ball with 2% of the cardamine paste in the lesion local 3￣5 minutes, with a cotton swab with 50% of the trichloroacetic acid coated lesions, so that the liquid to the base of the base; coated with attention to do not injure the surrounding healthy mucous membrane tissues, menstruation should not be used; the use of medication 2 times a week. Or use 20% salicylic acid glacial acetic acid external application.
(4) 1-3% peptidylbutylamine cream, external application of the drug, twice a day, without adverse side effects, can also be used for vaginal warts. Or first wash the affected area with 1:5000 potassium permanganate, then use the cream thick layer external coating, and gauze bandage, change the medicine once a day. 4 weeks for a course of treatment. The force is mild, no toxic side effects have been found, long-term treatment is required.
(5) warts off Xin (onychomycosis toxin solution) for the new high-efficiency treatment of warts of the drug, non-irritating, topical local, once a day, for 3 to 5 days can be.
(6) 20-25% of the foot leaf grass ester tincture (or 0.5% foot leaf grass fat toxin solution) or liquid paraffin preparations, applied directly to the lesions. Or use 20 - 25% foot leaf grass fat dissolved in benzoic acid tincture or mineral oil, in the local rubbing. Used 1 to 2 times a week, less than 6 weeks can be removed from the scab and healed. Because of its toxicity, each time the amount of medicine should be limited to less than 0.5 ml, the area of the drug should not exceed 10 cm2, 1-4 hours after the application of the drug to wash the local. The drug has side effects, local manifestations of erythema, vesicles, burning pain, severe cases can lead to ulceration and necrotic changes. Be careful to protect the surrounding skin and mucous membranes, the initial application of the drug 2-4 hours after washing with soap and water, repeated application of the drug in 6-8 hours should also be washed off, so as not to burn the skin. It has teratogenic effect and is prohibited for pregnant women. When applying the medicine, pay attention to protect the surrounding normal skin, you can apply petroleum jelly on the normal skin in advance as a precaution. The pain after using this method is heavy, often need to use painkillers. It can cause systemic toxic reaction, dizziness, drowsiness, coma, vomiting, etc. It is dangerous after using more dosage, recurrent neuritis, sensory abnormality, fever, leukopenia and thrombocytopenia, coma and even death. Pregnant women should not be used.
(7)Contraindicine, pingyangmycin to saline, external application of the affected area, 2 to 3 times a week.
(8)Acyclic guanosine cream
(9)Keep the affected area clean and dry, wash it with 3% hydrogen peroxide solution or 1:5000 potassium permanganate solution.
(10) 1-5% fluorouracil cream or 2% fluorouracil solution is applied externally once a day, and only a few lesions are applied at a time to avoid an erosive reaction of the scrotum and mucosa.
(11) 0.25% herpes net ointment, twice a day. 2 consecutive weeks for a course of treatment.
(12) Gram warts. Currently better topical drugs. Toxicity is small, the treatment is complete, leaving less scars. (You can find the urology department of Anzhen Hospital.) Review 3 months after the cure to prevent recurrence.
(12) 1% you butylamine cream coated control, three times a day, adhere to 6 weeks can also be expected to cure.
Two, microwave therapy. This is into the 90's after the rise of the treatment method. The principle is to use the high-frequency vibration of the microwave, so that the warts internal water evaporation, necrosis off. Microwave treatment is characterized by the destruction of warts thoroughly, not easy to recur, but the wound recovery is slow, easy to secondary infection. So microwave treatment is particularly suitable for the treatment of warts larger, isolated, scattered, and at the same time to stay away from the foreskin tie of the acromegaly, in order to prevent damage to the foreskin tie, affecting the male sexual function.
Three, cryotherapy: liquid nitrogen or carbon dioxide dry ice freezing, so that the wart tissue (i.e., skin damage local) necrosis. Condyloma acuminatum is a benign proliferation of the skin and mucous membranes due to the infection of the condyloma acuminatum virus. It has a large number of small blood vessels and proliferates rapidly. With freezing, the warts can be destroyed by causing ice to form within the acromegaly, creating a high degree of localized edema in the tissue. The biggest advantage of cryotherapy is that it leaves no traces on the local area, and the cure rate is about 70%. In addition to localized redness, swelling, pain and blisters, there is generally no obvious after-effects. Spray method or direct contact method can be used, suitable for flat and small warts. Generally freezing 1 time per week, 2 to 3 times in a row. Usually after menstruation treatment.
Four, laser treatment: on the vulva, around the anus and other superficial warts suitable; it is characterized by fast results, in the treatment of the time, the warts can fall off. The most common is the carbon dioxide laser, which is used to cauterize the warts, and usually 1 time can make the warts come off. However, because the laser beam is too concentrated, laser treatment is only suitable for warts smaller warts, such as warts larger, laser treatment is very easy to recur. The cure rate can be up to 80%.
Fifth, electrocautery treatment: electrocautery is an old treatment method. The dermatologist used to use a high-frequency electric knife or soldering iron to cauterize the common warts, pigmented nevi and other skin abnormalities. It is characterized by simple operation and quick results. High-frequency electric knife can directly excise and dry warts, the treatment is also more thorough, however, electric cauterization sore surface healing is slow. To summarize, electric cauterization treatment, can be used for any acromegaly treatment, but the technical requirements of the operator is high, too much or not enough cauterization is harmful. It is also important to pay attention to asepsis to prevent infection. High-frequency electrocautery or electro-acupuncture is more appropriate for treating smaller lesions on the cervix or vagina. Larger warts require electrocautery in batches.
Sixth, surgical excision: surgical excision can be considered for larger, isolated warts with tips. Surgical excision of acromegaly is generally not advocated, because after surgical treatment, acromegaly is easy to recur, so that the treatment fails. But for the larger warts with tips or suspected malignancy, surgical excision can be considered. Some patients have warts that grow too quickly, or are as large as cauliflowers, and other treatments are very difficult, so surgery can be considered. In order to prevent recurrence, after surgery with other treatment. According to the warts, covered area, choose lesion excision or vulvectomy.
Seven, surgical scraping method: the treatment of the left hand will be the lesion parts of the skin or mucous membrane taut, or hand-held disinfectant spatula from the root of a little force will be the lesion tissue scraping; off thoroughly remove the trauma of the remnants of the lesion tissue, and then 33% trichloroacetic acid solution or pure carbonic acid solution or 3% ferric chloride liquid coated with local.
Eight, surgical ligation method: applicable to a single small lesion with burdock, local disinfection and local anesthesia; with tweezers to lift the wart tissue, with hemostatic forceps clip the root, and then use the No. 1 silk thread to zap the base base base, usually in 3-5 days after ligation, warts can fall off.
Interferon: 1,000,000 units day intramuscular injection, continuous treatment 10-14 days after the change to 3 times a week injection, the application of about 4 weeks. 2, local injection: the use of interferon in the lesion of the base of the direct infiltration of the injection, 2 times a week.
Polymyocytes (inducer): a 20mg intramuscular injection, twice in the first week. 2-4 weeks for a course of treatment.
They each have their own indications, and their cure rate is between 50% and 80%. The cure rate is between 50% and 80%.