Summary of condyloma acuminatumFirst, etiologyCondyloma acuminatum is caused by human papilloma virus (HPV). HPV is a kind of DNA virus, the
Summary of condyloma acuminatum
Condyloma acuminatum is caused by human papilloma virus (HPV). HPV is a kind of DNA virus, the core is DNA double stranded.
Papilloma virus host is highly species-specific, human papilloma virus (HPV) is the only host. Human, animal animal including rats were not infected, HPV tissue culture environment has not yet been successful, so bring some difficulties to the research work. There are many different types of HPV, now known to have more than and 80 subtypes of HPV, different types of HPV can cause different clinical manifestations. CV is mainly caused by 6, type 11 (low risk), 16, 18, 31, 33 (Gao Weixing) and other subtypes.
Two, clinical manifestation
Predilection for male and female genital and perianal. Men with coronary sulcus and the frenulum is most common, is also found in parts of the penis, wrapping, glans and urethra etc.. After the union of women, labia minora is the most common, but also visible in the vagina, vaginal and cervical mucosa and other parts.
Most of the patients were young and middle-aged in the active period. Good hair age is 16-35 years old, and the highest incidence of 20-34 years old, men and women have occurred. There was a history of feculent sexual contact or spouse infection before onset. The incubation period ranged from 1 to 8 months with an average of 3 months. Clinically, the incidence of children can be seen, the General Department of contact with contaminated appliances such as towels and infectious.
1 typical damage:
The primary damage is small and soft pale red papules, needle cap or a grain of rice. Increases gradually, and the number gradually increased, becoming papillomatous, cauliflower, cockscomb or mushroom like vegetation, rough surface, soft texture, such as not timely treatment of warts will gradually increase, some become large cauliflower, basal stalk; some of each other, as the bulk, light gray, the surface of papilloma, can have erosion, ulcer, have secretion, because of secondary infection, can cause odor. Patients generally no symptoms.
2 subclinical infection:
Epithelial cells have been infected with HPV, but there is no visible change. Subclinical infection can be clearly demonstrated by the white vinegar test. Vinegar white test is a simple and easy method to identify the early condyloma acuminatum and subclinical infection.
3.HPV virus carriers:
Using molecular biology techniques for sensitive polymerase chain reaction (PCR), extracted from patients with condyloma acuminatum spouse or sexual partner of the vulva or vaginal swab specimens in DNA as template, amplified, found a considerable proportion of the spouse or sexual partner HPV positive, and although he (she) who has no clinical acuteness wet wart damage, no subclinical infection, can be said to be carriers of HPV.
4 the reproductive site of epithelial infection HPV, can show a very wide spectrum of performance. From HPV carriers with no clinical and microscopic changes to microscopic changes, but no visible changes in subclinical infection to condyloma acuminatum lesions with a typical clinical appearance. In fact, the typical clinical manifestations of condyloma acuminatum is only a small part of the population infected with HPV, most of which are in the state of HPV carriers or subclinical infection. Some scholars call it the iceberg phenomenon, namely the clinical appear on the number of typical condyloma acuminatum performance as a small portion of the floating out of the water in the Ocean ice, and huge iceberg that the main carriers of HPV and subclinical infection is also hidden under the surface of the water.
5 condyloma acuminatum of some special parts
The male urethra: performance for wart like the urethra, the surface may be smooth but also a papilloma, color flushing, the surface is wet, check to be urethral mouth mucosa fully exposed, can see the wart. Sometimes the HPV virus can go up along the urethra, causing infection of the urethral epithelium.
The female cervical: cervix epithelium is stratified squamous epithelium from the vagina to the endocervical columnar epithelium is transitional part, although not acuteness wet wart good parts, but once the infection is HPV16, type 18, epithelial cells more prone to atypical hyperplasia, and the occurrence of invasive cancer.
The anus: perianal skin more wrinkles, and walking more friction, so once there are often multiple condyloma acuminatum. At the beginning of most papules, after a wart like growth. A large pedunculated cauliflower, more flat, surface patches of small papillae. Occurred in the male perianal, should pay attention to ask whether there is a history of homosexuality, anal sex.
The oral and pharyngeal mucosa: condyloma acuminatum can occur even in the mucosa of the mouth and throat epithelium, as small, flushing, soft, wart like papillary surface, which occurs in the oral sex.
6 giant condyloma acuminatum
Refers to the shape of the giant condyloma acuminatum, the size of the fist, the surface of the papilloma, due to secondary infection, secretions often have a bad smell. The mucous membrane of the mucous membrane that is good at male and glans, also can be seen at anus week and female vagina. Giant condyloma acuminatum is a verrucous carcinoma, which is a low-grade squamous cell carcinoma.
Three, laboratory examination
1 histopathological examination:
Under the microscope, the typical condyloma acuminatum is characterized by papillary hyperplasia, acanthosis, superficial hyperkeratosis and hyperkeratosis. In the visible cell vacuolation of prickle cell layer and granular layer, the cell body was big, round hyperchromatic nuclei, perinuclear vacuolization, pale staining, in the nuclear membrane and seroserous filament is connected to cells in the cat's-eye.
2 vinegar test:
With 3%-5% acetate soaked gauze or cotton swab apply to the skin surface, 3-5 minutes after the change in sharp contrast with the surrounding normal tissue, is a white vinegar wipe test positive. Subclinical infection is a useful means of detecting changes that have not yet been seen. A white patch or spot that is clearly marked. Vinegar test is simple and easy, should be used as a routine examination of patients with condyloma acuminatum, can correctly determine the scope of lesions, and then guide the treatment. However, the white vinegar test is not a specific test, which may result in false positive results in epithelial cells proliferation or the initial healing after trauma.
3 colposcopy (Colposcopy):
Colposcopy is a special magnifying glass, which is mainly used for the observation of vaginal mucosa.
Mainly used to check whether the vagina or cervical epithelial HPV infection in head and neck were scraped cells and coated on a slide with 95% alcohol fixed, common Papanicolaou (Papanicolaou) staining under the microscope is divided into five levels: normal, grade II: inflammation, III: suspected cancer IV, highly suspected cancer, V-grade: Cancer. Class II and II A and II B. A series of inflammatory cells, in addition to the inflammatory cells outside the B, there are still a few mild nuclear heterogeneous cells. Cases of smear II B should be followed up regularly. In order to determine whether HPV infection, the use of specific anti HPV antibody, histochemical staining or in situ hybridization.
5 polymerase chain reaction (PCR)
To occur on the vulva and perianal typical verrucous or cauliflower tumors, the diagnosis of condyloma acuminatum is not difficult. On the basis of the test of white vinegar, colposcopy (female) or urethra (male) and other pathological examination should be taken for the diagnosis of early and sub clinical infection. Diagnosis is still difficult, it can be a specific histochemical examination, in situ hybridization or PCR to detect pathogen diagnose.
Five, differential diagnosis
1 flat condyloma:
This is the clinical characteristic of the second stage of syphilis, which is characterized by a flat papules on the anus or vulva. The surface is moist, about 0.5cm in size. A patient's trunk and palmoplantar visible rash. Syphilis serum test was positive. With the examination of the surface of the surface of the flat condyloma, the majority of the Treponema pallidum was examined under the microscope.
2 pearly penile papules:
In the glans after coronary sulcus, for skin color or light red needle cap big soft papules, smooth surface. Arranged in a row or two rows along the coronary sulcus. Normal, no treatment. White vinegar test negative, such as the diagnosis can be regularly followed up, the shape of the penis like papules will not change, will not increase. Many men in the frenulum two, visible one or two such as needle cap big white papules, slightly elevated leather, smooth surface, see this is normal, without treatment.
3 Pseudocondyloma of vulva:
In the medial labia minora, uniform distribution for the majority of pale red papules, is like caviar. Histopathological examination of empty cells, can be identified.
Six, the relationship between HPV infection and genital cancer
1 there is a lot of evidence that HPV infection is associated with genital cancer, especially in women with cervical cancer. Female cervical epithelium was infected with HPV16 or type 18, with approximately 2/3 of patients with moderate to severe atypical hyperplasia within two years.
2. Bowen's disease is a squamous cell carcinoma of the vulva. With a substantial proportion of patients had history of condyloma acuminatum, some patients with condyloma acuminatum with.
3 giant condyloma acuminatum, this is a place in genital verrucous carcinoma, histopathology showed low squamous cell carcinoma lesions is based on the original change, condyloma acuminatum, untreated, chronic stimulation evolved.
Acuteness wet wart treatment methods, including the use of external medicine, physical therapy and systemic treatment, the specific size, location, number of patients and the patient's body, especially the immune status of the body.
1 topical treatment:
1) 0.5%: Podophyllotoxin Tincture for small number of warts, single wart condyloma acuminatum with diameter less than 2 cm, 0.5% Podophyllotoxin Tincture is the preferred drug. The method is to apply the liquid to the wart body, two times a day, for a period of treatment for a period of three days, if the body did not fall off, then in the rest of the 4 days after treatment for a course of treatment, medication can be used for three consecutive courses. Adverse reactions were mainly local pain, swelling, and no systemic adverse reactions were found. Pregnant disabled. In patients with redundant prepuce, local redness is often more obvious after use, individual patients with high degree of edema of the penis and prepuce, this time should be suspended medication, and 0.9% saline or hypertonic saline for wet compress.
2) 10%-25% bamboo grass fat tincture: because of its toxicity, the use of a large area can produce systemic toxicity, so it has been replaced by the Podophyllotoxin Tincture 0.5% purification product. The use of 10%-25% bamboo grass with tincture of each medication dosage should not exceed 0.5 ml, 1 to 4 hours after the wash liquor. Pregnant disabled.
3) chloroacetic acid solution; concentration ranging from 30%-80%, which is a chemical etchant, should be experienced in the use of medical personnel, should not be used in patients with. The liquid is directly applied to the skin lesions, such as the wart body has not been eroded off, then a week can be reused. Medication should pay attention to protect the surrounding normal skin, so as not to burn.
4 (2.5%-5%) 5- fluorouracil ointment: external use 1 to 2 times a day, until the wart body falls off, if the surrounding normal skin mucous membrane swelling, erosion, should be suspended.
5) interferon: local injection can also be made of topical ointment. It is difficult to be accepted by patients because of the pain of local injection. Topical application of alpha 2 B interferon gel can stimulate T cells and inhibit the virus and play a therapeutic effect. The drug has the advantages of no stimulation, no local adverse reactions redness, pain, weakness is slow onset, the need for continuous for 4-6 weeks. The results of clinical trials show that, in the treatment of condyloma acuminatum after cryotherapy, laser therapy, the application of alpha 2 B interferon gel to prevent recurrence.
6) 5% imiquimod cream: (Imiquimod) is an immunomodulator. External use, skin cleaning before medication, a bag (250mg) drug extrusion in cotton stick, coated on the skin lesions and lightly massage several times, 3 times a week (every Monday, three, two, four, five or six times a night of medication), treatment for 8 weeks. Adverse reactions were mainly local irritation, including erythema, edema, erosion, burning and pain. The recurrence rate was lower after treatment.
7 other: there are a lot of external treatment of condyloma acuminatum, or through the corrosion damage to the organization, or through the inhibition of DNA or RNA, and the therapeutic effect.
2 physical therapy:
1) liquid nitrogen freezing: generally use cotton swab method, with cotton swab dipped in liquid nitrogen, put a little pressure on the skin lesions for several seconds, so many times. The major damage, can use gauze dipped in liquid nitrogen, the pressure in the affected area, freezing and thawing several times each week, usually takes several treatment. Side effects of local edema, sustainable for several days.
2 carbon dioxide laser: suitable for small cases of verrucous body, in the female cervix, male urethral orifice of condyloma acuminatum difficult to use, can use carbon dioxide laser treatment.
3 electric cauterization: suitable for pedicle, large condyloma acuminatum. When the cauliflower like warts in condyloma acuminatum or growth, often forming a basal pedicle, at first by fulguration in the pedicle cut, the remaining damage by freezing, laser or drug therapy.
4 photodynamic therapy (photodynamic therapy, PDT): apply to the occurrence of condyloma acuminatum in the urethra. PDT is the combined application of photosensitizer (common delta aminolevulinic acid) and the corresponding source (He Ne laser) by photodynamic reaction selective action on the target tissue caused by destruction of condyloma acuminatum without damaging a treatment of surrounding normal tissues. The advantages of this method are less side effects, no trauma, high cure rate and low recurrence rate.
3 system therapy:
1) interferon: 1 million U to 3 million U subcutaneous or intramuscular injection of 2 times per week or every other day. The efficacy of each report is very different, generally do not need to use, for immunocompromised patients with condyloma acuminatum, you can choose.
2 (levamisole): immune regulatory role, can enhance the function of lymphocytes. Oral three times a day, each time for 50 days, take for 3 days, stop for 11 days for a course of treatment, can take a few courses.
3 other immune modulators, such as transfer factor.
4 operation: suitable for large condyloma acuminatum, the main method of resection of the wart, the wound healing after the use of local drugs or freezing method. Some patients with redundant prepuce, in the foreskin of the majority of condyloma acuminatum lesions, it is recommended circumcision.
5 should pay attention to several problems in treatment:
1) recurrence: no matter what treatment have a certain recurrence rate, which is one of the reasons of recurrence in lesions without treatment of subclinical infection. As mentioned earlier, subclinical infection refers to HPV has invaded epithelial cells, resulting in histological changes, but has not yet appeared naked eye visible clinical changes, so the treatment is often "escape". We advocate for all patients with condyloma acuminatum, as before the treatment should be done first to identify the vinegar test, the lesion, especially in subclinical infection of this treatment can be completely, this is a very useful measure to reduce recurrence.
2 re infection: the patient's spouse or sexual partner should be checked, such as suffering from condyloma acuminatum, while treatment. Otherwise, the patient can be re infected.
3 male urethral mouth acuteness wet wart treatment: this part of the treatment is more difficult, and easy to relapse. Photodynamic therapy has good effect and less recurrence.
4) female patients with condyloma acuminatum, should be with the speculum vinegar test to check whether the infection of cervical epithelium. Due to the chronic infection of HPV16 and type 18 can lead to atypical hyperplasia of cervical epithelium, as well as the occurrence of cervical cancer, so the need for cervical condyloma acuminatum, including sub clinical infection to be treated in time.
5) for patients who have been basically cured, it is recommended that the use of topical alpha -2 B interferon gel, local irritation of the drug is small, no obvious adverse drug reaction. It can also be used for 2.5% 5- fluorouracil ointment, in order to avoid local irritation of the drug can be used once a day in the afternoon, wash it before going to bed. The medicine can be once a day or every other day for 2 to 3 months.
Eight, follow up
Regular follow-up should cure patients with condyloma acuminatum after 2-4 weeks, the general time, lasted for 3 months. Each follow-up should be 3% or 5% acetic acid solution to cover the original lesion site, once found lesions should be treated immediately. In the complete cure, should enjoin patient avoids sexual life.
1 guard to avoid extramarital sex.
2 advocate the use of condoms.
3 have acuteness wet wart should treat in time, sexual partner or spouse should go to a hospital at the same time check.
4 patients with underwear, towels should be used alone, and should pay attention to disinfection.