Female condyloma acuminatum

　　1. Poor sexual behavior

　　Most sexually transmitted diseases are caused by poor sexual behavior. If a woman has multiple sexual partners, the possibility of developing condyloma acuminatum is very high. A survey shows that the chance of developing condyloma acuminatum among those with multiple sexual partners is much higher than that of those with a single partner. Women who start having sexual relations at a very young age are also very likely to develop condyloma acuminatum. If women start having sexual relations before the age of 18, the incidence and recurrence rate of condyloma acuminatum are much higher than those of older women. Therefore, to ensure health, it is necessary to strictly prohibit poor sexual behavior, and to strictly prohibit sexual relations at a young age. If women develop condyloma acuminatum at a very young age, it will have a serious impact on their future fertility.

　　2. Low immunity

　　Patients with low immunity are prone to be infected by some diseases, such as lupus erythematosus, malignant tumors, renal transplantation, and those using corticosteroids. The incidence and recurrence rate of condyloma acuminatum will increase several times, and the warts are also large, making them difficult to treat. For patients with low immunity, it is necessary to carefully protect their bodies and take various preventive measures in life to prevent the occurrence of condyloma acuminatum effectively.

　　3. Other sexually transmitted diseases

　　Other sexually transmitted diseases can also lead to women developing condyloma acuminatum. Diseases such as gonorrhea, trichomoniasis, chlamydia, fungal infections, etc., can destroy the mucosal protective barrier, reduce the body's ability to resist these infections, and make the local environment of the reproductive organs moist, making it easy for the virus to thrive and reproduce, leading to women developing condyloma acuminatum.

　　1. Condyloma acuminatum can lead to malignant transformation. Epidemiological data show that there is a close relationship between condyloma acuminatum and genital cancer. Reports indicate that 5% to 10% of vulvar, cervical, and perianal warts may develop into cancer and become in situ and invasive cancer after a long period of time. 5% of female vulvar cancer occurs on the basis of existing condyloma acuminatum. Many experimental studies also prove that HPV, condyloma acuminatum, and genital cancer are interrelated in a causal relationship.

　　2. This disease often occurs concurrently with other STDs. About 1/3 of condyloma acuminatum patients also have gonorrhea, syphilis, chlamydia infection, trichomoniasis, and other diseases. Attention should be paid to examination, timely detection, and treatment.

　　The harm of condyloma acuminatum to female patients is very great. When the condyloma acuminatum occurs in the vulva, the most typical symptom is that in the early stage of onset, there are very few soft and small pink papules, which will further increase in size and number as the disease progresses. The papules may merge or overlap with each other, making the surface look very uneven, like a wart. Because some local areas are very moist and have chronic irritation, the warts may grow rapidly and eventually become different shapes, such as nipple-like, cauliflower-like, crown-like, or mushroom-like. These warts are very soft and are prone to bleeding when touched.

　　Some patients with condyloma acuminatum may produce white, dirty, or red secretions during the onset, which infiltrate the surface of the warts, causing great inconvenience to the lives of female patients. The root of the warts is very narrow, and there is also a pedicle, and the surface is also moist, often with oozing, erosion, and skin damage. At the same time, there are very purulent secretions pushed inside the fissures, which are very prone to bacterial infection and have a very strong foul smell. The symptoms felt by female patients themselves are very itchy, with burning or pressure sensation.

　　1. Remember to wipe from front to back after using the toilet:Because the anus may bring a lot of bacteria, please do not wipe from the anus to the vulva after using the toilet, in order to reduce the chance of infection. Do not rinse the vagina, as the vagina has a self-cleaning function, and deliberate rinsing may be counterproductive.

　　2. Washing underwear:It is best to wash hands with mild soap, do not use strong laundry detergent or washing machines. Wear cotton underwear, try not to wear nylon or synthetic fiber materials, in order to maintain ventilation and breathability.

　　3. Strictly prohibit sexual promiscuity:60% of patients with condyloma acuminatum are infected through sexual 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 acuminatum.

　　4. Prevent contact transmission:Do not use others' underwear, swimsuits, or bathtubs; advocate for showering instead of washing in the pool, and do not sit directly on the pool chairs after bathing; try to use the squatting toilet in public toilets; wash hands with soap before using the toilet; and do not swim in swimming pools with poor disinfection and high density.

　　1. Acetic acid white test

　　Apply 3-5% acetic acid to the wart for 2-5 minutes, and the lesion site becomes white and slightly elevated. Anorectal lesions may require 15 minutes. The principle of this test is that proteins coagulate and become white when they react with acid. The keratin produced by HPV-infected cells is different from that produced by normal uninfected epithelial cells, and only the former can be decolorized by acetic acid. The acetic acid white test has a high sensitivity for detecting HPV and is better than routine detection in observing histological changes. However, false positives may occur occasionally in cases of thickened epithelium or外伤擦破, with unclear and irregular whitening signs. The US CDC suggests that the acetic acid white test is not a specific test, and false positives are common.

　　2. Immunohistochemical examination

　　The peroxidase-antiperoxidase method (PAP) is commonly used to show the viral protein in condyloma acuminata, to prove the presence of viral antigen in the wart damage. When HPV protein is positive, a faintly pink weak positive reaction can appear in the superficial epithelial cells of condyloma acuminata.

　　3. Histological and chemical examination

　　A small amount of pathological tissue is made into a smear and stained with a specific antibody against human papillomavirus. If there is viral antigen in the lesion, the antigen-antibody complex can be stained red in the peroxidase-antiperoxidase (PAP) method. This method is highly specific and rapid, and is helpful for diagnosis.

　　4. Pathological examination

　　It is mainly characterized by incomplete keratinization of the stratum spinosum, marked hyperplasia of papilloma-like growth, thickening and elongation of the epidermal papillae, and the degree of hyperplasia can be similar to that of pseudosarcoma. The prickle cells and basal cells have a considerable number of nuclear divisions, which are very similar to carcinoma. However, the cell arrangement is regular, and the boundary between the hyperplastic epidermis and the dermis is clear. The characteristic is that the granular layer and the upper cells of the spiny layer have obvious vacuolation. These vacuolated cells are larger than normal, with pale cytoplasm and a large, round, deeply alkaline nuclear. Usually, there is dermal edema, dilatation of capillaries, and dense chronic inflammatory infiltration around. The giant condyloma acuminata of Bushke-loewenstein type, with the epidermis growing downward extremely, replacing the underlying tissue, is easily mixed with squamous cells, so multiple biopsies are required. If there is a tendency of slow development, it is a low-grade malignant process, known as verrucous carcinoma.

　　1. Enhancing immunity can avoid frequent infections of fungi, such as reducing the intake of starchy, sugary, and spicy foods (such as alcohol, spicy foods, fried foods), and eating more vegetables and fruits, ensuring adequate water intake.

　　2. Adhere to taking honey or royal jelly to enhance self-resistance and immunity. The recurrence of condyloma acuminata often occurs when the resistance is low.

　　3. It is advisable to consume some mushrooms, which contain a large amount of polysaccharides and can effectively improve the patient's cellular immune function, thereby reducing the recurrence rate of condyloma acuminata.

　　1. Western medicine treatment

　　Since there is currently no effective antiviral drug, the treatment of condyloma acuminata must be comprehensive.

　　1. Surgical therapy

　　For small, solitary condyloma acuminata, surgical excision can be performed; for giant condyloma acuminata, Mohs' surgery can be used to remove the lesion, and frozen section examination should be performed during surgery to check whether the damage has been completely removed.

　　2. Cryotherapy

　　Using liquid nitrogen at -196℃ to treat condyloma acuminatum by cryosurgery, promoting the necrosis and shedding of wart tissue. This method is suitable for a small number of small warts, and 1-2 treatments can be performed, with an interval of one week.

　　3. Laser therapy

　　Generally using CO2 laser, using burning method to treat condyloma acuminatum, this therapy is most suitable for female genital and perianal warts. For single or a small number of multiple warts, one-time treatment can be performed, for multiple or large warts, 2-3 treatments can be performed, with an interval of generally one week.

　　4. Electrocautery therapy

　　Using high-frequency electro-acupuncture or electro-knife to excise warts. Method: local anesthesia, then electrocautery, this therapy is suitable for a small number of small warts.

　　5. Microwave therapy

　　Using a microwave surgical treatment machine, lidocaine local anesthesia, insert the tip of the rod-shaped radiation probe directly into the base of the condyloma, when the wart body becomes smaller, darker, softer to hard, the thermal radiation coagulation is completed, and the probe can be withdrawn. The coagulated lesions can be removed with forceps. To prevent recurrence, the residual base can be coagulated again.

　　6. Beta-ray therapy

　　We have achieved satisfactory results in the treatment of condyloma acuminatum with beta-ray therapy, which has high efficacy, no pain, no injury, few side effects, and a low recurrence rate, and has clinical promotion value.

　　7. Drug therapy

　　(1) Podophyllotoxin: This therapy is suitable for warts in moist areas, but podophyllotoxin cannot be used to treat cervical condyloma acuminatum. Apply 20% podophyllotoxin tincture to the skin lesion or before medication, first protect the normal skin or mucosa around the skin lesion with an oil-based antibacterial ointment, then apply the medication, wash with 30% boric acid water or soap water after 4-6 hours, repeat medication if necessary after 3 days. This drug is the first choice for the treatment of this disease abroad, and generally one application can be cured. However, it has many drawbacks, such as great destructive power to tissues, which can cause local ulcers if used improperly. It has a high toxicity, mainly manifested as nausea, intestinal obstruction, leukopenia, and thrombocytopenia, tachycardia, oliguria or anuria, so it must be used with caution, and medication should be discontinued immediately if the above reactions are found.

　　(2) Antiviral drugs: 5% phthalamide ointment can be used, or 0.25% herpes ointment can be used, applied topically twice a day. Oral acyclovir, 5 times a day, 200mg each time, or use its ointment topically, alpha-interferon is injected intramuscularly 3 million units a day, five days a week. Or interferon 3 million units can be injected into the base of the wart, twice a week. Used for 2-3 weeks, the main side effect is influenza-like syndrome, and the side effects of local medication are fewer and milder.

　　(3) Corrosives or disinfectants: commonly used are 30%-50% trichloroacetic acid or saturated dichloroacetic acid, or 18% peracetic acid. A 10% salicylic acid glacial acetic acid or 40% formaldehyde, 2% liquid phenol, 75% ethanol distilled water 100ml mixed solution is used to spot the local area, for the treatment of genital warts and perianal warts, once a day or every other day, with a very good effect. Disinfectants can be applied topically with 20% iodophor tincture, or 2.5-5% iodophor can be injected into the base of the wart, 0.1-1.5ml each time, or use benzalkonium chloride topically or apply 0.1-0.2% externally, the latter requires配合 systemic therapy.

　　(4) Anticancer drugs

　　① 5-Fluorouracil (5-Fu): Generally, 5% ointment or cream is used topically twice a day for 3 weeks as a course of treatment. 2. 5% to 5% fluorouracil wet dressing treatment for penile and perianal condyloma acuminatum, apply for 20 minutes each time, once a day, 6 times as a course of treatment. It can also be used as a base for polyethylene glycol, with 5% of the dry powder of 5-Fu added to make suppositories for the treatment of condyloma acuminatum in the male and female urethra, or 5-Fu can be injected subcutaneously, and multiple injections can be given in batches.

　　② Tretinoin: It is mainly used for urethral condyloma acuminatum that fails to respond to 5-Fu treatment. A suppository (each containing 15mg) is used daily for 8 days, or 60mg of the drug can be added to 10-15ml of disinfectant water for weekly instillation into the urethra, maintaining for half an hour, with side effects including urethritis.

　　③ Colchicine: 2-8% normal saline solution can be used for external application, applied twice with an interval of 72 hours for the treatment of penile condyloma acuminatum, and superficial erosion may appear after application.

　　④ Bleomycin or Pingyangmycin: 0.1% normal saline solution is used for intradermal injection, with a total dose limit of 1ml (1mg) each time, most of which can be cured in one session. Pingyangmycin is a substitute for bleomycin, and the method of use is basically the same, and some also dissolve 10mg of pingyangmycin in 20ml of 10% procaine for injection.

　　8, Immunotherapy

　　(1) Autovaccine method: Use the patient's own wart tissue homogenate (lyophilized inactivated virus), and then heat treatment (56℃ for one hour) to collect the supernatant for injection, which can be used for refractory perianal condyloma acuminatum.

　　(2) Interferon inducers: Polyinosinic acid-polycytidylic acid and tilorone can be used. Polyinosinic acid-polycytidylic acid is injected intramuscularly 2ml daily for 10 days, and then stopped for 1-2 months before continuing the medication. Tilorone is taken 3 times a day, 300mg each time, stopped for 4 days, or 600mg orally every other day.

　　(3) Interferon, interleukin-2, Bifidobacterium, and Liliba combined application, the efficacy is better.

　　(4) Selection of treatment methods

　　① Medium-sized or smaller warts visible on the external genitalia (single wart diameter 0.5cm, wart mass diameter 1cm, wart number 15), generally topical drug treatment.

　　② Warts on the female vestibule, urethral opening, vaginal wall, and cervix; or warts that are larger or more numerous than the above standards, it is recommended to use physical methods for treatment.

　　③ If there are still a small number of warts remaining after physical therapy, topical drug treatment can be used again.

　　④ Whether it is drug treatment or physical treatment, acetic acid white test must be done to try to clear the lesions, including subclinical infection, to reduce recurrence.

　　⑤ Treatment of condyloma acuminatum in pregnant women: It should be treated as early as possible in the early stage of pregnancy; if there are still skin lesions near delivery, such as obstruction of the birth canal, or vaginal delivery may cause severe bleeding, cesarean section should be considered; podophyllotoxin (podophyllin), podophyllin ester, and fluorouracil have teratogenic effects, and are contraindicated in pregnant women; the safety of imiquimod for pregnant women has not been determined. Pregnant women can choose to use 50% trichloroacetic acid solution externally, laser therapy, cryotherapy, or surgical treatment. Condyloma acuminatum is not an indication for termination of pregnancy. When the warts are large, blocking the birth canal or causing severe bleeding, cesarean section should be considered.

　　9. Precautions

　　(1) Natural course: spontaneous regression, no change, increase in size and number. Some patients can heal without any treatment.

　　(2) The current treatment methods for condyloma acuminatum can reduce the infectivity, but may not be able to eradicate its infectivity.

　　(3) The appropriate treatment method should be selected according to the patient's condition and requirements, available resources, and the doctor's experience.

　　(4) Patients often have other infections, necessary examinations should be carried out before treatment, and other infections and inflammation should be controlled locally before treatment to prevent the spread of skin damage after treatment.

　　(5) Follow-up should be carried out after treatment, regardless of the treatment plan used, once the wart is removed, the local area should be kept clean and dry to promote wound healing. Local application of antibiotic ointment can be used, and antibiotics can be taken orally if necessary to prevent secondary bacterial infection.

　　10. Prognosis

　　The prognosis of condyloma acuminatum is generally good, although the recurrence rate after treatment is high, but through proper treatment, clinical cure can be achieved in the end.

　　Secondly, traditional Chinese medicine treatment

　　1. External washing formula for condyloma acuminatum: 30g of Polygonum cuspidatum, 30g of Scutellaria baicalensis, 30g of Rhubarb, 20g of Rubia cordifolia, 30g of石榴皮, 20g of Alumina, 30g of Curcuma, 30g of Viola yedoensis, decocted into 2000ml of water, gently wipe the wart for 15-20 minutes, twice a day.

　　2. A suitable amount of crystal ointment and lime water, and glutinous rice. Soak the glutinous rice in lime water for 24-36 hours, crush the glutinous rice into a paste for later use. Apply the paste directly to the wart, once a day, until the wart falls off.

　　3. After local anesthesia with moxibustion, place the moxa cone on the wart and light it, allowing it to burn out, 1-3 cones per session according to the size of the wart, once a day, until the wart falls off.

　　4. Under local anesthesia with a fire needle, the fire needle is directly pierced from the top of the wart to the bottom of the wart, 1-3 times per wart according to the size of the wart, until it falls off.

　　5. The bird's eye chrysanthemum preparation is commonly made into oil, paste, and ointment from a single bird's eye chrysanthemum or a compound preparation of bird's eye chrysanthemum. It is directly applied to the wart to wither and fall off. It has certain刺激性, and it is necessary to master the dosage and method of use of the bird's eye chrysanthemum.