What are the triggers that cause genital warts to recur?

　　Perineal condyloma acuminata also known as genital warts or sexually transmitted diseases Warts are caused by sexual contact with HPV. However, it is worth reminding that when women's sex hormone levels are high, their vulva is irritated by a large amount of secretions for a long time, and they may also develop pathological conditions similar to genital warts, which are called vulvar pseudocondyloma.

　　A large number of studies have shown that there are many factors leading to the recurrence of genital warts, including some factors such as HPV reinfection.

　　1. Genital wart damage and/or HPV has not been completely removed

　　Genital wart damage and/or HPV not being completely removed are one of the important factors causing the recurrence of genital warts. Some scholars have found that 45% of patients with condyloma acuminata still have latent HPV infection after spontaneous regression or treatment to remove the warts, and 67% of these patients show recurrence. This shows that HPV has not been completely eliminated by the body, and residual genital wart lesions or latent HPV infection are the main reasons for the recurrence of genital warts. The author believes that in the treatment of genital warts, each external therapy can greatly reduce the recurrence of genital warts as long as it is carefully performed, especially if the tissue range and depth of complete removal of HPV infection are mastered. But in clinical Not all can achieve this during the treatment process, which is closely related to the operator's technical level or the patient's understanding of genital wart lesions.

　　As mentioned earlier, the main site of HPV infection is the epidermis, and genital warts grow outward from the epidermis. Therefore, whether it is treated with topical drugs or laser therapy, the depth of treatment should reach above the basal cell layer of the epidermis, and the treatment range should be 1-2 mm beyond the edge of the genital wart damage in order to clear the lesions of genital warts. However, even if this is achieved during clinical treatment, a small number of patients with genital warts will still relapse after treatment. Zhu Wenyuan et al. found that HPV DNA was detected in the dermis of a small number of patients with genital warts. This result shows that in cases of recurrent genital warts, except for skin In addition to HPV in the epidermis, HPV in the dermis is another important reason for the recurrence of genital warts. The question is, since HPV is an epidermotropic virus, why does HPV exist in the dermis? There are several possible explanations: ① Due to the inflammatory response of the skin to HPV infection, HPV DNA is released. For example, inflammation causes liquefaction and degeneration of basal cells, which can lead to the release of HPV particles into the dermal papilla. ； ②known AIDS Epidermal Langerhans cells, lymphocytes and monocytes of patients can contain HIV. The above cells may phagocytose HPV DNA in the epidermis of genital warts, and they can migrate from the epidermis to the dermis.； ③HPV viremia results in the presence of HPV in the dermis, but since the virus cannot be found in the serum using immunological methods, this possibility is extremely small.

　　2. Genital warts vaccinate Infect

　　As mentioned earlier, during the treatment process such as laser therapy or surgical excision therapy, HPV-containing lesional tissue may contaminate other parts, such as inoculation of the skin and mucosa around the genital wart lesion or the distal skin and mucosa, resulting in genital warts.

　　3. Items contaminated with HPV

　　The indirect transmission route has been described in the infection route of genital warts, which may also become one of the factors for the recurrence of genital warts. If the towels contaminated by HPV used by the patient are not treated, they may cause genital warts to recur after contact again. Bergeron et al. also observed that underwear contaminated by HPV is also the cause of recurrence of genital warts.

　　4. Sexual partner has HPV infection or genital warts

　　The patient's sexual partner has HPV infection or the genital warts are not completely treated. If the patient's genital warts are cured, sexual contact with the patient again may cause the genital warts to recur.

　　5. Presence of HPV in special parts

　　Some studies have found that HPV infection in certain special parts has not been completely treated and has become a reservoir or shelter for HPV, such as female Cervical HPV infection, male HPV infection in the urethral orifice, there is also data showing that in male urine and ovaries, Uterus HPV exists in , endometrium, prostate and other parts of the body. According to Rosemberg, 22% of male subclinical HPV infections occur in the scrotum. Because people rarely pay attention to this area as a shelter for HPV, the scrotum may be an important site for the spread or recurrence of genital warts. In addition, Boxman et al. found that HPV types 6 and 1 were present in the pubic and perianal hair of genital patients, indicating that the endogenous reservoir of HPV plays a very important role in the recurrence of genital warts.

　　6. Subtypes of HPV infection

　　Some scholars have found that the subtypes of HPV infection are related to the recurrence of genital warts. For example, genital warts caused by HPV type 16 and HPV type 18 infections are more likely to relapse after treatment than HPV type 6 and HPV type ll infections.

　　7. Subclinical manifestations of genital warts and HPV latent infection

　　The subclinical manifestations of genital warts and the existence of latent HPV infection are the most important factors causing genital warts and their recurrence. Erpenbaeh et al reported that genital warts with extensive mucosa ； Clinical manifestations and latent HPV infection may cause the recurrence of 30%-70% of genital warts cases. Using PCR technology, it was found that 72% of non-lesional areas with negative acetic acid test and 37.5% of HPV-positive people had recurrence.

　　8. Integrity of the body’s immune system

　　As mentioned before, changes in the immune system of patients with genital warts play an important role in the development and regression of genital warts. Therefore, various internal and external factors cause the body's immune function to decline, causing the body's immune response and regulation to be disordered, ultimately leading to the imbalance or defect of the complete cellular immune system, which is one of the most important factors in the vicious cycle of recurrence of genital warts.

　　9.Others

　　Other factors that cause the recurrence of genital warts include patients' poor personal hygiene habits, male foreskin extension, various vulvar infections in females, and the local moist environment caused by increased secretions caused by them.