Abstract: The treatment of condyloma acuminata includes two aspects, one is wart removal, the second is the eradication of recurrence, because there is no one method to completely eradicate HPV, so in the clinic most of the use of integrated therapy. In the past, the treatment methods are laser, freezing as the representative of physical therapy, to ghost toxin, 5-fluorouracil as the representative of chemotherapy methods, in recent years, to interferon, imiquimod as the representative of immunotherapy is well applied. Recently, some new treatments, such as photodynamic therapy for CA, have also achieved good results, and the successful development of a vaccine for HPV infection may bring a new revolution in the prevention and treatment of CA.
The treatment of warts includes two aspects, one is the removal of warts, the second is the eradication of recurrence, because there is no method to completely eradicate HPV, so in the clinic most use a combination of therapies. The actual fact is that you can find a lot of people who have been in the business for a long time, and they’ve been in the business for a long time.
The overall principle of CA treatment is to clearly diagnose, exclude mixed infections (such as syphilis, AIDS and other STD or other local inflammatory diseases) and atypical proliferative damage (such as cervical cancer, etc.), remove the exophytic warts (directly destroy and remove the wart tissue or repeatedly use drugs and other coating wart damage and damage its epidermis, so that the HPV antigen within the epidermis is exposed to the immune system system within the dermis, thus establishing and The HPV antigen in the epidermis is exposed to the immune system within the dermis, thus establishing and performing a complete immune function to remove the wart tissue), improving the systemic and local immunity of the patient’s organism, and improving the patient’s organism’s ability to resist HPV infection.
The treatment methods are divided into chemical methods, surgical/physical methods, immunotherapy and antiviral treatment.
(i) Chemical methods
Chemical methods are mainly used for CA without comorbidities. Chemical drugs include cytotoxic drugs and chemically corrosive drugs. The main advantages of chemical methods for CA treatment are.
① Easy to use, some drugs can be used by patients themselves;
② Low damage to patients and low recurrence rate;
③ can be used repeatedly, and still effective;
④ For small lesions with a large number or multiple subclinical infections, the efficacy is better than physical therapy;
⑤ Some sites where physical/surgical procedures are not suitable are still available. However, there are some disadvantages of chemotherapy for CA.
(1) The duration of drug administration is long, taking several days, weeks, or even months;
(2) It is less effective for larger warts, warts that proliferate faster, and warts that occur on thicker skin;
③Pregnant women are not suitable for use;
1, cytotoxic drugs
It is a class of drugs that can affect nucleic acid metabolism and interfere with cell mitosis and reproduction.
1, ghost moth toxin (10% to 25% liposome ointment, 0.5% tincture)
The active ingredient extracted from the rhizomes of the Berberidaceae plant, the ghost moth toxin is a purification of the resin of the ghost moths (foot leaf lipid), which is an alkaloid. It has no direct killing effect on HPV-DNA, but it can block the mitosis of cells, promote the proliferation of macrophages, inhibit the metabolism of mitochondria, and cause the death and shedding of epithelial cells, so that HPV loses the human epidermal host cells on which it lives and the lesion can be treated. The actual fact is that you can find a lot of people who have been in the marketplace for a long time. If the warts do not completely subside, the treatment can be repeated for a total of no more than 3 courses.
2, 5-fluorouracil (5% cream or emulsion, 0.25% to 2.5% solution)
5-fluorouracil is a commonly used anti-tumor drug, which can inhibit thymidine nucleoside synthase, interfere with the biosynthesis of nucleic acid and DNA, thus inhibiting cell proliferation; at the same time, it can kill HPV by blocking the replication of viral DNA and chitin synthesis, thus curing CA and preventing recurrence. It can be used for intraurethral CA by delivering 2ml of emulsion into the urethra with a cone, once a night, for 3-8 days, or by intraurethral instillation of 2.5% solution, kept for 30 minutes and then urinated immediately, once a day, for 10-14 days. In addition, 5-fluorouracil can also be used for local injection.
3.Other drugs
The total amount of 50kg is 3 times a day, each time 10mg; weight < 50kg, 2 times a day, each time 10mg. are taken continuously orally, and After the warts have subsided, the dosage will be changed to 10mg once a day for 1 month.
4, cytokines
The actual immune function of CA patients, especially the cellular immune function, is related to the occurrence of warts, regression and response to treatment. serum IL-2 and IFN-γ levels of CA patients are significantly lower than normal; the lower the CD3+ percentage of peripheral blood, CD4+/CD8+ ratio before and after CA treatment, and the lower the IL-2 level and NK cell percentage after treatment, the higher the relapse rate. The application of cytokine IL-2 or IFN-γ can improve the body’s immune function and antiviral ability.
5, immune comprehensive therapy
The patient’s own wart cells into a suspension, and then add the triple biological adjuvant treatment of their condyloma acuminata. The study found that local treatment plus systemic medication combined with autologous wart cell suspension plus triple biological adjuvant group treatment method comprehensive, which, implantation of viral gene copy amount in 7.00 × 1011 or more, the course of treatment for 31.2 days, the cure rate of 93.3%; implantation of wart tissue in 0.3 grams or more, the course of treatment for 32.2 days, the cure rate of 86.4%. At the same time, the immune index of the patients was improved and the treatment cost was in the middle. Researchers believe that the therapeutic mechanism of autologous wart cells plus triple biological adjuvant is that it further improves the immune effect of body fluids and cells.
6, vaccine
With recent advances in immunology, molecular biology and biochemistry, there are three main strategies for vaccine design against HPV infection.
(i) Induction of neutralizing antibodies against structural viral capsid proteins to prevent viral entry into epithelial basal keratinocytes;
(ii) The most promising approach is based on the entry of self-assembled L1, L1, and L2 viral capsid proteins into shells or viruslikeparticles (VLPs), which may induce cellular immunity against viral nonstructural proteins and thus clear potentially infected cells;
(iii) Because VLPs can act as nucleic acid carriers and can induce CTL responses, DNA vaccines or fusion vaccines delivered by VLPs are expected to induce both prophylactic and therapeutic effects.
VLPs vaccines VLP vaccines have many advantages, such as maintaining the spatial conformation and neutralizing epitopes of the natural virus, being highly antigenic, and inducing highly potent neutralizing antibodies without adjuvants; HPV VLP vaccines are type-specific, with no cross-reactivity in VLP serology except for some cross-reactivity in highly homologous types. In addition, VLP induces a CTL response against capsid proteins, suggesting that cells with viral replication may be eliminated by this route. Phase I clinical trials of the HPV11 L1 VLP vaccine candidate in healthy adult volunteers found good tolerability, high titers of induced conjugative and neutralizing antibodies, a significant lymphoproliferative response after booster immunization, and statistically significant increases in IFN-γ and IL-5 in PBMC culture superfloaters.
Recombinant vaccines Infection of target cells with recombinant viral vectors carrying the HPV gene allows intracellular expression of target antigens with correct post-translational modifications, antigen processing similar to HPV infection, MHC-restricted antigen presentation, induced antibody production by the organism, lymphoproliferative and CTL responses. Commonly used expression vectors include recombinant pox vaccine, adenovirus, poliovirus, BCG vaccine, and Salmonella vaccine strains.
DNA vaccines A DNA vaccine for HPV is still under development. Plasmid DNA encoding capsid proteins L1 and L2 (prophylactic vaccines) and nonstructural proteins E6 and E7 (therapeutic vaccines) can stimulate antigen-specific humoral and cellular immune responses after entering the host.
7. Others Such as levamisole, Verben, short rods, thymidine, transfer factor, immune ribonucleic acid, etc. can also be used for the treatment of CA.
Chinese herbal medicine such as compound tincture of opium bark, Ma Guan wart elimination compound, etc.
Fifth, other such as hypertonic saline topical can be used for the treatment of CA in pregnant women.
In summary, there are many treatment methods for CA, including physical therapy, chemotherapy methods, immunotherapy, etc. Recently, some new treatment methods, such as photodynamic therapy for CA, have also achieved good results. However, each of these methods cannot completely eradicate HPV, so most of them are used in clinical practice as combination therapy. It is believed that with the further understanding of the pathogenesis of CA and the application of some new therapeutic methods, such as the successful development of a vaccine for HPV infection, a new revolution in the prevention and treatment of CA may be brought about.