Western medicine treatment for genital warts

　　Since there are no specific antiviral drugs at present, the treatment of genital warts must adopt comprehensive treatment.

　　(1) Treatment incentives: excessive leucorrhea, excessive foreskin, and gonorrhea.

　　(2) Improve the body’s immunity.

　　(3) Application of anti-disease drugs. Generally, it can be cured as long as you adhere to regular comprehensive treatment.

　　1. Surgical therapy

　　Single and small condyloma can be removed surgically; large condyloma can be removed by Mohs' surgery. During the operation, frozen sections are used to check whether the damage has been completely removed.

　　2. Cryotherapy

　　Using liquid nitrogen at a low temperature of -196°C, the compressed freezing method is used to treat genital warts to promote necrosis and shedding of wart tissue. This method is suitable for small numbers and small area of ​​genital warts. It can be treated in 1-2 times with an interval of one week.

　　3. Laser treatment

　　Usually CO2 laser is used to treat genital warts by cauterization. This therapy is most suitable for genital warts on the vulva, penis or perianal area. Single or a small number of multiple genital warts can be treated at one time, while multiple or large-area genital warts can be treated in 2-3 times, with an interval of one week.

　　4. Electrocautery treatment

　　Use high-frequency electroacupuncture or electrosurgery to remove genital warts. Method: local anesthesia, followed by electrocautery. This therapy is suitable for small numbers and small area of ​​genital warts.

　　5. Microwave treatment

　　Using a microwave surgical treatment machine and local anesthesia with lidocaine, insert the tip of the rod-shaped radiation probe into the sharp wettery directly to the base of the wart. When you see that the body becomes smaller, darker in color, and changes from soft to hard, the thermal radiation coagulation is completed and the probe can be withdrawn. Coagulated lesions can be removed with forceps. To prevent recurrence, the remaining base can be coagulated again.

　　6. Beta-ray therapy

　　We have achieved relatively satisfactory results by applying β-rays to treat genital warts. This method is highly effective, painless, non-invasive, has few side effects and has a low recurrence rate. clinical It has promotion value.

　　7. Drug therapy

　　(1) Podoca butter: This therapy is suitable for genital warts in moist areas, such as those on the glans and perineum where the foreskin is too long and has not been circumcised. But cervical condyloma acuminata cannot be treated with podocarpus resin. Apply 20% podocarpus butter tincture to the skin lesions or apply an oily antibacterial ointment to protect the normal surrounding skin lesions before use. skin Or mucous membrane, and then apply medicine. 4-6 hours after use, wash with 30% boric acid water or soapy water. Repeat the medicine after 3 days if necessary. This medicine is the first medicine used in the treatment of this disease abroad. Generally, it can be cured after one use. However, it has many disadvantages, such as being highly destructive to tissues and causing local ulcers if used improperly. It is highly toxic and mainly manifests as nausea, intestinal obstruction, leukopenia and thrombocytopenia, tachycardia, anuria or oliguria, so it must be used with caution. If the above reactions are found, the drug should be stopped immediately.

　　(2) Antiviral drugs: 5% phthalamide cream or 0.25% herpes net ointment can be used, applied externally twice a day. Acyclovir is taken orally, 200 mg 5 times a day, or used externally as an ointment, and 3 million units of α-interferon are injected daily, five days a week. Or inject 3 million units of interferon into the base of the wart, twice a week. When used continuously for 2-3 weeks, the main side effect is influenza-like syndrome, and the side effects of topical medication are less frequent and mild.

　　(3) Corrosives or disinfectants: 30%-50% trichloroacetic acid or saturated dichloroacetic acid, or 18% peracetic acid are commonly used. Use a 100ml mixed solution of 10% salicylic acid glacial acetic acid or 40% formaldehyde, 2% liquefied phenol, and 75% ethanol distilled water, and apply it locally on the glans and perianal condyloma. Once a day or every other day, the effect is very good. Disinfectant can be applied externally with 20% iodine tincture, or injected into the base of the wart with 2.5-5% iodine tincture, 0.1-1.5ml each time, or externally applied with chlormethionate or 0.1-0.2%, the latter needs to be combined with systemic therapy.

　　(4) Anticancer drugs

　　① 5-Fluorouracil (5-F u): Generally, 5% ointment or cream is used externally, twice a day, and 3 weeks is a course of treatment. 2.5%~5% fluorouracil wet compress is used to treat genital warts on the penis and perianal area. The application is applied for 20 minutes each time, once a day, and 6 times is a course of treatment. Polyethylene glycol can also be used as the base, and 5-FU powder accounting for 5% of the dry matter can be added to make a suppository to treat condylomata acuminatum in the urethra of men and women. 5-FU can also be injected basally, and more can be injected in batches.

　　② Thiotepa: Mainly used for condyloma in the urethra that fails to be treated with 5-FU. Suppositories (each containing 15 mg) should be used daily for 8 days. Thiotepa can also be added to 10-15ml of disinfected water and instilled into the urethra every week for half an hour. Side effects include urethritis. You can also add 10 mg of this product to 10 ml and soak the affected area 3 times a day for half an hour each time to treat condyloma of the penis and glans coronal sulcus. It is mainly used for those who have residual warts or relapse after treatment with other methods. This solution can also be diluted twice and soaked locally to prevent recurrence.

　　③ Colchicine: Use 2-8% normal saline solution for external application. Apply twice, 72 hours apart, to treat penile genital warts. Superficial erosion may occur after application.

　　④ Zhengguangmycin or pingyangmycin: Use 0.1% normal saline solution for intradermal injection. The total amount is limited to 1 ml (1 mg) each time. Most of the cases can be cured in one visit. Pingyangmycin is a replacement for Zhengguangmycin, and its usage is basically the same. Pingyangmycin 10 mg dissolved in 20 ml of 10% procaine can also be used for injection.

　　8. Immunotherapy

　　① self vaccine Method: Use the patient's own wart tissue homogenate (melt and cool to inactivate the virus), and heat it (56°C for one hour) to collect the supernatant for injection, which can be used for refractory perianal condyloma.

　　② Interferon inducers: polymyosin and tyrolone can be used. Inject 2 ml of polysaccharide every day for 10 days. After stopping the drug for 1-2 months, continue the drug. Tirolone is taken 300 mg three times a day, with a 4-day break, or 600 mg taken orally every other day.

　　③ The combined application of interferon, interleukin Ⅱ, prodizocin, and Libato has better efficacy.

　　(4) Selection of treatment methods:

　　①Warts of medium or smaller size visible in the external genitalia of both sexes (single wart diameter < 0.5 cm, wart mass diameter < 1 cm, number of warts < 15) are generally treated with topical medications.

　　②male In the urethra and perianal area, female For warts in the vestibule, urethral opening, vaginal wall and cervical opening; or if the size and number of warts in both men and women exceed the above standards, physical treatment is recommended.

　　③After physical therapy treatment, if there are still a few warts remaining, topical drugs can be used for treatment.

　　④Whether it is drug treatment or physical therapy, an acetic acid white test must be done to try to eliminate damage including subclinical infection to reduce recurrence.

　　⑤Treatment of condyloma acuminata in pregnant women: Treatment should be as early as possible in the early stages of pregnancy; if there are still skin lesions near delivery, such as obstruction of the birth canal, or vaginal delivery that will cause severe bleeding, cesarean section should be considered; podophyllotoxin (podophyllotoxin), podophyll ester, and fluorouracil have teratogenic effects and are contraindicated in pregnant women; the safety of imiquimod for pregnant women has not yet been determined. Pregnant women can choose 50% trichloroacetic acid solution for external application, laser treatment, cryotherapy or surgery. Genital warts are not an indication for termination of pregnancy. When the warts are large, obstruct the birth canal or cause severe bleeding, cesarean section needs to be considered.

　　3. Precautions

　　(1) Natural return form: subside on its own, remain unchanged, increase in size and number. Some patients recover without any treatment.

　　(2) Current treatments for genital warts can reduce the infectivity, but may not eradicate its infectivity.

　　(3) Appropriate treatment methods should be selected based on the patient's condition and requirements, available resources, and the physician's experience.

　　(4) Patients often have other infections. Necessary examinations should be carried out before treatment. When local inflammation or other infections occur, other infections and inflammations should be controlled first to avoid the spread of skin lesions after treatment.

　　(5) Follow-up should be carried out after treatment. No matter what treatment plan is used, once the wart is removed, the local area should be kept clean and dry to promote wound healing. Topical antibiotic ointment can be used, and oral antibiotics can be taken if necessary to prevent secondary bacterial infection.

　　(2) Prognosis

　　The prognosis of genital warts is generally good. Although the recurrence rate after treatment is high, clinical cure can eventually be achieved through correct treatment.