Genital warts generally refer to genital warts, which are caused by the human papillomavirus (HPV virus) A sexually transmitted disease mainly caused by verrucous proliferative lesions of skin and mucous membranes caused by infection.

It mostly occurs on the skin and mucous membranes of the genitals, anus or perianal area, and can also involve areas such as the groin or perineum. The disease is easy to relapse and requires repeated treatments over a long period of time, which has a great impact on patients' daily life and mental health.

The global estimated incidence of genital warts is (160-289)/100,000 person-years. Anogenital genital wart infections are the most common. Genital warts have a very high recurrence rate.

The reported incidence rate of genital warts at national STD surveillance sites in my country from 2008 to 2016 was (24.65~29.47)/100,000, Among them, the incidence rate of men is (25.91~28.97)/100,000, and the incidence rate of women is (23.30~29.99)/100,000, which is lower than the global incidence rate.

Humans are the only natural host of HPV, and infected persons are the source of HPV infection. The genital skin and mucous membranes contain more HPV, which is the reservoir of HPV and the source of virus transmission.

Transmission route

Susceptible groups

According to the type of skin lesions, they are divided into four types:

Typical genital warts

Papular warts

Flat warts

Subclinical and latent infections

HPV is a non-enveloped double-stranded DNA naked virus belonging to the Papillomaviridae family.

More than 200 HPV subtypes have been identified, of which more than 40 subtypes can be transmitted through sexual contact and infect the anogenital area. HPV can be divided into low-risk and high-risk types based on the risk of cancer. 90% to 95% of genital warts cases are caused by low-risk HPV types 6 and 11.

Genital warts are mainly spread through sexual intercourse, and the infection rate is highest among sexually active people. Therefore, having high-risk sexual partners and having unprotected sex may lead to genital warts.

Co-infections with various microorganisms such as bacteria, viruses and chlamydia, For example, human immunodeficiency virus (HIV), Chlamydia trachomatis and Neisseria gonorrhoeae can promote HPV infection.

In addition to HIV infection, organ transplantation, application of immunosuppressive drugs, congenital immunodeficiency diseases, lymphoma, Pregnancy, diabetes, etc. are more likely to cause genital warts, and the lesions grow rapidly, are more likely to relapse, and are difficult to treat.

The early stage of skin lesions manifests as local fine papules, ranging from the size of a pinhead to a millet, gradually enlarging or multiplying, spreading to the surroundings, and spreading. Gradually develop into papillary, comb-shaped, cauliflower-shaped or mass-shaped excrescences. Damage may be single or multiple. The color can range from pink to dark red (non-keratinized lesions), gray (severe keratinized lesions), or even brown-black (pigmented lesions).

A small number of patients develop large warts due to low immune function or pregnancy. It can involve the entire vulva, perianal area and groin, and is called giant genital warts.

Damage may be single or multiple. The color can range from pink to dark red (non-keratinized lesions), gray (severe keratinized lesions), or even brown-black (pigmented lesions). A small number of patients develop large warts due to low immune function or pregnancy. It can involve the entire vulva, perianal area and groin, and is called giant genital warts.

Generally, there are no subjective symptoms. A few patients may experience itching, foreign body sensation, pressure or burning sensation. A special odor may occur due to increased fragility of the skin lesions, ulceration, maceration, erosion, bleeding or secondary infection due to friction. Female patients may have increased vaginal discharge.

Patients may be worried that genital warts will affect future fertility and increase The risk of cancer creates psychological burdens, such as anxiety, guilt, anger and other negative emotions.

The first consultation is with a dermatology or dermatology and venereology department. (If it grows in the vagina, you can go to the urology department, and women can also go to the gynecology department.)

Have a history of contact

incubation period

Doctors often identify genital warts by carefully looking at a patient's genital and anal areas.

Acetic acid white test

Dermoscopy

Vaginal speculum, colposcope, anoscope, proctoscope and urethroscope

Pathological examination

Nucleic acid amplification test

The diagnosis of genital warts is mainly based on the condition (history of sexual contact and infection history of spouse, etc.), Typical clinical manifestations and laboratory examinations (histopathological examination, etc.) are used for diagnosis.

The symptoms of genital warts may be similar to those of other diseases.

Pearly papules on penis

pseudogenital warts

ectopic sebaceous glands

Penile parafrenulum papules

Condylomata plana (secondary syphilis)

squamous cell carcinoma

verrucous carcinoma

Existing treatments. Local treatment may cause itching, burning sensation, Reactions such as erosion and pain. It is not recommended to use highly toxic drugs or methods that are prone to scarring.

Due to large individual differences, there is no absolute best, fastest, or most effective medication. In addition to commonly used over-the-counter drugs, the most appropriate drug should be selected based on the individual situation under the guidance of a doctor.

Warts of medium or smaller size visible in the external genitalia of both men and women can be treated by the patients themselves with topical medications. In order to ensure the therapeutic effect, doctors will provide medication guidance to patients during outpatient visits. Please follow the doctor's instructions when taking medication.

Some commonly used clinical drug treatments

cryotherapy

Ion and high frequency electrosurgery

laser treatment

microwave treatment

Photodynamic therapy (PDT)

When the skin lesions are small in number and are pedunculated or large-volume warts, cutting or excision can be used under local anesthesia. Treatments such as electrocautery can be used to destroy the remaining warts and control bleeding, eliminating the need for suturing.

In our country, it contains gallbladder, sophora flavescens, honeysuckle, Daqingye, and Hedyotis diffusa. Compound external preparations based on traditional Chinese medicines such as Apiaryllium sibiricum and Cnidoma monnieri have been used for many years.

Research shows that it has inhibitory and killing effects on HPV through cytotoxicity. There are also single topical preparations of cantarin, which are effective in removing genital warts and preventing their recurrence. However, due to the difficulty in standardization and the limitations of the research methods used, there is a lack of relevant high-quality evidence-based medical evidence.

Studies have confirmed that topical sodium nitrate combined with citric acid, topical nitrogen-zinc complex, Ingenol methacrylate gel and virus-like particle immunotherapy are effective for genital warts. However, further research is needed before these treatments can be promoted.

self-healing

radical

•Condylomata acuminata will increase the fragility of the skin lesions. If friction occurs, Ulceration, maceration, erosion, bleeding, or secondary infection may occur.

•You may experience a mild burning sensation when treating genital warts. Complications include stinging sensation, erythema, mild edema, erosion, and pigmentation.

Genital warts can recur.

•Patients should pay attention to the areas where skin lesions occur and observe carefully for recurrence.

•Local skin dryness can be relieved by increasing water intake.

•Eat scientifically during the recovery stage and avoid spicy, seafood and other stimulating foods.

•Completely separate personal toiletries from family members, and refrain from sexual intercourse until recovery to avoid cross-infection.

diet

sports

lifestyle

Emotional Psychology

•People with genital warts should be screened for sexually transmitted diseases, especially syphilis and HIV.

•Female patients should undergo regular cervical cytology screening.

•Change bad living habits, quit smoking and drinking, etc.

Patients should proactively inform sexual partners; all sexual partners should undergo STD screening and physical examination within 6 months.

It is recommended that patients have follow-up visits at least every 2 weeks during the first 3 months after treatment. If you have special circumstances, you should see a doctor at any time. Relapses mostly occur in the first 3 months, and after 3 months, The follow-up interval can be appropriately extended according to the patient's specific conditions until 6 to 9 months after the last treatment.

Recurrence of genital warts in HIV-infected or otherwise immunocompromised patients even after successful treatment and clearance of lesions The risk may still be high. For such patients, they should self-observe changes in skin lesions and return for regular follow-up visits to extend the follow-up time.

daily prevention

vaccine prevention