condyloma acuminatum
Introduction
Introduction to Condyloma Acuminata Condyloma acuminata, also known as genital warts or sexually transmitted diseases, is a sexually transmitted disease caused by human papillomavirus. The incubation period is about 3 months, the short is 3 weeks, the elderly is 8 months or more, and the average is 3 months. It is mainly sexually active. The incidence is 20 to 30 years old. The incidence depends largely on the inoculation. The number of viruses and the body-specific immunity are clinically characterized by spikes and moist surfaces, hence the name. basic knowledge The proportion of illness: 0.001% - 0.005% Susceptible people: good for young men and women Mode of transmission: sexual transmission Complications: penile cancer vulvar cancer gonorrhea syphilis hematuria urinary tract obstruction
Cause
Condyloma acuminata
Unclean sex life (32%):
The main cause of genital warts is unsanitary sex between husband and wife. According to research, unclean sex between men and women is the main cause of infection with genital warts. The genital warts of male friends are mainly caused by sexual contact. Patients with condyloma acuminata are the main source of infection, with rapid spread and high infection rate. Ask patients to pay special attention to their daily lives.
Low autoimmunity (28%):
Low self-immunity is also one of the main causes of condyloma acuminata. At first, friends who have no genital warts contact the secretions of condyloma acuminata or contaminated equipment in daily life such as: foot cloth basin, clothes quilt, even toilet Toilet seats, etc., can be infected. Therefore, please pay special attention to your daily life, so as not to cause unnecessary trouble.
Trauma infection (15%):
The main cause of condyloma acuminata is caused by a traumatic infection of the patient. The papillomavirus of the condyloma acuminata can invade the body through a small ruptured wound on the skin or mucous membrane, causing a large number of germs to begin to develop. Therefore, fracture wounds should be treated with caution. Ask patients to pay special attention to their daily lives.
Prevention
Condyloma acuminata prevention
Controlling sexually transmitted diseases is the best way to prevent CA. It is found to treat patients and their sexual partners; to carry out health education and sexual behavior control; condoms have the effect of preventing HPV infection, and there is no effective vaccine.
Complication
Condyloma acuminata complications Complications penile cancer vulvar cancer gonorrhea syphilis blood urinary tract obstruction
1. Condyloma acuminata can be complicated by malignant transformation. Epidemiological data indicate that there is a close relationship between condyloma acuminata and genital cancer. It has been reported that 5%~10% of vulva, cervix and perianal genital warts may develop cancer after a long period of time. And developed into carcinoma in situ and invasive carcinoma, and found that 15% of penile cancer, 5% of female vulvar cancer occurred on the basis of the original condyloma acuminata, many experimental studies have also proved that HPV, condyloma acuminata and genital cancer are between There is a causal relationship.
2. This disease is often complicated with other STD. About 1/3 of patients with condyloma acuminata suffer from gonorrhea, syphilis, chlamydia infection, trichomoniasis, etc., should be checked, promptly found and treated.
Condyloma acuminata in the urethra is usually asymptomatic, but brittle damage can cause hematuria. A large carcass can cause urinary tract obstruction. Infants and adolescent boys and girls can develop perianal wetness. Female children can have vulva wetness and throat condyloma acuminata. Most cases are reported in infants, mainly caused by HPV6 and HPV11. The viral infection pathway is transplacental, perinatal or postnatal infection is still unclear. Subclinical infections Most genital tract anus HPV infection is subclinical, organization Cytological methods can only detect less than half, and more are subclinical infections at the nucleic acid level.
Symptom
Symptoms of condyloma acuminata Common symptoms Diffuse infiltration of urethra, vaginal discharge, increased vulva, phlegm, itchy papules, hematuria, squamous epithelium
The incubation period is from 3 weeks to 8 months, with an average of 3 months. It is more common in sexually active young and middle-aged men and women. The peak age of men and women is 20-25 years old. The average male and female patients with a disease duration of 3-5 months are shortly after sexual contact. In male patients with an onset of disease and an average duration of 12 months, sexual contact may not occur. Most patients are generally asymptomatic. Damage varies in size and shape. It can be only a few, or it can be a large needle-like lesion: it can grow into a large tumor in the anus and anus, and it has a sense of oppression; it has a bad smell; sometimes a small wet wart can cause genital itching and discomfort, and the patient can appear. Urine blood and dysuria; genital warts in the rectum can cause pain, blood in the stool, and large wet sputum in the rectum can cause a sense of urgency.
male
Patients occur in the foreskin ligament, coronary sulcus, foreskin, urethra, penis, around the anus and scrotum. At the beginning of the disease, it is a reddish or smudged red-brown-sized scorpion, soft in nature, slightly pointed at the tip, gradually growing or increasing. It can develop into a papillary or saclike shape, the base is slightly wide or banded, and the surface has particles. In the anus often grows, like a cauliflower, the surface is wet or bleeding, there are often accumulated pus in the particles, emitting a stench smell, after the scratch can be secondary infection. Genital warts located in dry areas with low humidity, the damage is often small and flat. The sputum located in the wet and humid part often appears as filamentous or papillary, and easily merges into large clumps. In patients with severe liver disease, wetness can increase. Pregnancy can cause recurrence or growth of the genital warts.
female
The damage often involves multiple sites from the cervix to the anus of all squamous epithelial coverage. It is a multi-center lesion. In severe cases, it can affect the uterine cavity. Cervical genital warts often occur in the cervical transition zone. Single or multiple hairs can be fused, somewhat similar. In the papillary epithelial hyperplasia, but can see the regular tube sputum under the translucent epithelium, relying on a vaginal mirror with a magnifying glass, you can find that about 1/3 of women with vulvar genital warts have vaginal wetness, vaginal wetness often occurs, more common in In the upper 1/3 and lower third of the vagina, the lesions are high, dense white protrusions, and sometimes a keratinized plaque with a convex avascular distribution. One of the characteristics of vaginal wetness is spontaneous regress. Especially after the treatment of lesions of the cervix and vulva, vulvar genital warts are the most common, usually soft, pink or grayish white, with vascular pedicles, with multiple finger-like protrusions on the surface, beginning with moist and sexual friction, such as Vaginal mouth, labia, urethra, hymen, can also spread to other parts of the vulva or perianal, non-mucosal area of the genital warts are more keratinized, similar to common warts, female genital warts Most asymptomatic, sometimes itching, pain, bleeding after intercourse and vaginal secretions.
Infants and adolescent boys and girls can have perianal genital warts, female children can have vulvar genital warts, and their contagiousness is difficult to judge. Whether it is due to the long-term incubation of HPV, sexual abuse or transmission through daily utensils can not be determined, foreign experts pointed out that genital warts It is a sign of child sexual abuse.
Most cases of condyloma acuminata in the throat are reported to occur in infants, mainly caused by HPV6 and HPV11. The viral infection pathway is transplacental, and the perinatal or postnatal infection is still unclear; adult genital warts are related to oral sex, and huge condyloma acuminata Also known as cancer-like condyloma acuminata, manifested as hyperplasia of the corpus callosum, similar to squamous cell carcinoma, but histologically showed benign lesions, associated with HPV6 infection, genital warts in pregnancy, fast growth, increased fragility, should be removed; in view of cesarean section to prevent newborns The value of the infection is unknown, vaginal delivery should still be used routinely, and cesarean section is recommended only when the corpus callosum is enlarged to block the birth canal or may cause major bleeding.
Subclinical infection:
The vast majority of genital anal HPV infections are subclinical, and tissue cytology methods can only detect less than half, more are subclinical infections at the nucleic acid level, and sub-clinical infections at the tissue cell level can be found in the white acetate test. The main parts are in the penis and scrotum; women can be detected by colposcopy, acetic acid white test, pathology, cervical smear, etc., the most common type of cervical infection, there are three kinds of acetic acid white epithelial area, vaginal vestibular papilloma, fusion papilloma. which performed.
Clinically observed typical lesions, combined with:
1. History of exposure: a history of non-marital sexual behavior or a history of spouse infection or indirect infection.
2. Clinical manifestations: males and females appear in the genitals, perineum or anus, appearing multiple pink, gray-white or taupe papules, or papillary, cockscomb, cauliflower-like mites, a few patients have itching, foreign body sensation, oppression Feeling or burning pain, bleeding due to increased skin fragility, women may have increased vaginal discharge.
3. Auxiliary examination: Acetate white test, pathological examination and other auxiliary examinations are helpful for diagnosis.
Examine
Condyloma acuminata examination
First, histopathological changes
The epidermis is papillary-like hyperplasia and the acanthosis is hypertrophic. The surface has mild keratosis and parakeratosis. The vacuolated cells are visible in the spine cells and the granular layer. The cell bodies are large, and there is a round deep-stained nucleus. The nucleus is vacuolated, lightly stained, and filaments are connected between the nuclear membrane and the serosa. It is cat-like. Cavitation cells are characteristic of genital warts and are more pronounced in the upper and upper layers of spine cells. The medium-density infiltration of the superficial vascular layer of the dermis is mainly lymphocytes, and plasma cell infiltration is also observed. The dermal papillary vessels are dilated, the nipple is widened, and the nipple is extended.
Second, the vinegar white test
Wrapped with gauze soaked in 3% to 5% acetic acid solution or applied to the surface of suspicious skin or mucous membranes. After 3 to 5 minutes, the typical condyloma acuminata will present white papules or mites. Subclinical infections appear as white patches or spots. The vinegar white test is a simple and easy method for identifying early condyloma acuminata damage and subclinical infection. It is a very useful tool for discovering subclinical infections that have not seen visible changes. The vinegar white test is simple and easy, and should be used as a routine examination method for patients with condyloma acuminata, which helps to determine the extent of the lesion and guide the treatment. However, the vinegar white test is not a specific test, and false positive results may occur on the epithelial cells after epithelial cell hyperplasia or post-traumatic injury.
Third, colposcopy (colposcopy)
The colposcope is a special magnifying glass. It is mainly used for the observation of the mucosa of the cervix and the vagina. It can be used for the examination of the vulva and vaginal epithelium. Colposcopy can amplify the cervical performance by 20 to 40 times. It is helpful for the early detection of subclinical infection of the cervical epithelium, early detection of precancerous lesions, and early diagnosis. Patients should avoid vaginal washing and sexual intercourse within 24 hours prior to the examination. A colposcopy examination of the cervix with a gauze soaked in 3% to 5% acetic acid solution for 3 minutes will help to detect subclinical infections of HPV. White patches or spots with clear boundaries should be further taken for histopathological examination. Cervical intraepithelial neoplasia (CIN) can be divided into three grades.
Fourth, cytological examination
It is mainly used to check the infection of HPV in women's vagina or cervical epithelium. The cells were scraped off on the test site and applied to the slide, fixed with 95% alcohol; commonly used Pap staining, the microscopic findings were divided into five grades; grade I was normal; grade II was inflammation; grade III was suspected cancer; Grade IV is highly suspicious cancer; grade V is cancer. Class II is divided into IIa and IIb. IIa is an inflammatory cell; the IIb smear contains a little mild nuclear heterogeneous cells in addition to inflammatory cells. Cases of smear IIb should be followed up and checked regularly. To determine if there is HPV infection, specific anti-HPV antibodies are used for histochemical staining or in situ hybridization.
V. Polymerase chain reaction (PCR)
Take a sample of diseased tissue or suspicious part, extract DNA, and amplify the target DNA with specific primers. Primers can be HPV universal primers or specific primers for a certain type. The method is highly sensitive and specific, but the method should be carried out in a laboratory accredited or certified by the relevant institution.
Diagnosis
Condyloma acuminata diagnosis
diagnosis
1. History of unclean sexual intercourse.
2. Typical skin lesions are papules, papillary, cauliflower-like or cockscomb-like sputum in the genital or perianal areas, and the surface is rough and keratinized.
3. The acetic acid white test was positive, and the pathological sections showed poor keratinization and hollow cells.
4. Nucleic acid hybridization can detect HPV-DNA related sequences, and PCR can detect specific HPV-DNA amplified bands.
Differential diagnosis
1. The villi-like labia minora, also known as pseudo-condyloma, occurs in the inner side of the labia minora of young women. The vaginal vestibule and the urethral opening are symmetrically densely distributed with a diameter of 1 to 2 mm white or reddish small papules. The surface is smooth and some are It is fluffy, caviar or polypoid, with no obvious symptoms, occasional itching, and the acetic acid white test is negative.
2. The pearly penis papule rash is located in the coronal sulcus of the glans. It can be seen as pearly, conical or irregular white, yellowish white or skin color papules. It can be translucent, smooth surface, hard and pimples. Without fusion, the coronary sulcus is regularly arranged in one to several rows, and the acetic acid white test is negative.
3. Sebaceous gland ectopic glans, in the foreskin or labia minora can be seen in the size of the miliary, isolated and slightly uplifted, in groups or into pieces of yellow-white or yellowish papules, no symptoms, histological features for each pimples are A small group of mature sebaceous gland lobes, surrounded by small sebaceous gland ducts, negative for acetic acid white test.
4. Penile collateral papular fibroma is a white or yellow-white miliary papule that occurs symmetrically on both sides of the penis ligament, single or several, soft, smooth surface, not integrated, according to medical history and acetic acid white test Negative can be distinguished from genital warts.
5. Luster moss is a flat-shaped papule that occurs in the dry part of the penis. It is a bright polygonal or round flat-top papule. The tip of the needle is dense to the size of the miliary, but it can be densely distributed but not fused. The pathological changes are characteristic.
6. Flat genus is a second-stage syphilis, which is a papule or plaque that occurs in the genital area. The surface is flat and moist. It can also be granular or cauliflower-like. Dark-field examination can detect syphilis, and syphilis is positive for serological reaction.
7. Bowen-like papulosis skin lesions are gray-brown or reddish-brown flat papules, mostly multiple, round or irregular, papular surface can be velvety-like appearance, or mild keratinized, how good men are. In the penis, scrotum and glans, women occur in the labia minora and perianal, generally no symptoms, histopathological examination helps to identify.
8. Sweat tube tumors appear as small and hard solid skin color or brown pimples, about a few millimeters in diameter, multiple, usually no symptoms, histopathological examination can confirm the diagnosis.
9. Genital squamous cell carcinoma is more common in people over 40 years old. The damage is a mass or plaque. The infiltration is obvious, the quality is hard, the bleeding is easy, and ulcers are often formed. Histopathological examination can confirm the diagnosis.
10. Pseudocondyloma: The lesion is confined to the labia minora. The miliary granules are slightly reddish papules or villous, the surface of the lesion is smooth, the acetic acid white test is negative, and there is no diagnostic empty cell in pathology.
