Anal condyloma acuminatum

　　For the etiology of anal condyloma acuminatum, it is generally believed that the internal cause is the decrease of the patient's cellular immune function, and the external cause may be related to poor ventilation, humidity, and easy infection of the wound, as well as easy friction and injury during walking and activity. Specifically, the etiology of anal condyloma acuminatum mainly includes:

　　First, direct sexual contact, including anal or non-anal sex, accounting for one-third of patients.

　　Second, indirect transmission, which may be related to some personal hygiene products they use, or infection in saunas, bathhouses, and other places, accounting for one-third of patients.

　　Third, self-infection, laser treatment may lead to self-infection. For vulvar, perineal condyloma acuminatum, some patients may relapse around the anus after laser treatment, accounting for one-third of all perianal patients.

　　In addition to general symptoms, anal condyloma acuminatum can also cause other diseases. Patients with this disease may have malignant lesions, chlamydia infection, and other complications. Therefore, if there is discomfort, it is necessary to seek medical attention in a timely manner to avoid delaying the disease.

　　The自觉 symptoms of anal HPV infection are often not obvious, sometimes there may be burning, itching, and pressure around the anus. At the initial stage of anal condyloma acuminatum, a few small pale red papules can be seen around the anus, which gradually increase in size and number, tend to merge or overlap, and present as cauliflower-like, nipple-like, mushroom-like, or goose crest-like proliferation of varying sizes. The texture is soft, and part of the skin lesions may have a peduncle. Due to the secretion infiltration, the surface may appear white, dirty gray, red, or with bleeding. The granules accumulate pus and emit an unpleasant smell. Due to local scratching and friction, the warts may break, the surface may become ulcerated, and there may be exudation, bleeding, and secondary infection. At the same time, the growth of warts is particularly obvious.

　　1、To prevent anal condyloma acuminatum, avoid unclean sexual activity and adopt correct sexual intercourse methods (refuse anal sex), maintain self-respect and cleanliness;

　　2、To prevent anal condyloma acuminatum, avoid contact with infection, do not use public towels or bathmats, and do not bathe in public bathtubs. Wash hands before and after defecation. In public places, do not use communal toilets and should use squat toilets. Avoid sharing bathtubs, towels, and try to minimize visits to public swimming pools.

　　3,To prevent anal condyloma acuminatum, it is also necessary to keep the anal area clean and dry. Change underwear frequently every day, and clean the anus after defecation.

　　First, acetic acid white test

　　Apply 3-5% acetic acid externally to the wart for 2-5 minutes, the lesion site becomes white and slightly elevated, and anal lesions may require 15 minutes. The principle of this test is the result of protein coagulation and whiteness due to acid, and the keratin produced by HPV-infected cells is different from that produced by normal uninfected epithelial cells, only the former can be decolorized by acetic acid. The acetic acid white test has a high sensitivity for detecting HPV, and it is better than routine detection in observing histological changes. However, false positives and false positive whitening signs may appear in cases of thickened epithelium or外伤擦破, and the boundary seems unclear and irregular. The US CDC suggests that the acetic acid white test is not a specific test, and false positives are common.

　　Second, immunohistochemical examination

　　The commonly used peroxidase-antiperoxidase method (PAP) is used to show the viral protein in the warts, to prove that there is viral antigen in the wart damage. When HPV protein is positive, there can be a faintly pink weak positive reaction in the superficial epithelial cells of condyloma acuminatum.

　　Third, histochemical examination

　　Take a small amount of lesion tissue to make a smear, and stain it with a specific antibody against human papillomavirus. If there is viral antigen in the lesion, there is antigen-antibody binding. In the peroxidase-antiperoxidase (PAP) method, the nucleus can be stained red. This method is highly specific and rapid, and is helpful for diagnosis.

　　Fourth, pathological examination

　　It is mainly characterized by incomplete keratinization, hyperplasia of the stratum spinosum, papillary hyperplasia, thickening, elongation of the epidermal papillae, and the degree of hyperplasia can be similar to pseudo-epitheliomatous. The prickle cells and basal cells are accompanied by a considerable number of nuclear divisions, which are very similar to carcinoma. However, the cell arrangement is regular, and the boundary between the hyperplastic epidermis and the dermis is clear. The characteristic is the formation of obvious vacuoles in the granular layer and the upper part of the acanthus layer. These vacuolar cells are larger than normal, the cytoplasm is lightly stained, and the nucleus is large, round, and deeply alkalophilic. Usually, there is dermal edema, capillary dilatation, and chronic inflammatory infiltration around. Bushke-loewenstein giant condyloma acuminatum, the epidermis grows downward extremely, replacing the underlying tissue, and is easy to be mixed with squamous cells, so it is necessary to perform multiple biopsies. If there is a tendency of slow development, it is a low-grade malignant process, that is, so-called verrucous carcinoma.

　　Fifth, genetic diagnosis

　　To date, HPV is difficult to detect using traditional viral culture and serological techniques, and the main experimental diagnostic technology is nucleic acid hybridization. In recent years, the PCR method developed has the advantages of specificity, sensitivity, simplicity, and rapidity, and has opened up a new way for HPV detection.

　　The common characteristics of dietary therapy for condyloma acuminatum are the functions of clearing heat and detoxifying, removing dampness and eliminating warts. Patients can choose appropriately under the guidance of a doctor.

　　Dietary therapy for condyloma acuminatum:

　　Smilax glabra drink

　　500g of Smilax glabra root and 25g of licorice

　　用法水煎2次，滤液合并，再以文火浓缩至100mL，每服50mL，每日2次。

　　适应证尖锐湿疣中医辨证属毒热者。

　　蛇舌草饮

　　组成白花蛇舌草30～60g

　　用法水煎取汁，去渣，调入蜂蜜适量，频饮。

　　适应证尖锐湿疣中医辨证属毒热者。

　　尖锐湿疣饮食宜忌

　　宜

　　坚持服用蜂蜜或蜂王浆，增强自身抵抗力和免疫力。尖锐湿疣的复发往往都是在抵抗力低下时发生的。

　　可以食用一些香菇，它含有大量多糖类物质，可有效地提高患者的细胞免疫功能，从而降低尖锐湿疣复发率。

　　多吃蛋白质含量高的食品，并同时进行体育锻炼。

　　忌

　　在去掉尖锐湿疣疣体后，应戒掉烟，酒。每只香烟能使人体损失约3到5毫克的VC，而VC是增强免疫力的重要维生素。

　　少吃海鲜类食品。

　　手术疗法

　　对于单发、面积小的湿疣，可手术切除；对巨大湿疣，可用Mohs氏手术切除，手术时用冷冻切片检查损害是否切除干净。

　　冷冻疗法

　　利用-196℃低温的液体氮，采用压冻法治疗湿疣，促进疣组织坏死脱落，本法适用于数量少，面积小的湿疣，可行1-2次治疗，间隔时间为一周。

　　激光治疗

　　通常用CO2激光，采用烧灼法治疗湿疣，本疗法最适用女阴、阴茎或肛周的湿疣。对单发或少量多发湿疣可行一次性治疗，对多发或面积大的湿疣可行2-3次治疗，间隔时间一般为一周。

　　电灼治疗

　　采用高频电针或电刀切除湿疣。方法：局部麻醉，然后电灼，本疗法适应数量少，面积小的湿疣。

　　微波治疗

　　采用微波手术治疗机，利多卡因局麻，将杆状辐射探头尖端插入湿直达疣体基底，当看到疣体变小、颜色变暗、由软变硬时，则热辐射凝固完成，即可抽出探头。凝固的病灶可以用镊子挟除。为防止复发，可对残存的基底部重复凝固一次。