Genital warts

　　尖锐湿疣是由人乳头瘤病毒（HPV）感染引起的鳞状上皮增生性疣状病变。HPV有多种亚型，与生殖道尖锐湿疣有关的主要有HPV6、11、16、18型。中国外报道外阴尖锐湿疣的发病率明显升高，已成为常见的女性性传播疾病。HPV主要感染鳞状上皮，外阴尖锐湿疣约50％—70％同时伴有阴道、宫颈的尖锐湿疣，且易与多种性传播疾病如淋病奈氏苗、滴虫、白念珠菌、衣原体、梅毒螺旋体等并存。温暖、潮湿的外阴皮肤易于HPV的生长；妊娠、糖尿病、影响细胞免疫功能的全身疾病时，尖锐湿疣生长迅速，且不易控制。少部分患者的尖锐湿疣可自行消退，但机制不明。HPV除可引起生殖道的尖锐湿疣外，还可能与生殖遭肿瘤的癌前病变有关．尤其是HPVl6、18型与外阴癌、宫颈癌的关系更为密切。

　　The source of transmission of vulvar condyloma acuminata is not only the patients but also the carriers and subclinical patients. Condyloma acuminata can lead to malignant transformation. Epidemiological data show that there is a close association between condyloma acuminata and genital cancer. It has been reported that 5% to 10% of vulvar, cervical, and perianal warts can develop into cancer and become in situ cancer and invasive cancer after a long period of time, and 15% of penile cancer and 5% of female vulvar cancer are reported to have occurred on the basis of existing condyloma acuminata. Many experimental studies also prove that there is a causal relationship between HPV (human papillomavirus), condyloma acuminata, and genital cancer. This disease often occurs concurrently with other STDs (sexually transmitted diseases), about 1/3 of condyloma acuminata patients also have gonorrhea, syphilis, chlamydia infection, trichomoniasis, and other diseases, and attention should be paid to examination, timely detection, and treatment.

　　The incubation period of vulvar condyloma acuminata is 3 weeks to 8 months, with an average of 3 months. Most patients are young women. Lesions are more common in areas easily damaged during sexual intercourse, such as near the navicular fossa, the labia majora and minora, around the anus, the vestibule of the vagina, the urethral opening, and can also involve the vagina and cervix. Clinical symptoms are often not obvious, and some patients may have vulvar itching, burning pain, or pain after sexual intercourse. The typical sign is the initial appearance of small scattered papillary warts, soft, with fine finger-like protuberances; or small and pointed papules, slightly hard, solitary, scattered, or in clusters, pink or white. Lesions gradually increase in size and number, fuse into cauliflower-like or broccoli-like shapes, and the tips may have keratinization or ulceration. Cervical lesions are mostly flat, difficult to detect with the naked eye, and often require colposcopy and acetic acid test to assist in detection.

　　Vulvar condyloma acuminata, also known as genital warts or sexually transmitted disease warts, is caused by sexual contact with human papillomavirus (HPV). The prevention of vulvar condyloma acuminata mainly involves avoiding unclean sexual intercourse and multiple sexual partners, and specific preventive measures include the following aspects.

　　1. Strictly prohibit sexual chaos:60% of condyloma acuminata patients are infected through sexual contact. If one person in the family is infected from society and then transmits it to their spouse through sexual contact, there is also a possibility of transmitting it to other family members through close contact, which not only brings physical pain but also causes family discord and mental stress. Therefore, improving sexual morality and not engaging in extramarital affairs is an important aspect of preventing the occurrence of condyloma acuminata.

　　2. Prevent contact transmission:Do not use others' underwear, swimming suits, and bathtubs; advocate for showering instead of washing in the hot spring pool, and do not sit directly on the hot spring chairs after bathing; use squat toilets as much as possible in public toilets; wash hands with soap before using the toilet; and do not swim in swimming pools with high density and poor disinfection.

　　3. Pay attention to personal hygiene:Clean the external genitals and change underwear daily. Each person should wash their own underwear separately. Even among family members, one person should use one basin and separate towels.

　　4. Prohibit sexual life after the partner is sick:If the partner has only undergone physical therapy, although the external genital warts are invisible, the patient still carries human papillomavirus and should receive comprehensive treatment with oral medication and external washing medication. Review after treatment. During this period, if sexual activity occurs, a condom can be used for protection.

　　5. Cesarean section:Pregnant women with external genital warts can choose cesarean section to avoid infecting the fetus during delivery. Do not bathe with the baby in the same basin after delivery.

　　Typical cases of external genital warts can be diagnosed by naked eye. Patients with external genital warts should have a thorough examination of the vagina and cervix to avoid missed diagnosis. For those with atypical signs, auxiliary examinations are needed to confirm the diagnosis. The main auxiliary examinations include the following:

　　Cytological examination

　　Empty cells can be seen, characterized by large nuclei in the middle layer of cells, and sometimes double nuclei can be seen, with deeply stained nuclei and large empty spaces around the nuclei. Although the specificity of empty cells is high, the detection rate of empty cells is low.

　　Vaginoscopy

　　Vaginoscopy is very helpful in detecting cervical lesions. Typical lesions are characterized by a central vascular loop under the semi-transparent epidermis of each papillary projection. After applying 3% acetic acid to the cervix, white plaque-like areas can be seen in the transitional zone, with elevated and uneven or small papillary-like projections, central capillaries, and can also be presented as flower-like or finely镶嵌ed dots.

　　Pathological tissue examination

　　External genital warts show outward growth under the microscope, with small and dense papillae proliferation, and superficial cells with incomplete or excessive keratinization; the stratum spinosum is highly proliferative, with empty cells appearing, which are characteristic changes of HPV (Human Papillomavirus) infection; the basal cells proliferate, the dermis swells, the capillaries dilate, and there is chronic inflammatory cell infiltration around.

　　Polymerase Chain Reaction (PCR)

　　PCR is simple, rapid, sensitive, and specific. It can detect extremely small amounts of HPV DNA, not only to confirm whether there is HPV infection, but also to determine the type of HPV. Pay attention to take fresh lesions from the surface scraping or tissue to improve the positive rate.

　　Nucleic Acid DNA Probe Hybridization

　　In situ hybridization is used more frequently. In situ hybridization is a direct hybridization reaction performed on tissue sections or cell smears, and is checked under a light microscope. This method is helpful in distinguishing suspicious histological lesions.

　　Patients with external genital warts should eat less seafood products in terms of diet. They can consume some mushrooms, which contain a large amount of polysaccharides that can effectively improve the cell-mediated immune function of patients, thereby reducing the recurrence rate of external genital warts. Consistently taking honey or royal jelly can enhance their own resistance and immunity. The recurrence of external genital warts often occurs when the body's resistance is low. Patients with external genital warts should quit smoking and drinking, as each cigarette can cause the body to lose about 3 to 5 milligrams of vitamin C, which is an important vitamin for enhancing immunity.

       Since this disease often occurs in people with irregular sexual behavior and unclean habits, the occurrence of warts is often concurrent with淋证, so the treatment should also focus on the pathogenic factors of the disease. There are also cases of warts occurring alone, which are often seen in children, especially those whose mothers have the disease and are infected at birth. Prevention of this disease is very necessary.

　   1. Differential Treatment

　　Condyloma acuminatum is a proliferative lesion caused by a virus in the genital, anal, and other parts, manifested as papular or cauliflower-like growths, which has a strong infectious nature and often occurs after unclean sexual contact. Western medicine uses topical drugs, laser, electrocautery, and surgical excision, and some cases are prone to recurrence. In traditional Chinese medicine, the treatment of condyloma acuminatum focuses on the invasion of heat and dampness toxins into the liver meridian. Treatment includes the combination of Wuxing Xiaodu Decoction for clearing heat and detoxifying and Simiao Pill for clearing heat and dampness, promoting blood circulation, and reducing turbidity, which has achieved satisfactory clinical efficacy. Simiao Pill is composed of Huangbai, Cangzhu, Niuxi, and Yiyiren. For those who are ineffective or recurrent with laser, cryotherapy, and topical drug treatment, traditional Chinese medicine treatment is often adopted in clinical practice. From many years of clinical evidence, traditional Chinese medicine and Chinese herbal medicine have achieved good results in the treatment of chronic and recurrent diseases, and have significant clinical efficacy in treating internal heat and dampness diseases.

　　2. Traditional Chinese Medicine

　　Longdan Xigan Pill, taken orally, 6 grams each time, 3 times a day, taken with warm water; Antiviral Oral Liquid, taken orally, 1 vial (10 milliliters) each time, 3 times a day, taken with warm water; Longdan Xigan Granule, taken orally, 1-2 packets (4-8 grams) each time, 2 times a day, taken with warm water.

　　3. External Treatment

　　External application with Kushen Decoction, followed by sprinkling Qingdai Powder. Apply Yadanzi oil (1 part of Yadanzi kernel, 2 parts of peanut oil soaked for half a month) to the affected area, 1-2 times a day. For those with greater damage, surgical resection is recommended, and carbon dioxide laser therapy, cryotherapy, microwave therapy, and other treatments can also be adopted.