What is the pathogen of condyloma acuminatum?
This disease is caused by human papillomavirus (HPV). The virus was observed by electron microscope in 1949, and Dunn et al. further proved the existence of virus particles in human genital warts by electron microscope in 1968. On this basis, Oxiel and others further confirmed that all viruses causing warts belong to papillomavirus containing DNA.
Human papillomavirus (HPV) belongs to the family of HPV and is a subgroup of HPV. It is spherical under the electron microscope, and the particles contain a double-stranded DNA molecule, which is covalently closed and has a circular supercoiled structure.
What is the transmission route of condyloma acuminatum?
(1) Sexual transmission route: In the past, the incidence of condyloma acuminatum in China was not high, which did not attract attention, nor did it pay attention to whether it was transmitted through sex. After the incidence of condyloma acuminatum increased obviously in western countries, a sexually transmitted disease was proposed. At first, this view was not widely accepted in China. In recent years, condyloma acuminatum has increased significantly, and the obvious fact that heterosexual and homosexual couples are infected with each other has gradually been recognized by people. According to the survey, 89.85% of 335 cases of condyloma acuminatum were infected through sexual contact. Two-thirds of people who have sexual contact with patients with condyloma acuminatum will have this disease. Three and a half months is the most contagious, and with the increase of illness period, the infectivity has a downward trend.
(2) Other infection routes: Non-sexual contact infection also exists. For example, many people in a unit get sick at the same time, which may be related to indirect infections such as contaminated underwear, bathtub, bath towel and bathroom stool. Infants with condyloma acuminatum or laryngeal papilloma can be infected by passing through the fetus infected with human papillomavirus during delivery or by close contact with the mother with condyloma acuminatum after birth. In addition, we can also see the bleeding of trauma and placental transmission. People with chronic gonorrhea, women with more leucorrhea and men with too long foreskin, are prone to the disease. Some clinical data show that the incidence of gonorrhea is about 20%-30%.
What is the etiology and pathogenesis of condyloma acuminatum?
After human papillomavirus invades the nucleus, it causes the rapid division of cells, and at the same time, with the replication and diffusion of virus particles, these virus particles become the source of invading new cells and spreading. The study also confirmed that in addition to external conditions such as tissue trauma and local humidity, the deficiency of cellular immune function is also an important factor of disease. Some experts measured the number of T cells in peripheral blood of patients with venereal warts by E- rose ring test, and compared it with those who had suffered from the disease but had subsided for more than 1 year or normal people. The results suggest that the dysfunction of human lymphocytes plays an important role in the pathogenesis of condyloma acuminatum. The abnormal lymphocytes of those who subsided after illness have returned to normal function.
Traditional Chinese medicine believes that the occurrence of this disease is due to disharmony between qi and blood, unclean sexual intercourse, dirty feeling, struggle with wind and evil, and skin coagulation. If the evil toxin persists for a long time, according to the constitution and the evil prevails over the right, there will be spleen deficiency and dampness, or blood deficiency and wind dryness will lead to blood deficiency, or qi and blood weakness, or damp heat will follow the liver meridian, and dampness will stagnate in the yin and anus, resulting in phlegm and turbidity.
What are the clinical manifestations of condyloma acuminatum?
(1) incubation period
The incubation period of condyloma acuminatum is 2~3 weeks short and 8 months old, with an average of 3 months.
(2) the era of preference
Most of them are between 20 and 30 years old. The peak age of onset in western countries is 22 years old, and the female is 19 years old.
(3) The most common sites
Men are prone to coronary sulcus, glans penis, foreskin, frenum and urethral orifice, and a few are found in penis. 0.5%~5% of male genital warts can spread from urethral orifice to urethral mucosa. The perianal and intra-anal condyloma of male homosexuals is 5~7 times that of penile condyloma, which can spread to rectal mucosa. The humidity in these areas provides a more suitable environment for human papillomavirus infection. Anorectal condyloma can have pain and heavy feeling after urgency. Female condyloma acuminatum mainly occurs in labia majora, labia minora and perineum. About 1/3 of them were accompanied by vaginal condyloma, and 6%~20% were accompanied by cervical condyloma. Vagina and cervical condyloma have no obvious symptoms in the early stage, and leucorrhea and bleeding may occur after sexual intercourse in the late stage. Women's vulvar condyloma acuminatum is often more damaged than men because of the stimulation of vaginal secretions. Especially in pregnant women with condyloma acuminatum, the wart body is obviously enlarged, which may be related to the change of hormone metabolism.
Characteristics of skin lesions
The lesions began to be scattered red papules the size of millet or mung bean, with rough surface and soft texture. With the local persistent chronic stimulation (such as friction and dampness) gradually increasing, it will fuse into one or more bumps with uneven surfaces, showing wet papilloma-like hyperplasia, mushroom-like, vegetable-like or comb-like protrusions, and some are dense prickly warts with dark red or reddish brown color, slight erosion and easy bleeding. Purulent secretions often overflow in the combined cracks, giving off bad smell and easily causing secondary infection. Condyloma acuminatum can not be cured for a long time, and its morphology can vary according to different parts: skin and mucosa are multiple papilloma-like or verrucous lesions; The dry part can be small and flat; Warm and humid parts are often filamentous or papilloma-like, which are easy to fuse into large pieces, and a few patients will also have huge condyloma acuminatum.
Giant condyloma acuminatum, first described by Busek, is a rare localized giant tumor-like lesion. The difference between condyloma acuminatum and common condyloma acuminatum is that the former can invade deep tissues and is extremely destructive. Because of its invasive characteristics and histopathological changes, it is now named verrucous carcinoma.
There are four types of condyloma acuminatum examined by colposcopy. Verruca plana: white, multiple, slightly granular; The chrysanthemum pattern is rough, epithelial hyperplasia and finger-like protrusions. Observe the surface of the chrysanthemum carefully. Spike: rough and uneven; White cervical vaginitis condyloma: the mucosal surface is rough and uneven, or it is cauliflower-like.
subjective symptom
Genital condyloma acuminatum is usually asymptomatic and painless. However, when condyloma acuminatum breaks and erodes, it feels itchy, and there may be pain at this time, because of the secondary infection caused by scratching. When warts invade the surrounding tissues, there will be various symptoms, such as urinary CA hematuria, dysuria, rectal CA pain, bloody stool (mainly caused by anal sex of homosexuals), and even a sense of urgency and heaviness in stool.
complication
Condyloma acuminatum can be complicated with malignant transformation. Epidemiological data show that condyloma acuminatum is closely related to genital cancer. It is reported that 5%~ 10% of vulva, cervix and perianal condyloma can become cancerous, and after a long time, it develops into carcinoma in situ and invasive carcinoma. It was also found that 15% of penile cancer and 5% of female vulvar cancer occurred on the basis of the original condyloma acuminatum. Many experimental studies have also proved that there is a causal relationship between human papillomavirus, condyloma acuminatum and genital cancer. It is generally believed that HPV 16 is more likely to cause cancer. Human papillomavirus (HPV) is not the only carcinogenic factor, but also other synergistic or initiating factors, including environmental carcinogens (ultraviolet rays, radiation, etc. ), genetic quality (susceptibility), host immune state (immunosuppression) and other factors.
This disease is often associated with other sexually transmitted diseases. About13 patients with condyloma acuminatum suffer from gonorrhea, syphilis, chlamydia infection and trichomoniasis. Attention should be paid to inspection, timely detection and treatment.