Tumor at vaginal opening

The vagina is a relatively private part of women, and everyone attaches great importance to the hygiene and maintenance of the vagina. In the eyes of many people, the diseases involving the vagina are mostly gynecological diseases such as inflammation. In fact, vaginal sarcoma is also a relatively common disease, and this disease is also contagious. Therefore, everyone must have a correct understanding of this disease. Let's take a look at how to treat and prevent vaginal sarcoma.

Genital warts are a sexually transmitted disease caused by human papillomavirus (HPV) infection, with proliferative lesions in the anal and genital area as the main manifestation. Most cases occur in young and middle-aged people aged 18 to 50. The disease occurs after an incubation period of about half a month to eight months, with an average of three months. This disease is relatively common and is mainly transmitted through sexual contact.

Other Names

Venereal warts, anogenital warts, genital warts

Causes and transmission

There are different types of HPV. The most common HPV types that cause genital warts are HPV types 6 and 11. HPV can easily survive and reproduce in the warm and humid conditions of the human body, so the external genitalia and perianal area are the most susceptible areas to infection. There are several ways of transmission:

1. Sexual contact transmission

is the main route of transmission. Therefore, this disease is prone to occur among people with disordered sexual relations.

2. Indirect contact transmission

A small number of patients may become ill through contact with items used by patients, such as underwear, bath towels, bathtubs, toilet seats, etc.

3. Mother-to-child transmission

During delivery, the disease is transmitted through the birth canal and may cause laryngeal papilloma in the infant.

Clinical manifestations

The incubation period is 1 to 8 months, with an average of 3 months, and it mainly occurs in sexually active people.

1. Typical genital warts

The genitals and perianal area are the most common sites. In men, it is more common in the foreskin, frenulum, coronal sulcus, glans penis, urethral orifice, penis shaft, perianal area, rectum and scrotum. In women, it is more common in the labia majora and minora, posterior symphysis, vestibule, clitoris, cervix and perianal area. It can occasionally be seen in areas other than the genitals and perianal area, such as the armpits, umbilicus, mouth, breasts, and between the toes. Female vaginitis and male foreskin are factors that promote the occurrence of genital warts.

The lesions initially appear as small, light red papules, which gradually increase in size and number, and are distributed singly or in clusters. They are moist and soft, with an uneven surface and appear as nipple-like, cockscomb-like, or cauliflower-like protrusions. Red or dirty grey. The roots often have pedicles and are prone to erosion and exudation, and bleed easily when touched. Purulent secretions often accumulate between the cracks of the skin lesions, causing a foul odor, and secondary infection may occur due to scratching. This disease often has no subjective symptoms, and some patients may experience foreign body sensation, pain, itching or pain during sexual intercourse. Genital warts in the rectum may cause pain, blood in the stool, and a feeling of tenesmus.

HPV infection cannot be identified clinically by the naked eye, but evidence of HPV infection can be found by acetic acid whitening test (local whitening after applying or compressing with 5% acetic acid solution), tissue pathology or nucleic acid detection technology.

3. Relationship with tumors

A large amount of epidemiological data shows that HPV infection (mainly high-risk HPV, such as HPV-16 and HPV-18) is closely related to the occurrence of genital cancers, such as cervical cancer and penile cancer.

The prognosis is generally good after treatment. However, no matter which treatment method is used, recurrence is possible.

examine

1. Acetic acid whitening test

Topical application or wet compress of 3% to 5% acetic acid solution for 5 to 10 minutes can cause whitening in the HPV-infected area, the so-called "acetic acid whitening phenomenon." However, the specificity is not high, and some chronic inflammations, such as candidal vulvitis, genital trauma and nonspecific inflammation, may result in false positives.

2. Cytological examination

Using vaginal or cervical wart tissue smears and Papanicolaou staining, two types of cells can be seen, namely vacuolated cells and dyskeratotic cells, which are of diagnostic value for condyloma acuminatum.

3. Histopathological examination

The presence of vacuolated cells above the spinous layer and in the granular layer is important evidence for diagnosing HPV infection.

4. Immunological tests

Antibodies against HPV proteins are used to detect HPV antigens in lesions. The sensitivity of this method is not high, with a detection rate of only about 50%.

5. Nucleic acid hybridization test

It is an important means of detecting HPV infection, including dot blot hybridization, tissue in situ hybridization, and nucleic acid imprinting (Southern blot hybridization). These methods have high specificity and sensitivity and are sensitive and reliable methods for diagnosing HPV infection. However, the technical operation is cumbersome and has not been widely used in clinical practice.

6. Polymerase chain reaction (PCR)

It is currently the most sensitive method for detecting HPV infection, and can also perform type-specific analysis. It has the characteristics of high sensitivity, simplicity and rapidity. It has been widely used clinically.

diagnosis

1. Typical skin lesions are papules, nipple-shaped, cauliflower-shaped or cockscomb-shaped fleshy growths with rough and keratinized surfaces in moist areas such as the genitals or perianal area.

2. Auxiliary examinations: The acetic acid white test is positive, nucleic acid hybridization can detect HPV-DNA related sequences, and PCR detection can show specific HPV-DNA amplification bands, etc.

3. Most patients have a history of unclean sexual life or a history of infection in their spouse. A few cases of genital warts are infected through contact with contaminated utensils, and newborns can also be infected through the birth canal. The incubation period ranges from 1 to 8 months, with an average of 3 months.

treat

The treatment of genital warts must adopt comprehensive treatment.

1. Treat the cause (foreskin is too long, vaginitis, balanitis, gonorrhea, etc.).

2. Improve the body's immunity.

3. Chemotherapy

(1) 0.5% podophyllotoxin tincture (or 0.15% cream)

It is suitable for treating genital warts with a diameter of ≤10mm, and the clinical cure rate can reach about 90%. The total wart area should not exceed 10cm2, and the total daily medication should not exceed 0.5ml. After application, the topical medication should be allowed to dry naturally. The main side effects are local irritation, which may include itching, burning pain, redness, swelling, erosion and necrosis. In addition, this drug is teratogenic and should not be used by pregnant women.

(2) 5% Imiquimod cream

The average wart clearance rate for the treatment of genital warts is 56%. The advantage of this therapy is the low recurrence rate, which is about 13%. The appearance of erythema is not an indication for discontinuation of medication, but the appearance of erosion or damage requires discontinuation of medication and a follow-up visit. The doctor will treat the wound and decide whether to continue the medication. Side effects are mainly local irritation, which may include itching, burning pain, erythema, and erosion. The safety of imiquimod during pregnancy has not been established and it is contraindicated in pregnant women.

(3) 80% to 90% trichloroacetic acid or dichloroacetic acid

Treatment must be administered by a doctor. When using, apply a small amount of liquid medicine on the wart lesion and wait for it to dry. At this time, a layer of white frost will form on the surface. During treatment, care should be taken to protect the surrounding normal skin and mucous membranes. If there is an excess of topical liquid medicine, talcum powder, sodium bicarbonate (baking soda) or liquid soap can be applied to neutralize excess, unreacted acid. This medicine should not be used for hyperkeratosis or large, multiple, or extensive warts. Adverse reactions include local irritation, redness, swelling, erosion, etc.

4. Cryotherapy

Using liquid nitrogen at a low temperature of -196℃, the freezing method is used to treat genital warts, which promotes the necrosis and shedding of wart tissue. The operation is simple, efficient, and easy for patients to tolerate. This method is suitable for condyloma acuminatum with a small number and small area. It can be treated 1 to 2 times with an interval of one week.

Usually CO2 laser is used to treat genital warts by cauterization. Single or a small number of warts can be treated once, while multiple or large warts can be treated 2 to 3 times, with an interval of one week generally.

6. Electrocautery

Use high-frequency electroacupuncture or electrosurgery to remove warts. This therapy is suitable for warts with small number and small area.

7. Aminolevulinic acid photodynamic therapy (ALA-PDT therapy)

This method can selectively kill vigorously proliferating cells, not only destroying condyloma acuminatum visible to the naked eye, but also clearing subclinical lesions and latently infected tissues. It has the advantages of high cure rate, low recurrence rate, few and mild adverse reactions, and good patient compliance.

8. Surgery

Suitable for giant genital warts, for removal of the warts in whole or in batches.

9. Immunotherapy

It is not recommended to be used alone, but can be used as an auxiliary treatment and to prevent recurrence. Interferon can be injected intramuscularly, subcutaneously, or at the base of the lesion, interleukin-2 can be injected subcutaneously or intramuscularly, and polycytokines can be injected intramuscularly.

prevention

1. Resolutely put an end to sexual promiscuity

Genital warts are mainly transmitted through sexual contact. When one member of a family contracts a disease from society, the disease is passed on to the spouse through sexual intercourse and then to family members through close contact, which not only causes physical pain but also causes family discord. Therefore, improving sexual morality and avoiding extramarital sex are important aspects of preventing the occurrence of genital warts. Make sure sex partners get treatment as well.

2. Prevent contact infection and pay attention to personal hygiene

Do not use other people's underwear, swimsuits and bathtubs; do not take a bath in a public bath, showers are recommended, and do not sit directly on the bathtub seat after bathing; try to use squat toilets in public toilets; wash your hands with soap before and after going to the toilet.