Condyloma acuminatum is a sexually transmitted disease caused by human papillomavirus (HPV) infection with wart-like lesions. The disease is highly contagious, easily recurs and requires repeated treatment over a long period of time.
Treatment.
General principles
Remove warts as early as possible, eliminate subclinical infection and latent infection around warts as much as possible, and reduce recurrence.
Treatment options
The recommended treatment options for external genital warts are as follows.
Out-of-hospital treatment.
The recommended regimen is 0.5% haematoxylin tincture (or 0.15% haematoxylin cream): apply topically twice daily for 3 d. Subsequently, stop for 4 d. 7 d is a course of treatment. If necessary, the treatment can be repeated for no more than 3 courses of treatment. Or 5% Imiquimod cream, applied to the wart, once every other night, 3 times a week, after 10h of medication, wash the area with soap and water, up to 16 weeks.
In-hospital treatment.
Recommended options: CO2 laser or high frequency electrical treatment, liquid nitrogen freezing, microwave, photodynamic therapy;
Alternative: 30%-50% trichloroacetic acid solution, single topical application. If necessary, repeat every 1-2 weeks for up to 6 times; or surgical excision; or intra-dermal injection of interferon.
Liquid nitrogen freezing with a freezing head is contraindicated for the treatment of warts in the cavity to avoid vaginal-rectal fistulas, etc. 30%-50%
Trichloroacetic acid solution is suitable for the treatment of small lesions or papular lesions, and should not be used for hyperkeratosis or warts that are large, multiple or large in size. Care should be taken to protect the surrounding normal skin and mucous membranes during treatment. Adverse reactions are local irritation, redness, swelling, erosion, ulceration, etc.
Cervical warts.
For patients with cervical ectopic warts, HPV type, CIN grade, exfoliative cytology and biopsy for cancerous lesions should be determined before starting treatment. A gynecologist should be consulted for ectocervix warts. If you are diagnosed with low-risk cervical warts, you can be treated with CO2 laser, microwave and 30%-50% trichloroacetic acid solution.
Vaginal warts.
Liquid nitrogen cryotherapy (cold probe is not recommended because of the possible risk of vaginal perforation and fistula formation), or high-frequency electric knife, C2 laser, microwave and other treatment options.
Urethral acromegaly.
Liquid nitrogen cryotherapy or 10%-25% tincture of benzoin of ghost resin. The warts are coated and allowed to dry before they can come into contact with the normal mucosa. If necessary, repeat 1 time in 1 week. Despite the limited information on the evaluation of the application of onychomycin and imiquimod for the treatment of distal urethral warts, some experts advocate the application of this treatment in some patients. The unique effectiveness of photodynamic therapy in the treatment of urethral warts has been confirmed by several national trials.
Perianal warts.
Liquid nitrogen cryotherapy, or 30%-50% trichloroacetic acid: apply only a small amount of the solution to the wart, and when it dries, a layer of white cream is visible on the surface, then use or acid or acid in the liquid. Have to, 1-2 weeks later repeat 1 time, up to 6 times. Surgical treatment: Some patients with perianal warts accompanied by rectal warts should undergo rectal finger examination and/or anoscopy. The management of rectal warts should be consulted by an anorectal specialist.
Photodynamic therapy.
The diameter of single warts <12,5px and warts masses <25px can be treated directly with photodynamic therapy, beyond the above warts size it is recommended to use other physical therapies combined with photodynamic therapy, combined with rectal warts can be treated with photodynamic therapy alone with columnar light source or with physical methods combined with photodynamic therapy.
Intra-anal warts.
Joint treatment by STD and anorectal specialists is required. The rectal mucosal warts are sometimes accompanied by rectal warts. Patients with anal warts should be routinely examined for rectal mucosa, using anal fingering, conventional anoscopy, and high-resolution anoscopy.
Giant condyloma acuminatum.
Mostly combined treatment protocols are used. Pathological biopsy is required before treatment to clarify whether the tissue is cancerous. The primary treatment is removal of the warts, either surgical or high-frequency electric knife removal of the warts, followed by photodynamic therapy or topical medication.
Subclinical infections.
There is no effective management for asymptomatic subclinical infections, and treatment is generally not recommended because there is no effective way to remove HPV from infected cells and overtreatment can lead to potential adverse consequences. Treatment is based on close follow-up and prevention of transmission to others. Treatment (e.g., laser, cryotherapy) may be given on a case-by-case basis to suspected sites of infection with a positive white acetate test. Some studies suggest that photodynamic therapy may be effective for subclinical infections.
Whether it is drug therapy or physical therapy, a white acetate test can be performed first to try to clear the subclinical infection to reduce recurrence.
Management of special cases
Pregnancy.
The use of onychomycin and imiquimod is contraindicated during pregnancy. Because of the rapid growth of warts during pregnancy, warts in pregnant women should be treated early in pregnancy with physical methods such as liquid nitrogen freezing or surgery. Pregnant women with warts should be informed that HPV 6 and 11 can cause respiratory papillomatosis in infants and children, that newborns born to women with warts are at risk of developing the disease, and that there is no good reason to advise pregnant women with warts to terminate their pregnancy if there is no other reason to do so, and that abortion increases the risk of pelvic inflammatory disease and HPV upstream infection.
In pregnant women with warts, a cesarean section may be considered after the fetus and placenta have fully matured and before the amniotic membranes have broken. Postpartum newborns should avoid contact with HPV-infected individuals; if necessary, a joint obstetrics and gynecology and venereal disease specialist consultation is required. Topical trichloroacetic acid can also be used for treatment.
Co-infected with HIV.
Patients with suppressed immune function due to HIV infection or other reasons are less effective with commonly used therapies than those with normal immunity and are more likely to relapse after treatment. Depending on the circumstances, a combination of treatments may be used. These patients are more likely to develop squamous carcinoma on top of acromegaly and thus often require biopsy to confirm the diagnosis.
Cases of recurrence.
A small number of patients have multiple recurrences of condyloma acuminatum lesions, for which there is no clear and effective therapy. When using laser treatment, care should be taken to detect subclinical infections early, and treatment should extend beyond 2 mm of the lesion to a depth of the superficial dermis. Removal of possible etiologies, such as other coexisting infections. After extensive and complete removal of warts, topical treatment with photodynamic therapy or imiquimod may reduce the recurrence rate.
Follow-up
For the first 3 months after treatment of warts, patients should be instructed to follow up at least once every 2 weeks, and to visit any time there are special circumstances (e.g., new lesions or bleeding from the wound surface) so that appropriate clinical management can be obtained in a timely manner. At the same time, the patient should be informed to pay attention to the good site of skin lesions and carefully observe whether there is recurrence, which mostly occurs in the first 3 months. after 3 months, the follow-up interval can be extended appropriately according to the patient’s specific situation, 6 months after treatment.
Prevention
Condom use can reduce the risk of HPV infection in the genital tract and the risk of HPV infection-related diseases (i.e., condyloma acuminatum or cervical cancer). However, HPV infection can occur in areas that are not safely covered or protected such as the scrotum, labia, or perianal area.