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What triggers cause recurrent genital warts
Perineal condyloma acuminatum, also known as genital warts or venereal warts, is caused by sexual contact with HPV. However, it is worth reminding that women in the period of high sex hormone levels, the vulva is stimulated by a lot of secretions for a long time, and a morbid condition similar to condyloma acuminatum can also occur, which is called vulvar pseudocondyloma acuminatum.
A large number of studies have shown that there are many factors that lead to the recurrence of condyloma acuminatum, including some factors such as HPV reinfection.
1. Condyloma acuminatum lesions and/or HPV have not been completely removed
Condyloma acuminatum damage and/or incomplete removal of HPV is one of the important factors causing the recurrence of condyloma acuminatum. Some scholars have found that 45% of patients with condyloma acuminatum spontaneously regressed or removed the wart after treatment had latent HPV infection, and 67% of the patients showed recurrence. This indicates 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 authors believe that as long as each topical therapy is carefully operated during the treatment of condyloma acuminatum, especially the extent and depth of tissue that can completely remove HPV infection, the recurrence of condyloma acuminatum will be greatly reduced. However, this is not always possible in the clinical treatment process, which is closely related to the operator's skill level or the patient's understanding of condyloma acuminatum lesions.
As mentioned above, the HPV infection site is mainly in the epidermis, and condyloma acuminatum grows outward from the epidermis. Therefore, whether it is topical medicine or laser therapy, the treatment depth should reach above the basal cell layer of the epidermis, and the treatment range should exceed the damage edge of condyloma acuminatum. 1-2mm to remove condyloma acuminatum lesions. However, even if this is done during the clinical treatment, there are still a few patients with condyloma acuminatum relapse after treatment. Zhu Wenyuan et al. found that HPV DNA was detected in the dermis of a few patients with condyloma acuminatum. This result indicated that in addition to the presence of HPV in the epidermis of the condyloma acuminatum, the presence of HPV in the dermis is another important cause of the recurrence of condyloma acuminatum. The question is, since HPV is an epidermotropic virus, why does HPV exist in the dermis? There are several possible explanations: ? HPV DNA is released due to the inflammatory response of the skin to HPV infection, such as liquefaction and degeneration of basal cells caused by inflammation, which can lead to the release of HPV particles into the dermal papilla; ? Epidermal Langerhans cells of known AIDS patients , Lymphocytes and monocytes can contain HIV, and the above cells may phagocytose HPV DNA in the epidermis of condyloma acuminatum, and they can travel from the epidermis to the dermis; ? HPV viremia causes HPV in the dermis, but due to the lack of immunological methods The virus can be found in the serum, so this possibility is extremely small.
2. Condyloma acuminatum inoculation infection
As mentioned above, in the process of laser therapy or surgical excision therapy, the lesion tissue containing HPV may contaminate other parts, such as inoculation of the skin and mucous membranes around or distal to the lesions of condyloma acuminatum, resulting in condyloma acuminatum.
3. Items contaminated with HPV
The indirect transmission route of condyloma acuminatum has been described in the transmission route of condyloma acuminatum, which may also become one of the factors for the recurrence of condyloma acuminatum. If the HPV-contaminated towels used by the patient are not treated, re-contact can cause condyloma acuminatum recurrence. Bergeron et al. also found that HPV-contaminated underwear is also the reason for the recurrence of condyloma acuminatum.
4. Sexual concomitant HPV infection or the presence of condyloma acuminatum
The patient's sexual accompaniment HPV infection or condyloma acuminatum has not been thoroughly treated. After the patient's condyloma acuminatum has been cured, it may cause the recurrence of condyloma acuminatum after sexual contact with it again.
5. The presence of HPV in special parts
Some studies have found that HPV infections in certain specific sites have not been thoroughly treated and become HPV storage or shelters, such as cervical HPV infection in women and HPV infection in the urethra of men. HPV exists in the endometrium, prostate and other parts. 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, so the scrotum may be an important site for transmission or recurrence of condyloma acuminatum. In addition, Boxman et al. found that HPV6 and HPV11 exist in the pubic and perianal hair of genital patients, which indicates that the HPV endogenous reservoir plays a very important role in the recurrence of condyloma acuminatum.
6. Subtypes of HPV infection
Some scholars have found that the subtype of HPV infection is related to the recurrence of condyloma acuminatum. For example, HPV16 and HPV18 infection are more likely to recur after treatment of condyloma acuminatum caused by HPV6 and HPV11 infection.
7. Subclinical manifestations of condyloma acuminatum and latent HPV infection
The subclinical manifestations of condyloma acuminatum and the existence of latent HPV infection are the most important factors causing condyloma acuminatum and its recurrence. Erpenbaeh et al. reported extensive mucosal genital warts; clinical manifestations and latent HPV infection may cause recurrence in 30%-70% of genital warts cases. Detected by PCR technique, it was found that 72% of the non-lesional areas with negative acetic acid test�37.5% of HPV-positive patients relapsed.
8. The integrity of the body�s immune system
As mentioned above, changes in the immune system of patients with condyloma acuminatum play an important role in the development and regression of condyloma acuminatum. Therefore, various internal and external factors lead to the decline of the body's immune function, which makes the body's immune response and regulation disorder, and ultimately leads to the imbalance or defect of the complete cellular immune system, which is one of the most important factors in the vicious circle of condyloma acuminatum recurrence.
9. Others
Other factors that cause the recurrence of condyloma acuminatum include the patient's poor personal hygiene habits, excessive foreskin in men, various genital infections in women, and the local humid environment caused by the increase in secretions caused by it.
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