This is a disease in which small, papillary warts appear scattered or in clusters around the anus and penis in men, and around the vagina in women (Figure 29).
What is the cause?
It is known as an STD caused by the human papillomavirus (HPV). Of the more than 80 genotypes, genital warts are caused by HPV types 6 and 11. The incubation period is 3 weeks to 8 months (average 2.8 months). It is said that infection occurs through sexual intercourse with a partner who has HPV, and 70% of cases develop the disease.
There are also reports from overseas that many of those who have developed anal ulcers are homosexual or bisexual. There have also been many reported cases of anal ulcers in children, including newborns. In general, there is no difference between men and women, but there seems to be an overwhelming number of men who have developed ulcers around the anus.
Recent studies have shown that genital warts themselves are malignant and that they occur on the female vulva. Squamous epithelium Cancer Uterus There have also been reports that genital warts are related to the cause of cancer.
The number of cases of genital warts is increasing among teenagers (15% of all cases), and there are also cases of newborns with the disease, which may be due to infection in the birth canal. As sexual customs change, the incidence of cases on the lips is increasing worldwide, primarily in Europe and the United States.
How symptoms manifest
Small, slightly whitish papillae Warts The warts may be scattered or clustered together and cause pain, itching, and discharge.
A particular lesion associated with this disease is giant genital warts (Buschke-Lowenstein tumor). Papilloma are crowded together and rapidly increase to a huge Mass They form spores that emit a foul odor and can become malignant. Approximately 21% of cases become malignant.
Testing and diagnosis
It is important to examine the anal area, and a visual examination can diagnose the condition almost 100%, but if there is any doubt, a tissue examination is performed. Perineum If the lesion extends to the uterus, it is considered to be a uterine cancer. neck Since the onset of the condition is not uncommon in children, it is necessary to see a gynecologist. Anal skin tag It may be confusing sometimes.
Treatment methods
1. Surgical method
The wart is removed together with a small portion of the skin, leaving as much normal skin as possible, and then released. Create If the lesion extends to the anal canal, care must be taken to prevent anal stenosis after the procedure. Small or slight recurrences are cauterized with an electric scalpel.
In obstetrics and gynecology, vaporization using a carbon dioxide laser is also commonly used.
② Apply antiviral ointment
In the past, application of fluorouracil (5FU) ointment was the most widely known treatment, but this could lead to ulceration of the wound, causing pain and deformation. Recently, imiquimod ointment has been released and may be effective in preventing recurrence after lesion removal. Local injection of bleomycin or application of ointment has also been reported to be effective.
③Other
There have been reports that taking the traditional Chinese medicine Coix seed or applying an ointment containing 10% urea (Urepearl) topically is effective.
What to do if you notice an illness
Since the virus is transmitted to other people through sexual intercourse, please take adequate precautions, such as using condoms when having sex. Your partner will also need to be treated for 6 to 12 months. Please see a proctologist, gynecologist, or urologist as soon as possible.
It is transmitted primarily through sexual intercourse by the human papillomavirus (HPV). Mass It is a disease that causes warts. It is one of the most common sexually transmitted diseases (STDs), and it is said that 60-80% of people who have sex with someone who has genital warts will become infected.
The most common age for warts is between the late teens and early 30s, and the most common areas for warts to appear are the vulva, vagina, and uterus. neck on the skin and mucous membranes of buttocks It is said that it does not spread to the abdomen or thighs. perineum It often occurs at the back of the vaginal opening and on the labia minora.
Most external genital warts are caused by HPV types 6 and 11, and are thought to have little to no connection to cancer.
How symptoms manifest
For HPV infection to occur, it is necessary to infect the cells of the basal layer of the skin, not the cells of the surface layer, so warts often develop in areas where the epidermis is easily damaged by sexual intercourse. The incubation period of HPV is said to be 3 weeks to 6 months. After an average incubation period of about 3 months after infection, warts form.
Symptoms include genital warts that can be felt by touching them, Leucorrhea (Vaginal discharge) will only increase, but it can also cause trichomoniasis vaginitis, candidiasis vulvovaginitis, Gonorrhea It is often accompanied by an infection, which can cause itching and pain.
Cervical and vaginal genital warts may be asymptomatic, so they are often discovered when abnormalities are found in the cytology test results during cervical cancer screening.
Testing and diagnosis
The typical warts occurring on the vulva are highly keratinized and have numerous raised warts on their surface. Point It is filled with hard protrusions ( Cockscomb ), and sometimes large warts form. Although these types can be easily diagnosed by visual inspection alone, it is often difficult to diagnose lesions that are insufficiently keratinized or early lesions where wart formation is incomplete.
As a disease to be distinguished, Bowen Papular disease These include precancerous lesions caused by HPV16 infection and vulvar cancer, so it is important to diagnose them by removing a small piece of tissue.
Treatment methods
Surgical treatments such as surgical excision, electrocoagulation, cryotherapy, and laser vaporization have been common, but recently imiquimod cream (Beserna cream) has become more commonly used as a topical medication.
Some experts claim that genital warts often recur, while others believe that they recur when vaginal or cervical lesions are not properly controlled.
What to do if you notice an illness
If you notice any vulvar warts, we recommend you visit a gynecologist.
Human Papilloma Genital warts are caused by infection with the human papillomavirus (HPV) types 6 and 11. Unlike warts on the hands and feet, Point Its characteristic is that it is pointed (both 'point' and 'kei' mean pointed).
It is mainly transmitted through sexual intercourse. Along with genital herpes, it is a typical viral sexually transmitted disease. It is characterized by a long incubation period, averaging three months from infection to onset. It is also known that many people who are infected with this virus are asymptomatic.
There are many types of human papillomaviruses, but types 16 and 18, among others, have been found to be deeply involved in the cause of cervical cancer and are attracting attention.
How symptoms manifest
Small, pointed warts appear frequently on the mucous membrane or skin of the vulva (the outer part of the genitals). Some are flat. In women, they appear around the entrance to the vagina, on the labia majora and minora, and on the skin of the genitals. perineum It often occurs in the anus, but can also occur at the entrance to the uterus or on the vaginal wall. It is almost painless, with only itching and a foreign body sensation.
Testing and diagnosis
Because the warts have a unique shape, they can be diagnosed almost exclusively by examining the vulva. When they appear at the entrance to the uterus, they may be diagnosed histologically by scraping off cells or taking tissue samples. Papilloma It is now possible to detect viruses.
Treatment methods
Conventionally, cryotherapy (liquid nitrogen etc.), electricity Cauterization Surgical treatments such as laser vaporization and surgical excision have been used, but recently a new topical cream (5% imiquimod cream) has become available for insurance coverage. It is applied three times a week at bedtime and washed off the next morning.
It takes longer to heal, but the advantage is that it can be treated at home.
What to do if you notice an illness
It is a viral disease that is transmitted through sexual intercourse, so if you notice you have it, seek treatment.
Genital warts are unlikely to become cancerous, but there are malignant vulvar lesions that resemble genital warts, so see a doctor. Recently, a vaccine to prevent genital warts has been developed.
Takashi Kawana
Genital warts Condyloma acuminata Condyloma acuminatum (Male reproductive system diseases)
What is the disease?
The genitals, especially penis It is a benign tumor that develops in the cervix and is a sexually transmitted disease spread by a virus. In women, it is believed that there is a link between the causative virus and cervical cancer.
What is the cause?
It is caused by infection with human papillomavirus (HPV) types 6 and 11, which are spread through sexual intercourse. Not all people infected with this virus develop symptoms immediately, and it is said that there are many people for whom the virus is still lurking in their bodies. Therefore, in many cases, it is unclear who the person who infected them is.
How symptoms manifest
It is a painless tumor that occurs on the skin of the penis and glans. It is brittle and soft, grows in a papilla-like shape, and when it occurs in large numbers, it takes on a cauliflower-like appearance. In rare cases, it may occur on the urethral mucosa, or on the skin around the anus or in the oral cavity. Even if it disappears after treatment, the virus often lurks under the skin and recurs repeatedly.
Testing and diagnosis
syphilis Seen in Flat Unlike condyloma, these boils have pointed tips and can occur multiple times. crest In most cases, the diagnosis can be made by appearance alone. If it is difficult to make a diagnosis, a portion of the lesion will be removed and examined under a microscope.
Treatment methods
Topical ointments such as 5FU ointment and urea ointment are also said to be effective, but liquid ointments are generally used. nitrogen cryocoagulation, laser, electric scalpel Cauterization If the lesion is large, multiple, or recurs, it will be removed along with the surrounding skin.
These treatments can temporarily remove the tumor, but the virus remains hidden in the surrounding skin, resulting in a recurrence rate of 20-50%.
What to do if you notice an illness
Small, wart-like bumps measuring 1 to 2 mm may be seen on a normal penis, but these do not require treatment.
However, it can occur on the penis. Mass There are various types of boils, including malignant ones and those that can be transmitted through sexual intercourse, so if you find a boil that concerns you, it is best to see a dermatologist or urologist. Once a diagnosis is made, you should refrain from sexual intercourse until it has healed properly, or use a condom.
Genital warts are a sexually transmitted disease caused by human papillomavirus types 6 and 11; types 16 and 18 of this virus are associated with the development of penile cancer (and cervical cancer in women).
How symptoms manifest
In men, Glans , Coronary sulcus , foreskin Lesions often occur around the anus and urethral meatus, and rarely in the urethra and bladder. The incubation period is 1 to 6 months (average 3 months). The lesions are painless and papillary or Cockscomb-shaped The bumps (like crests) tend to grow and appear in clusters or in large numbers. They may bleed on contact, become infected, or develop sores.
Testing and diagnosis
Genital warts are easy to diagnose because of their characteristic appearance, but a definitive diagnosis requires a histopathological examination. If possible, it is preferable to examine the DNA type of the human papillomavirus.
Treatment methods
Genital warts may disappear naturally, but in principle some kind of treatment is required. There are surgical and drug treatments, but in Japan surgical treatment is the mainstream. In recent years, imiquimod (Veselna) cream has been released, which is applied to the affected area every other day, three times a week. It takes time for the warts to disappear, so it must be continued for 16 weeks.
What to do if you notice an illness
penis Other things you can do Mass Please visit a urologist to distinguish it from a plastic lesion (a wart-like mass) or penile cancer. Even with various treatments, recurrence is expected to occur to some extent, so long-term follow-up is necessary. When there are visible warts, it is considered highly infectious, so it is best to avoid sexual intercourse.
Yasuharu Kunishima and Yasuji Tsukamoto
Source: Houken “Sixth Edition Family Medicine Encyclopedia” Information about the Sixth Edition Family Medicine Encyclopedia
