Condyloma acuminatum in males

　　1, Condyloma acuminatum, caused by the human papillomavirus (HPV), belongs to DNA viruses and humans are the only hosts. Its mode of transmission is: direct transmission, by contacting items contaminated with human papillomavirus, such as underwear, towels, bathtubs, bathrooms, toilets, and other items through direct contact; and indirect transmission, by having sexual contact with patients with condyloma acuminatum and contracting the disease.

　　2、发病机制：病部位肉眼可见散在疣状或乳头瘤状损害。组织病理检察可见表皮角化不全，棘层高度肥厚，表皮突增厚延长，呈乳头瘤样增生，表皮与真皮之间分界清楚。其真皮水肿，毛细血管扩张，周围有较致密的慢性炎症细胞浸润。

　　3、另外，间接接触被污染物亦是其病发的原因之一。若是生活环境有被感染者，接触被污染物，或是与被感染者处于一个空间等皆可致病。不勤换内裤，很可能出现多种感染，都可导致尖锐湿疣的产生。

　　染HPV发生病变多数属于良性，能自行消退，但也有恶化病例。如肛周、男性生殖器粘膜上形成扁平上皮癌的报道。还有罕见的遗传性皮肤疾患、疣赘状表皮发育异常症（EV）续发的皮肤癌等，在癌细胞中检出HPV。

　　男性尖锐湿疣的基本损害初起为细小淡红色小疙瘩，大小不一，单个或群集分布，湿润柔软，呈乳头样、鸡冠状或菜花样突起，红色或污灰色，根部常有蒂，且易发生糜烂渗液，触之易出血。皮损裂缝间常有脓性分泌物郁积其中，致有恶臭，且每因搔抓而引起继发感染。由于不断受到局部潮湿与慢性刺激的作用，往往迅速增长。本病常无自觉症状，部分病人可出现局部疼痛或瘙痒。偶尔可转化为鳞状细胞癌。

　　发生于尿道口或前尿道的尖锐湿疣一般不易观察到，由于男性尖锐湿疣血管丰富，容易出血，有些病人往往是由于性生活后或用力后尿血来就诊，一般无疼痛等自觉症状。发生于肛门部位的尖锐湿疣比较容易和痔疮混淆，但发生于肛内的尖锐湿疣如果无肛镜不易观察，有时仪表现为大便后出血。肛周皮肤多皱褶，且行走时多摩擦，因此一旦发生尖锐湿疣常常多发。初起时为多数丘疹，以后疣体呈赘状生长，可呈大的有蒂菜花状，更多见扁平、表面有小乳头的斑块状。由于继发感染，分泌物常有难闻的臭味。个别病例病变可出现在肛门的粘膜上皮。发生在肛周的，应注意询问有否同性恋，肛交史。

　　1、坚决杜绝性乱：尖锐湿疣患者中60％是通过性接触染病的。家庭中一方从社会上染病，又通过性生活传染配偶，还有可能通过密切的生活接触传给家中其他人，既带来了生理上的痛苦，又造成家庭不和，背负精神压力。因此提高性道德，不发生婚外性行为是预防尖锐湿疣发生的重要方面。

　　2. Prevent contact transmission: Do not use others' underwear, swimsuits, and bathtubs; do not bathe in the pool in public bathhouses, advocate for showering, do not sit directly on the bath chair after bathing; use a squat toilet in public toilets as much as possible; wash hands with soap before using the toilet; do not swim in crowded, poorly disinfected swimming pools.

　　4. Pay attention to personal hygiene: Wash the vulva daily, change underwear, and wash personal underwear separately. Even among family members, one person should use one basin, and towels should be used separately.

　　3. Abstain from sexual activity after the partner is infected. If the partner has only undergone physical therapy, although the visible condyloma acuminatum in the vulva has disappeared, the patient still carries human papillomavirus and should receive comprehensive treatment with oral medication and external washing medication, and be re-examined after treatment. During this period, if sexual contact occurs, a condom can be used for protection.

　　5. To avoid infecting the fetus during delivery, pregnant women with condyloma acuminatum can choose cesarean section. After delivery, do not bathe with the baby in the same basin.

　　6. When staying in a hotel, do not use the bath towels, hand towels, and other cleaning utensils provided by the hotel.

　　1. Acetic acid white test

　　Apply 3-5% acetic acid to the疣 body for 2-5 minutes, and the lesion site becomes white and slightly elevated. Anorectal lesions may require 15 minutes. The acetic acid white test has a high sensitivity for detecting HPV, and it is better than routine detection in observing histological changes. However, occasionally, in cases of thickened epithelium or外伤擦破, false positives may occur, and the signs of whitening appear unclear and irregular.

　　2. Immunohistochemical examination

　　The Peroxidase-Anti-Peroxidase method (PAP) is commonly used to show the viral protein within condyloma, to prove the presence of viral antigens in疣 lesions. When HPV protein is positive, there may be a faint, weak positive reaction in the superficial epithelial cells of condyloma acuminatum.

　　3. Histological and chemical examination

　　A small amount of lesion tissue is prepared into a smear and stained with a specific antibody against human papillomavirus. If the lesion contains viral antigens, there is an antigen-antibody complex. In the Peroxidase-Anti-Peroxidase (PAP) method, the nucleus can be stained red. This method is highly specific and rapid, and is helpful for diagnosis.

　　4. Pathological examination

　　The main characteristics are incomplete keratinization, hyperplasia of the stratum spinosum, papillomatous hyperplasia, thickening and elongation of epidermal processes, with the degree of hyperplasia resembling pseudosarcomatous. The cells show a considerable number of nuclear divisions, resembling cancer. However, the cells are arranged in regular patterns, and there is a clear boundary between the hyperplastic epidermis and the dermis. The characteristic feature is the formation of vacuoles in the granular layer and the upper layer of the spinous layer. These vacuolar cells are larger than normal, with pale cytoplasm and a large, round, deeply alkaline nucleus in the center. Usually, there is dermal edema, capillary dilation, and dense chronic inflammatory infiltration around. The Bushke-loewenstein giant condyloma acuminatum grows extensively downward, replacing the underlying tissue, and is easily confused with squamous cells, so multiple biopsies are required. If there is a tendency for slow development, it is a low-grade malignant process, known as verrucous carcinoma.

　　5, Genetic diagnosis

　　So far, HPV is difficult to detect with traditional virus culture and serological techniques, and the main experimental diagnostic technique is nucleic acid hybridization. In recent years, the PCR method developed has the advantages of specificity, sensitivity, simplicity, and rapidity, and has opened up a new path for HPV detection.

　　One, Diet therapy

　　1, Rhizoma Smilacis glabrae tea

　　Composition: Rhizoma Smilacis glabrae 500g, Glycyrrhiza uralensis 25g.

　　Usage: Boil twice, filter the liquid and merge, then concentrate with low heat to 100mL, take 50mL each time, twice a day.

　　Indications: Condyloma acuminatum in traditional Chinese medicine belongs to toxic heat.

　　2, Herba Hedyotis tea

　　Composition: Herba Hedyotis diffusa 30-60g.

　　Usage: Boil the water, remove the dregs, and add a proper amount of honey. Drink frequently.

　　Indications: Condyloma acuminatum in traditional Chinese medicine belongs to toxic heat.

　　Two, What patients should not eat

　　1, After removing the condyloma acuminatum, quit smoking and drinking. Each cigarette can cause the human body to lose about 3 to 5 milligrams of VC, and VC is an important vitamin for enhancing immunity.

　　2, Eat less seafood.

　　Three, What should patients eat

　　1, Adhere to taking honey or royal jelly to enhance the body's resistance and immunity. The recurrence of condyloma acuminatum often occurs when the resistance is low.

　　2, You can eat 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 acuminatum.

　　3, Eat more protein-rich foods and exercise at the same time.

　　One, Surgical therapy

　　For single, small condyloma acuminatum, surgical resection can be performed; for giant condyloma acuminatum, Mohs' surgery can be used for resection, and frozen section examination is used during surgery to check whether the damage is completely resected.

　　Two, Cryotherapy

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

　　Three, Laser therapy

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

　　Four, Electrocoagulation therapy

　　Using high-frequency electroacupuncture or electro knife to excise condyloma acuminatum. Method: local anesthesia, then electrocoagulation, this therapy is suitable for a small number of small condyloma acuminatum.

　　Five, Microwave therapy

　　Using a microwave surgical treatment machine, lidocaine local anesthesia, insert the tip of the rod-shaped radiation probe into the base of the sharp condyloma acuminatum, when the body becomes smaller, the color becomes darker, and changes from soft to hard, then the thermal radiation coagulation is completed, and the probe can be withdrawn. The coagulated lesions can be removed with forceps. To prevent recurrence, the remaining base can be coagulated once again.

　　Six, Beta-ray therapy

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

　　7. Drug therapy

　　1. Podophyllotoxin: This therapy is suitable for warts in moist areas, such as warts on the glans of the penis that occur in cases of phimosis without preoperative circumcision. Apply 20% podophyllotoxin tincture to the lesion site or apply it before the drug, first protect the normal skin or mucosa around the lesion with an oil-based antibacterial ointment, then apply the drug, wash with 30% boric acid water or soap water 4-6 hours after use, repeat the drug if necessary after 3 days. This drug is the first choice for the treatment of this disease in foreign countries, and it can usually be cured with one application. However, it has many disadvantages, such as strong tissue destructive properties, which can cause local ulcers if used improperly. It has a high toxicity, mainly manifested as nausea, intestinal obstruction, leukopenia, and thrombocytopenia, tachycardia, anuria, or oliguria, so it must be used with caution, and the drug should be discontinued immediately if the above reactions are found.

　　2. Antiviral drugs: Currently, macrocyclic triterpenes are mainly used, whose main therapeutic principle is that macrocyclic triterpenes can kill hpv virus hiding in the skin and mucosa. This type of treatment drug has a long course of treatment, and the shedding of warts is relatively slow, but the recurrence rate is very low. The advantages of this type of drug treatment are that the side effects are very small, the safety is very high, it will not cause skin damage to normal skin, and there will be no scar after treatment. It is a good choice for condyloma acuminatum in the male urethra, oral cavity, and rectum.

　　3. Corrosive or disinfectant agents: Commonly used are 30%-50% trichloroacetic acid or saturated dichloroacetic acid, or 18% peracetic acid. A mixture of 100ml of a solution containing 10% salicylic acid glacial acetic acid or 40% formaldehyde, 2% liquid phenol, and 75% ethanol distilled water can be applied locally, for condyloma acuminatum of the glans and perianal area, once or every other day, with excellent results. Disinfectants can be applied externally with 20% iodine tincture or 2.5-5% iodine tincture injected into the base of the wart, 0.1-1.5ml each time, or apply new Jiejerming externally 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 applied externally twice a day, for a course of 3 weeks. 2.5% to 5% fluorouracil wet敷 can be used to treat condyloma acuminatum of the penis and perianal area, applying for 20 minutes each time, once a day, for a course of 6 times. It can also be used as a base for suppositories by adding 5% fluorouracil powder to polyethylene glycol, which is used to treat condyloma acuminatum of the urethra in males. It can also be used for subcutaneous injection of 5-Fu base, which can be administered in batches for multiple warts.

　　(2) Tretinoin: Mainly used for condyloma acuminatum of the urethra after failure of 5-Fu treatment. Daily use suppositories (each containing 15mg), for 8 consecutive days. Alternatively, 60mg of the drug can be added to 10-15ml of disinfectant water and instilled into the urethra once a week, keeping it for half an hour. Side effects include urethritis. It can also be used by adding 10mg of the drug to 10ml of solution for soaking the affected area, three times a day, for half an hour each time, to treat condyloma acuminatum of the penis, glans, and coronal sulcus. It is mainly used for those with residual warts or recurrence after treatment by other methods. The solution can also be diluted twice to prevent recurrence.

　　(3) Colchicine: 2-8% saline solution can be used externally, applied twice with an interval of 72 hours for treating penile condyloma, which may cause superficial erosion after application.

　　There are many antiviral and condyloma acuminatum drugs, with different treatment mechanisms. Improper use may increase the burden on the liver, so selective application should be made. While using antiviral drugs, attention should also be paid to the side effects that cause liver and kidney dysfunction, and both symptoms and root causes should be treated to achieve the goal of protecting health and clearing viruses in the body.

　　Eight, Immunotherapy

　　1. Interferon inducer: Polyinosinic acid polymers and Tilorone can be used. Polyinosinic acid polymers are injected intramuscularly 2ml daily for 10 days, and then the drug is continued after stopping for 1-2 months. Tilorone is taken orally 3 times a day, 300mg each time, and stopped for 4 days, or 600mg is taken every other day.

　　2. Interferon, interleukin-2, Erythromycin, and Libato are used in combination, with better efficacy.

　　Nine, Antiviral Drugs

　　5% phthalic anhydride cream can be used, or 0.25% herpes simplex cream, applied externally twice a day. Acyclovir is taken orally 5 times a day, 200mg each time, or its ointment can be used externally. Alpha interferon is injected intramuscularly 3 million units daily, and the drug is taken for five days a week. Or interferon 3 million units is injected into the base of the wart, twice a week. Use for 2-3 weeks, the main side effect is influenza-like syndrome, and the side effects of local application are fewer and less severe.

　　Ten, Blood-letting Therapy

　　The method and steps of blood-letting therapy are as follows:

　　1. Acupuncture points: Usually measured by the tip of the finger.

　　2. Blood-letting sites: Evolve blood-letting at the immune enhancement points indicated in the instruction manual, once a week. Around 8 a.m. is most suitable. The first week starts with the left hand, and the second week switches to the right hand, alternating treatments. Generally, the instruction is stopped after 6 times, and severe cases can be strengthened for 3-6 times.