What are the manifestations of condyloma acuminatum and how is it diagnosed?

  Condyloma acuminatum, also known as genital warts, is a disease formed by infection of the genital area with the human papilloma virus. It is one of the common sexually transmitted diseases and is related to the occurrence of genital cancer.  The incubation period varies from 3 weeks to 8 months, with a maximum of 8 – 12 months and an average of 3 months. It is mostly seen in sexually active young and middle-aged men and women, with the peak age of onset being 20 – 25 years. Most patients are generally asymptomatic. The lesions vary in size and shape. They can be as few as a few or as many as a pinhead. They can grow into large tumor-like objects in the anus and pubis, with pressure and a foul odor; sometimes small warts can be painful and itchy in the pubic area, and patients may have blood in the urine and difficulty urinating.  In men, the warts are found on the prepuce, coronal sulcus, foreskin, urethra, penis, perianal area and scrotum. The first is a pale red or dirty red corn-like superfluous organism, soft in nature, slightly pointed at the tip, gradually growing or increasing. They may develop into papillae or cysts, with a slightly wide base or band and a granular surface. In the anus, they are often enlarged and resemble cauliflower, with a moist or bleeding surface, and pus often accumulates between the granules, emitting a foul odor, and can become secondary to infection after scratching. The genital warts are located in dry areas with low humidity, the damage is often small and flat warts. The warts located in hot and humid areas often appear filiform or papillomatous, easily fused into large clusters. Warts can increase in size in patients with severe liver disease. Pregnancy can cause warts to recur or grow faster.  The size and shape of warts can be clinically classified into five types: cauliflower warts, papular warts, keratinized warts, nodular warts and giant warts. The subclinical infection is a clinically unrecognizable lesion, but with 3%-5% acetic acid solution applied topically or wet for 5-10 minutes can be white in the area of HPV infection, the so-called “white acetate phenomenon”.  The diagnosis of this disease is generally not difficult based on the characteristics of the rash, the site of onset, and the development of the disease combined with a history of possible contact. Subclinical infections can be isolated or coexist with typical lesions and can be diagnosed with the help of a white acetate test. For latent infection, in situ hybridization or polymerase chain reaction (PCR) can be used to confirm the diagnosis, and PCR can detect HPV DNA.