Male condyloma acuminatum

Introduction to male genital warts Male genital warts are caused by human papillomavirus (HPV) on the skin, forming proliferative lesions on the pharyngeal, perianal, and male genital mucosa. The viral type is a small DNA virus. Most of the lesions that are infected with HPV are benign and can resolve on their own, but there are also cases of deterioration. Such as the formation of squamous cell carcinoma on the perianal and male genital mucosa. There is also a rare hereditary skin disorder, skin cancer that continues with verrucous epidermal dysplasia (EV), and HPV is detected in cancer cells. Male genital warts have an incubation period of 3 weeks to 8 months, an average of 3 months, more common in sexually active young and middle-aged men, with a peak age of 20-25 years, male patients with an average disease duration of 3-5 months, in sexual contact Shortly after the onset, male patients with an average disease duration of 12 months may not have sexual contact. basic knowledge The proportion of illness: 0.003% Susceptible people: male Mode of transmission: sexual transmission Complications: skin cancer

Male condyloma

Sexual transmission factors (65%):

The disease is mainly transmitted through sexual behavior. Male genital warts virus (human papillomavirus) HPV causes sputum on the skin, forms proliferative lesions on the pharynx, perianal, and male genital mucosa, and its viral type is a small DNA virus.

Life factor (30%):

Smoking is also an independent risk factor for genital warts. Studies have shown that the incidence of genital warts in smokers is more than three times higher than that of non-smokers, and the incidence increases with the increase in smoking age and daily smoking, and smoking can promote the recurrence of condyloma acuminata. Drinking alcohol affects the activity of the body's T lymphocytes and inhibits the body's immunity. At the same time, alcohol can inhibit the central nervous system, reduce anxiety, enhance sexual desire, increase high-risk sexual behavior, and increase the occurrence and recurrence of condyloma acuminata to some extent.

Drug factor (5%):

In a small number of patients, the occurrence of this symptom is related to the use of immunosuppressive agents.

The male HPV is a member of the genus A of the genus Pseudoviridae, a virion with a 50-55 nm virion-free icosahedron, a 7800 base pair circular double-stranded DNA, and the size of the virus particles under electron microscope. The morphology is very similar to that of the polyomavirus. Papillomavirus (PV) is species-specific and HPV has not yet been able to propagate in tissue culture or experimental animal models.

Some patients are associated with the use of immunosuppressive agents.

Male genital warts prevention

(1) Resolutely put an end to sexual disorder: 60% of patients with genital warts are infected through sexual contact. One of the family members is infected with the society, and the spouse is transmitted through sexual life. It is also possible to pass on to other people in the family through close contact with the family. This brings both physical pain and family disharmony and stress. Therefore, improving sexual ethics and not taking extramarital sex are important aspects to prevent the occurrence of genital warts.

(2) Prevent contact infection: do not use other people's underwear, swimwear and bath tub; do not wash the pond in the public bath, advocate shower, do not sit directly in the bath seat after bathing; use the squat toilet in public toilets; Wash your hands with soap before the toilet; do not swim in a pool with high density and poor disinfection.

(3) Pay attention to personal hygiene: clean the vulva, change the underwear, and clean the individual underwear separately. Even family members should be able to make one person and one basin, and the towels should be used.

(4) Sexual life should be prohibited after the spouse is sick. If the spouse has only physical therapy, although the condyloma acuminata visible in the vulva disappears, the patient still carries the human papillomavirus, and should also receive comprehensive treatment of oral and external washing drugs, and review after treatment. If you have sex during this time, you can use a condom for protection.

(5) Do not use the hotel's bath towels, hand towels and other toiletries.

Male condyloma complication Complications skin cancer

Most of the lesions that are infected with HPV are benign and can resolve on their own, but there are also cases of deterioration. Such as the formation of squamous cell carcinoma on the perianal and male genital mucosa. There is also a rare hereditary skin disorder, skin cancer that continues with verrucous epidermal dysplasia (EV), and HPV is detected in cancer cells.

Symptoms of male genital warts Symptoms common symptoms of glans pruritus itchy sputum nodules anal itching anal area redness and painful scrotum scrotum pruritus genital side near the yin... Penile superficial ulcer vulvar squamous epithelial hyperplasia scrotal proliferative scrotum Swollen

The disease often has no symptoms, and some patients may have local pain or itching. Occasionally it can be converted to squamous cell carcinoma. The main complaints of male patients may be itching, bleeding after traumatic friction, and stench after a large carcass infection.

Common clinical lesions include papules, keratotic plaques, papillary or cauliflower-like organisms, scattered or fused, and the same patient often has multiple manifestations. The color varies from pink to off-white depending on the filling state of the individual nipple capillaries. The sizes vary, single or cluster distribution, the texture is mostly soft and prone to erosive exudate, and it is easy to bleed. The most common sites are coronary sulcus, foreskin, glans, ligament, urethra, penis, perianal and scrotum. There are often pedicles in the roots, and there are often purulent secretions in the cracks of the skin lesions, which cause odor and cause secondary infections due to scratching. Due to the constant local moist and chronic stimuli, it tends to grow rapidly.

Because male genital warts are rich in blood vessels, they are prone to bleeding. Some patients often come to see a doctor because of sexual life or after exerting blood, and generally have no symptoms such as pain.

Condyloma acuminata in the urethra is usually asymptomatic, but brittle damage can cause hematuria, and large carcasses can cause urinary tract obstruction.

Condyloma acuminata that occurs in the anus is more likely to be confused with acne and often occurs frequently. At the beginning, it is the majority of papules. Later, the corpus callosum grows like a scorpion. It can be a large pedunculate cauliflower. It is more plaque-like and has a small nipple on the surface. Due to secondary infections, secretions often have an unpleasant smell. Individual case lesions can occur in the mucosal epithelium of the anus. Occurred in the perianal, should pay attention to ask whether there is homosexuality, anal history.

Nipple-like or cauliflower-like mites mainly occur in moist areas such as the foreskin cavity, urethral opening and perianal. The round papules are mainly located in dry areas, such as the penis and the hairy perineum, and the color can be skin color or pigmented. The flattened keratinized plaque has no pedicle, rough surface, slightly higher than the leather surface, and has varying degrees of pigmentation.

Giant genital warts are a special form of genital warts. They can be fist-sized and have a cauliflower-like surface. Due to secondary infections, secretions often have an unpleasant smell. Occurs in the foreskin mucosa and glans of male genital warts. The giant genital warts are essentially a squamous cell carcinoma. The pathology is a change in low-grade squamous cell carcinoma, although it rarely occurs, but the damage can penetrate deep.

Male genital warts check

First, acetic acid white test

The carcass is externally coated with 3-5% acetic acid for 2-5 minutes, and the lesion becomes white and slightly elevated, and the anal lesion may take 15 minutes. The sensitivity of the acetic acid white test for detecting HPV is high, and it is better than the conventional examination to observe histological changes. Occasionally, false positives and false positive whitening signs appear in cases of epithelial thickening or traumatic scuffing, which appear to be unclear and irregular.

Second, immunohistological examination

The peroxidase antiperoxidase method (PAP) is commonly used to display viral proteins in the sputum to prove that there is a viral antigen in the sputum lesion. When the HPV protein is positive, a pale red weak positive reaction may occur in superficial epithelial cells of condyloma acuminata.

Third, histochemistry examination

A small amount of diseased tissue was taken to make a smear, and stained with an antibody specific for human papillomavirus. If there is a viral antigen in the lesion, the antigen and antibody bind. In the peroxidase antiperoxidase (PAP) method, the core can be stained red. This method is specific and rapid, and is helpful for diagnosis.

Fourth, pathological examination

Mainly for parakeratosis, high abdomen hypertrophy, papillary hyperplasia, epidermal thickening, prolongation, its degree of hyperplasia may be pseudo-epitheliomatosis. The thorn cells and basal cells have a considerable number of nuclear divisions, which are quite cancerous. However, the cells are arranged in a regular manner, and the boundary between the proliferating epithelium and the dermis is clear. It is characterized by obvious vacuolization in the upper cells of the granule layer and the thorn layer. Such vacuolar cells are larger than normal, the cytoplasm is lightly colored, and the center has large and round, deep basophilic nuclei. Often dermal edema, telangiectasia, and dense, chronic inflammatory infiltration around. Bushke-loewenstein's huge condyloma acuminata, the epidermis grows extremely downward, replacing the tissue below it, easily mixed with squamous cells, so multiple biopsies are required. If there is a tendency to develop slowly, it is a process of low-grade malignant transformation, so-called sickle cancer.

Five, genetic diagnosis

To date, HPV has been difficult to detect using traditional viral culture and serological techniques. The main experimental diagnostic technique is nucleic acid hybridization. The PCR method developed in recent years has the advantages of being specific, sensitive, simple and rapid, and opens up a new way for HPV detection.

Diagnosis and diagnosis of male condyloma acuminata

diagnosis

1. Typical skin lesions are papules, nipples, cauliflower-like or cockscomb-like sputum in the wet parts of the genitals or perianal, and the surface is rough and keratinized.

2, acetic acid white test is positive, the living body test can be seen similar to the erosion pattern, the middle is bright red to brown, the surrounding color gradually fades.

3. HPV-DNA-related sequences can be detected by nucleic acid hybridization, and specific HPV-DNA amplified bands can be detected by PCR.

4, patients have a history of unclean sexual life or spouse infection, a small number of condyloma acuminata infected by contact with contaminated equipment, newborns can also be infected through the birth canal. The incubation period ranges from 1 to 8 months, with an average of 3 months.

5, genital warts HPV virus is not soluble in the blood, but can be obtained by detecting serum antibodies in the blood. Through the advanced virus detection system, the serum can be quickly tested and tested for three items, namely "virus antibody, virus type, virus quantity".

Differential diagnosis

1, pearly penile papules

The rash is located at the coronal sulcus of the glans. It can be seen as pearly, conical or irregular white, yellowish or dark skin pimples. It can be translucent, smooth and hard, and the papules do not fuse with each other. Regularly arranged in one to several rows. The acetic acid white test was negative.

2, sebaceous gland ectopic disease

The glans, foreskin and other parts can be seen as miliary size, isolated and slightly bulged, clustered or sliced yellow-white or yellowish papules, with no symptoms. Histologically, each papule is composed of a small group of small mature sebaceous gland lobes, which surround the sebaceous gland duct. The acetic acid white test was negative.

3, penile collateral papular fibroma

A white or yellow-white miliary papule that occurs symmetrically on either side of the penile ligament, single or several, soft, smooth, and non-fused. According to the medical history and the negative test of acetic acid white, it can be differentiated from condyloma acuminata.

4, luster moss

For shiny, polygonal or round flat papules that occur in the dry part of the penis, the tip of the needle to the size of the miliary can be densely distributed but not fused. Its pathological changes are characteristic.

5, flat wet warts

It 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 granulated or cauliflower-like. Dark-field examination can detect syphilis, and syphilis is positive for serological reaction.

6, Bowenoid papulosis

The skin lesions are taupe or reddish-brown flat papules, mostly multiple, round or irregular, with a velvety-like appearance on the surface of the papules or a mild keratinization. How good men are in the penis, scrotum and glans. Generally no symptoms. Histopathological examinations are helpful for identification.

7, sweat duct tumor

It appears as a small, hard-toned complexion or tan pimples, about a few millimeters in diameter, often multiple, usually without symptoms. Medical histopathological examination can confirm the diagnosis.

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