The disease occurs in sexually active young and middle-aged people. The incubation period is generally 2 weeks to 8 months, with an average of 3 months. In men, the lesions are found in the coronal sulcus, prepuce, glans, ligament, urethra, penis body and perineum, in homosexuals, in the anus and rectum, in women, in the labia majora and minora, vaginal opening, clitoris, vagina, cervix, perineum and perianal area, and in a few patients, outside the anogenital area (e.g., oral cavity, armpit, breast, interdigital area, etc.).
The lesions start as single or multiple scattered reddish papules with soft texture and sharp tips, and then increase in size, depending on the morphology of the warts, they can be classified as sessile (i.e. papule-like lesions) or sessile, which can be papillary, cauliflower, coronary and myxoid. The warts are often white, pink, or gray, and the surface is prone to erosion, oozing, maceration, and rupture, and may be combined with bleeding and infection (Figure 28-4 Warts). The majority of patients have no obvious conscious symptoms, but a few may experience foreign body sensation, burning pain, itching or discomfort during intercourse. The cervical warts are usually small, well-defined, smooth or granular, and can increase significantly during pregnancy. In a small number of patients, the warts are overgrown and become giant condyloma acuminata (Buschke-Lowenstein tumor). The histology shows benign lesions, often associated with HPV-6 infection.
The vast majority of genital-anal HPV infections are latent or subclinical infections. The former has a normal local skin mucosal appearance and a negative white acetate test, but the presence of HPV can be detected by molecular biology methods, HPV latent infection is one of the main causes of recurrence of condyloma acuminata; the latter shows lesions that are not recognizable to the naked eye, positive white acetate test or with typical histopathological manifestations, the presence and reactivity of subclinical infection is related to the recurrence of the disease!
Diagnosis and differential diagnosis of condyloma acuminatum
Diagnosis of condyloma acuminatum
The diagnosis of this disease is based on medical history (history of sexual contact, history of spousal infection or history of indirect contact, etc.), typical clinical manifestations and laboratory test results (white acetate test, histopathological examination).
Differential diagnosis of condyloma acuminatum
This disease needs to be differentiated from the following diseases.
Pseudo condyloma: (pseudo condyloma) often occurs on the inner labia minora and vaginal vestibule in women, as small white or light red papules with a smooth surface, symmetrically distributed, without conscious symptoms; the white acetate test is negative.
Pilar papules: small cone-shaped, single or multiple rows of white or reddish papules on the edge of the coronal sulcus of the glans in men, not fused, no conscious symptoms.
Flat warts: These are characteristic lesions of second-stage syphilis, occurring as multiple or clusters of reddish-brown myxoid plaques in the anogenital area, with a flat surface, wide base, and no tip, often vesicular and exuding; syphilis spirochetes can be detected in the dark field on lesion sampling; syphilis serology is strongly positive.
The skin glands are odorous: small yellowish papules occurring on the lips of the mouth, glans and labia, located subcutaneously and not increasing in size; the white acetate test is negative and the histopathology shows mature sebaceous gland tissue.
Treatment of Condyloma acuminatum
Topical treatment
The actual tincture of the 0.5% footwear tincture of toxin (ghost toxin tincture): an antiviral mitogenic drug. The actual fact is that you can find a lot of people who are not able to get a good deal on a lot of things. It is suitable for any part of the lesion (including male intra-urethral and female intravaginal lesions), but should be noted that its teratogenic effect, pregnant women are prohibited.
10%~25% tincture of pedicel tincture: topical application 1~2 times a week, wash off after 1~4 hours of application. Because of the large irritation, so should pay attention to protect the normal tissue around the lesions; this drug has teratogenic effects, pregnant women are prohibited.
50% trichloroacetic acid or dichloroacetic acid solution: can destroy the warts through the coagulation of the virus protein, so that the warts tissue necrosis off. This is a good idea to use it once a week or every other week, not more than 6 weeks in a row. It is corrosive and care should be taken to protect normal tissues.
Others: 5% 5-fluorouracil is used topically once a week; or 5% Imiquimod is used topically 2-3 times a week Topical application before bedtime, wash off after 6-10 hours, can be used for 16 weeks, mild to moderate local irritation symptoms can occur.
Physical therapy such as laser, freezing, electrocautery, microwave, etc., can be used as appropriate, huge warts can be surgically removed.
Internal substance treatment, can be used with interferon.