How is condyloma acuminata diagnosed?
Patient’s Complaint: The patient’s conscious symptoms include itching, foreign body sensation, pressure or pain, and often bleeding due to increased brittleness of the lesions. Women may have increased leucorrhea.
The first thing the doctor should do is to ask if there is a history of unclean sexual contact, a history of spousal infection or if there is a history of indirect infection.
(While examining the lesions and taking a medical history, an experienced physician can make an initial inference about the size and shape of the lesions and the stage of the disease. (See the next section for more details on the visual inspection method.)
The first question most often asked by doctors is “What have you done in the last few months?”
Patient: “Nothing.”
Doctor: “Think about it more carefully. What kind of work do you do?”
Patient: “……”
Because the disease involves the patient’s privacy, the process of taking a medical history can be unsatisfactory. If the patient does not want to talk about it, the doctor usually does not pursue it; in addition, he or she will suggest his or her sexual partner to come for examination and treatment as well.
Visual examination: judgment based on typical lesion patterns
Auxiliary tests (laboratory tests): The diagnosis is generally not difficult based on the characteristics of the rash, the site of onset, and the medical history. If necessary, white acetate test, cytological examination and histopathological examination can be done to assist in the diagnosis.
Acetic acid white test: That is, using 5% acetic acid solution applied externally or wet compress on the affected area, after 3~5 minutes, the lesion becomes white locally and the boundary is clear is positive (the figure below). The mechanism may be the increased expression of keratin in the epithelium of HPV-infected epithelial cells, which is easily coagulated by acetic acid and whitened. In clinical practice, a few large hospitals (such as the Institute of Dermatology of the Chinese Academy of Medical Sciences) have made the white acetate test a routine mandatory test for condyloma acuminatum, the purpose of which is to diagnose, on the one hand, and to mark clinical infection and subclinical infection lesions with a certain localization function in order to remove the lesions as thoroughly as possible. However, it is not routinely used in most hospitals.
Histopathological biopsy: microscopically, there is mainly pseudoepithelioma-like hyperplasia with marked vacuolar degeneration in the granular layer and the upper part of the spinal cells; there is dermal edema, dilated capillaries, and moderate chronic inflammatory cell infiltration around them. The characteristic pathological changes are vacuolated cells.
Cytologic examination: generally indicated for intravaginal lesions in women, smears of vaginal cervical and other tissues are taken and Pap staining is done, vacuolated cells and dyskeratotic cells can be seen.
Molecular biology examination: Human papillomavirus (HPV) is detected by PCR method.
Photodynamic localization diagnosis: It is the most cutting-edge advancement in the diagnosis of acromegaly, which is currently in the research stage and has not yet entered the clinical use stage. The basic principle is to use short-wavelength excitation light to excite the focal cells that accumulate photosensitizer to produce red light, thus distinguishing them from normal tissue. The operation starts with a 10-20% aqueous solution of aminoketovaleric acid hydrochloride wet compress on the affected area, and after 2-4 hours of irradiation with short wavelength light (generally using 400-410nm wavelength), the lesion area will be red. The advantage is that it can show not only clinical lesions and subclinical infections, but also latent infection sites, thus, its significance is not only for diagnosis, but also for localization to guide clinical treatment.
The following diseases are similar to condyloma acuminata in terms of the state of the lesions, which can easily lead to clinical misdiagnosis and need to be differentiated from condyloma acuminata.
1, flat warts: for the second stage of syphilis a performance, skin lesions for infiltration, smooth flat elevation, no tip, damage can be found within the syphilis spirochete, syphilis serological reaction positive.
2, pseudo warts (also known as fluffy labia minora): young women’s labia minora medial appear clusters of non-fused fish-egg-like papules, part of the fluffy, mucous membrane color or light red, the surface is smooth without conscious symptoms, touch the granular or soft feeling, more leukorrhea and other symptoms, and long-term vaginal secretions stimulation related. The histopathological changes are chronic inflammatory manifestations, lacking specific vacuolated cells and other changes. The white acetate test is negative.
3, Genital cancer: Mostly seen after middle age, with outward growth to deep infiltration, can form ulcers with infection, hard nature, easy to bleed, malodorous, histopathology can see intercellular changes, no vacuolated cells.
4, Bowen-like papulosis: This disease is carcinoma in situ, mainly related to HPV16 infection. It is manifested as multiple dark red or brownish red papules, scattered distribution or clustered arrangement into lines or rings, with slow development and histologically similar to Bowen’s disease-like changes.
5, penile pearly papulosis: young adults are common, manifested as pearly, white or light red cone-shaped, spherical or irregular translucent papules arranged along the coronal sulcus, do not fuse with each other, no conscious symptoms.
6, sebaceous ectopia: pinhead-sized, isolated, non-overlapping growth of small yellowish-white papules occurring on the glans penis and labia mucosa, with no conscious symptoms.
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. But such a disease will have a very good prognosis and cost less than that after regular treatment in a regular hospital.
The last time I returned to a patient’s posting, I talked about the cost of treatment, and today, I was able to open my eyes ……
I, for example, started treatment at Renai Hospital on September 12, and as of October 8, spent a total of RMB 21060,00 (roughly checked, only more and less!). The total cost was 21,060,000 RMB (I’ve probably checked, it’s only more!). The actual fact is that you can find a lot of people who have been in the business for a long time. The actual fact is that you can find a lot of people who have been in the marketplace for a long time, and they’ve been in the market for a long time. (What to say.) In the end, the doctor prescribed one week of ganciclovir capsules, acyclovir ointment, 2 tubes of erythromycin ointment, 2 bottles of inosine tablets and vitamin B1 each.
I arrived in Germany in mid-October, less than a month after the relapse, the first use of acyclovir does not work, JJ only see big not small, really can not stand, a few days afternoon went to the hospital. I was embarrassed, but the female doctor was so kind that she didn’t even call me by my surname, but by my first name, and when you were nervous, she kept talking to you, and from time to time, she patted you down and looked very intimate. Then she prescribed me a total of four vaginal suppositories once a day and a tube of ointment (I was prescribed two and one for my boyfriend, but I said I couldn’t forgive him and broke up with him, so she immediately changed it to one), and said it was okay, and I said I had JJ and HPV (I can’t believe I thought she forgot)! She smiled and said, “I know, don’t be nervous, the virus can not be completely cured, but if it’s not cancer-causing, don’t worry too much, told me to wait for the test results, if there is a problem, call me, no problem, I’ll live as usual, if the pain is severe to come to her. I was also told to drink more water, especially green tea (she loves our Chinese green tea), and to eat more fruits and vegetables and to sleep properly. Just fine!!!
Finally, I ran to the pharmacy to buy medicine, only cost 8.6 euros, and less than 90 yuan, I was a little bit want to cry the urge! The same doctor, treating the same disease, how the difference is so big?
The female doctor also did not specifically emphasize that I want to avoid eating, that is, we Chinese diet structure is very healthy, told me not to give up healthy eating habits because I was born in Europe, but also recommended that I drink green tea with lemon daily, said it is beautiful and healthy. Try it out, sisters!
This is a little bit of a psychological burden for me, I have health insurance, so I do not have to pay for the examination and laboratory fees, haha. Although I did not recover, however, this fact inspires everyone, do not be scared by JJ, so that the black-hearted doctors take advantage of the opportunity to deceive Oh!
The efficacy of those foreign drugs, even after using to know ah, but listen to the doctor’s words, rest assured ……