Article 164: Symptoms, Relationship to Cancer, and Diagnosis and Treatment of Genital Warts
◇A Guide to Caring for Your Husband's Health as a Good Wife◇
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Treatment and recuperation of common diseases
What are the symptoms?
Besides the external genitalia, genital warts can also occur in the armpits, navel, breasts, mouth, and throat. In men, they commonly appear on the frenulum, glans penis, and urethral opening, and less frequently on the penile shaft, base of the penis, and scrotum. In homosexual men, they occur in the perianal area and rectum. However, some men who have never had anal intercourse may also develop perianal genital warts, mainly because the moist environment of the anal and rectal region is suitable for the growth and reproduction of the human papillomavirus (HPV). In women, they commonly appear on the vaginal opening, labia majora and minora, clitoris, urethral opening, perianal area, and perineum. In a few patients, they may also occur in the vagina and cervix.
The lesions initially appear as single or small, scattered, soft, pale red, elongated, pointed lesions, sometimes filamentous and pedunculated. They gradually increase in number and size, resembling nipple-like, cauliflower-like, or cockscomb-like growths. The surface of the warts is uneven and rough, white, red, or light gray. When complicated by bacterial infection, they form erosions and foul odors. Some erosions bleed easily upon touch.
Genital warts in the throat manifest as multiple small papules on the posterior pharyngeal wall, soft palate, and tongue. They begin as filiform, pale red papules that rise above the tongue coating, gradually enlarging into flat, dirty gray, and sessile lesions.
Genital warts can be accompanied by one or more other sexually transmitted infections, such as gonorrhea, trichomoniasis, syphilis, and chlamydia. Phimosis, excessive vaginal discharge, and concurrent gonorrhea or chlamydia infections can promote the growth of genital warts.
What is the relationship between genital warts and genital cancer?
Epidemiological data shows a close link between genital warts and genital cancer. Reports indicate that 5%–10% of genital warts on the vulva, cervix, and perianal area can develop into carcinoma in situ or invasive carcinoma after a period of time. It has also been found that 15% of penile cancer and 5% of female vulvar cancer develop from pre-existing genital warts. Numerous laboratory studies have further demonstrated a causal relationship between human papillomavirus (HPV), genital warts, and genital cancer. Therefore, it is crucial to seek prompt and thorough treatment after contracting genital warts. Consulting a specialist is the best option; otherwise, inappropriate treatment and stimulation can accelerate malignant transformation.
What tests should be done?
Typical genital warts can usually be diagnosed without laboratory testing. However, when the patient's symptoms or the location of the warts are atypical, laboratory testing is necessary to confirm the diagnosis.
1. Cytological examination: Smears of condyloma tissue from the vagina, cervix, etc., are prepared and stained with Papanicolaou stain. Two types of cells can be observed in the smear. One type of cell has a halo around its nucleus, occupying most of the cytoplasm, which is compressed to the periphery and appears condensed; this type of cell is called a vacuolated cell, originating from superficial squamous epithelial cells. The other type of cell is called a dyskeratotic cell, which can be distributed singly or in clusters, with orange-red to pale yellow cytoplasm and a small, dense nucleus. These two types of cells often coexist in smears from condyloma acuminata.
2. Histopathological changes: mainly parakeratosis, significant acanthosis, and papillomatous hyperplasia. Obvious vacuolation is observed in the granular layer and upper spinous layer cells. A considerable number of mitotic figures are present in the basal cells of the spinous layer, resembling carcinoma, but the cells are arranged regularly, and the boundary between the proliferating epithelium and the dermis is clear.
3. Histochemical examination: A small amount of lesion tissue is taken and prepared into a smear, which is then stained with a specific antibody against human papillomavirus (HPV). If viral antigens are present in the lesion, the antigen-antibody will bind, and the nucleus will be stained red using the peroxidase-antiperoxidase method. This method is highly specific and relatively rapid, and is helpful for diagnosis.
Laboratory tests for genital warts are still very immature. Histological and histopathological examinations have a certain rate of misdiagnosis, and examinations should be conducted in well-equipped hospitals.
How does Western medicine treat this?
1. Surgical treatment: For single, small condyloma acuminata, surgical excision can also be performed; for giant condyloma acuminata, surgical excision can also be performed. During the operation, frozen section is used to check whether the lesion has been completely removed.
2. Cryotherapy: Using liquid nitrogen at a low temperature of -196℃, the method of freezing is used to treat condyloma acuminata, which promotes the necrosis and shedding of the wart tissue. This method is suitable for condyloma acuminata with a small number of warts and a small area. One to two treatments can be performed with an interval of one week.
3. Laser treatment: CO2 laser is usually used to treat genital warts by cauterization. This method is most suitable for warts on the vulva, penis, or perianal area. Single or a few multiple warts can be treated in one session, while multiple or large-area warts may require 2-3 treatments, with an interval of about 1 week.
4. Electrocautery: High-frequency electrocautery or electrocautery is used to remove condyloma acuminata. Method: Local anesthesia is administered, followed by electrocautery. This method is suitable for condyloma acuminata that are few in number and cover a small area.
5. Microwave Therapy: Using a microwave surgical treatment machine and local anesthesia with lidocaine, the tip of a rod-shaped radiation probe is inserted into the base of the condyloma acuminata. When the wart shrinks, darkens in color, and hardens, thermal coagulation is complete, and the probe can be withdrawn. The coagulated lesion can be removed with forceps. To prevent recurrence, the remaining base can be coagulated once more.
6. Drug therapy:
(1) Podophyllin: This treatment is suitable for condyloma acuminata in moist areas, such as condyloma acuminata on the glans penis and perineum in cases of phimosis without circumcision. However, podophyllin cannot be used to treat cervical condyloma acuminata. Apply 20% podophyllin tincture to the lesion, or protect the normal skin or mucous membranes around the lesion with an oily antibacterial ointment before applying the medication. After 4-6 hours, wash with 30% boric acid solution or soapy water. If necessary, repeat the medication after 3 days. This drug is the first-line drug for the treatment of this disease abroad, and it can usually be cured with one application. However, it has many disadvantages, such as high tissue damage and the possibility of local ulceration if used improperly. It is highly toxic, mainly manifested as nausea, intestinal obstruction, leukopenia and thrombocytopenia, tachycardia, urinary retention or oliguria. Therefore, caution must be exercised when using it, and the drug should be discontinued immediately if the above reactions are observed.
(2) Antiviral drugs: 5% phthalimide cream or 0.25% acyclovir ointment can be applied topically twice daily. Acyclovir can be taken orally at a dose of 200 mg five times daily, or applied topically as an ointment. Alpha interferon can be injected at a dose of 3 million units daily for five days a week. Alternatively, interferon can be injected at a dose of 3 million units into the base of the wart twice a week. Continue for 2-3 weeks. The main side effect is flu-like syndrome; topical medications have fewer and milder side effects.
(3) Corrosive agents or disinfectants: Commonly used ones include 30%~50% trichloroacetic acid or saturated dichloroacetic acid, or 18% peracetic acid. A mixture of 10% salicylic acid and glacial acetic acid, or 40% formaldehyde, 2% liquefied phenol, 75% ethanol, and 100 ml of distilled water, can be applied topically to the glans penis and perianal condyloma, once daily or every other day, with excellent results. For disinfection, 20% iodine tincture can be applied topically, or 2.5%~5% iodine tincture can be injected into the base of the wart, 0.1~1.5 ml each time, or benzalkonium chloride can be applied topically, or 0.1%~0.2% can be applied topically; the latter requires systemic therapy.
(4) Anticancer drugs:
5-Fluorouracil: Generally, a 5% ointment or cream is applied topically twice daily for 3 weeks as one course of treatment. 2.5%~5% 5-Fluorouracil wet compresses are used to treat penile and perianal condyloma acuminata, applied for 20 minutes each time, once daily, for 6 times as one course of treatment. Suppositories can also be made by adding 5% 5-Fluorouracil powder to polyethylene glycol as a base for the treatment of urethral condyloma acuminata in both men and women. 5-Fluorouracil-based injections can also be used; for multiple cases, injections can be administered in batches.
Thiotepa: Primarily used for urethral condyloma acuminata that has failed 5-fluorouracil treatment. It is administered daily as a suppository (15 mg per suppository) for 8 consecutive days. Alternatively, 60 mg can be added to 10-15 ml of disinfectant and instilled into the urethra weekly for half an hour. Side effects include urethritis. Alternatively, 10 mg can be added to 10 ml of disinfectant to soak the affected area three times daily for half an hour each time. This is used to treat penile and coronal sulcus condyloma, mainly for cases with residual warts or recurrence after other treatments. The solution can also be diluted twice to soak the affected area to prevent recurrence.
Colchicine: A 2% to 8% saline solution can be applied topically twice, with a 72-hour interval, to treat penile condyloma. Superficial erosion may occur after application.
Bleomycin or bleomycin: Inject intradermal solution of 0.1% saline solution, with a total dose limited to 1 ml (1 mg) each time. Most cases can be cured with one treatment. Bleomycin is a replacement for bleomycin, and the usage is basically the same. It is also sometimes used that 10 mg of bleomycin is dissolved in 20 ml of 10% procaine for injection.
7. Immunotherapy:
(1) Autologous vaccine method: The patient's own wart tissue homogenate (cold-inactivated virus) is heated (56℃ for 1 hour), and the supernatant is collected and injected. It can be used for stubborn perianal condyloma.
(2) Interferon inducers: Poly I:C and tiloron can be used. Poly I:C is injected with 2 ml daily for 10 days, then stopped for 1-2 months before resuming treatment. Tiloron is administered 300 mg three times daily for 4 days, or 600 mg orally every other day.
(3) The combined use of interferon, interleukin, levofloxacin, and ribavirin has a better therapeutic effect.