Genital warts (CA) are epidermal tumor-like growths on the genitals, perineum, and anus caused by human papillomavirus (HPV) infection. It is a sexually transmitted infectious disease.
Etiology
This disease is caused by human papillomavirus (HPV) infection. 90% of genital warts are caused by HPV6 or HPV11 infection. HPV16, 18, 31, 33, and 35 can also cause genital warts (often in conjunction with HPV6 or HPV11 infection), and are frequently associated with in situ or high-grade marginal intraepithelial lesions (HSIL). Infection with HPV40–45 and 51 has also been reported.
Clinical features
This disease commonly affects sexually active individuals. The incubation period is generally 2 weeks to 8 months, with an average of 3 months. In women, it frequently occurs on the labia majora and minora, perineum, clitoris, vaginal opening, vagina, cervix, and perianal area. Initially, it presents as pale red papules with pointed tips, gradually increasing in number and size, merging into papillary, cockscomb-like, or cauliflower-like growths. The surface may be dirty or bleeding, and the base is narrow and often pedunculated. When it occurs on the cervix, it often lacks a papillary morphology, and the lesions are generally smaller, with a smooth, granular, or grooved surface.
In rare cases, excessive proliferation of lesions can develop into giant condyloma acuminata, also known as Buschke-Loewenstein condyloma acuminata, which is associated with HPV6 infection. HPV16 or HPV18 infections can progress to carcinoma in situ or even squamous cell carcinoma. During pregnancy, warts can enlarge rapidly, possibly related to estrogen. Wiping the warts with a 5% acetic acid solution can turn them white.
Pathological features
The epidermis shows papillomatous hyperplasia, with vacuolar degeneration in the granular layer and upper spinous layer as its pathological characteristics. The cells are large with a round, deeply stained nucleus, resembling a cat's eye. The dermis may show edema, capillary dilation, and perivascular lymphocyte infiltration.
Differential diagnosis
Genital warts on the female vulva need to be differentiated from the following diseases.
1. Pseudocondyloma: Multiple, clustered granular papules or villous protrusions symmetrically distributed on the inner side of the labia minora or the vestibule of the vagina in women, with a negative acetic acid test.
2. Condyloma acuminata: This is a characteristic skin lesion of secondary syphilis, appearing as flat, moist papules around the anus and genitals with a broad base and no stalk. It is positive for syphilis serological tests.
3. Bowenoid papulosis: Commonly seen as multiple, isolated brownish-red or brown papules on the skin and mucous membranes of the genitals, which may also merge into plaques. Histopathologically, it resembles Bowenoid changes.
4. Hepatic duct tumors of the genital area: These commonly occur on the inner side of the labia majora in women, presenting as multiple hemispherical papules with a smooth surface, skin-colored or pale yellow in color. Histopathology can differentiate them.
treat
The recurrence rate of this disease is high, and most patients need long-term and repeated treatments to achieve the desired results.
1. Topical medications: 0.5% podophyllin tincture, 10%–25% podophyllin tincture, 50% trichloroacetic acid, 5% imiquimod ointment. These medications have a corrosive effect on normal skin and mucous membranes, so care should be taken to protect the skin during use.
Normal skin and mucous membranes surrounding the lesion.
2. Physical therapy: cryotherapy, CO2 laser, photodynamic therapy; surgical excision may be considered for giant condyloma acuminata.
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