A large number of studies have shown that many factors leading to recurrence of genital warts, including some HPV re-infection and other factors.
- Genital warts damage and/or HPV have not been completely removed.
Genital warts damage and/or HPV have not been completely removed is one of important factors of recurrence of genital warts. Some scholars have found that, after using electro-ion burning to remove wart, there’re still 45% of patients had HPV latent infection, 67% of which relapse. This indicates that HPV is not completely cleared by the body, and residual lesions caused by genital warts or latent HPV infection are the main reason of recurrence of genital warts. Author believes that, in the course of treating genital warts, as long as each operation of topical therapy is careful, and especially the master to achieve the range and depth to which each operation could completely remove HPV infection tissue, the recurrence of genital warts will be significantly reduced. However, the clinical course of treatment was not able to do this, as is closely related to the skill level of operator.
HPV infection sites are primarily in the skin, genital warts grow outward from the skin. Thus, whether topical or laser therapy even other treatment, the depth of the treatment should reach the top of epidermal basal cell layer, the range of the treatment should be 1~2 mm more than the edge of the lesions , so as to clear lesions tissue completely. However, even the clinical course of treatment do that, there are still a small number of patients relapse after treatment. Many studies have found that，HPV DNA was detected within a few patient’s dermis. The results show that, in cases of genital warts relapse, except for existing in the epidermis, HPV also exists in the dermis, as is another important reason to cause recurrence of genital warts. Now the problem is that, since HPV is a kind of virus which attack epithelial cells or go in for epidermis, why it does exist in the dermis? There are several possible explanations: genital warts viruses
- The skin’s response to the inflammation caused by HPV infection could lead to the release of HPV DNA, for example, the liquefaction and degeneration of basal cell caused by the skin’s inflammation may lead to HPV particles released into the dermal papilla.
- As is known, AIDS patients’ epidermal Langerhans cells, lymphocytes and mononuclear cells can contain HIV; these cells in epidermis of genital warts may engulf HPV DNA, and they can walk from the epidermis to the dermis.
- HPV viremia can cause that dermis contains HPV, however, it has been failed to find the virus in serum with the immunological methods, so this possibility is highly unlikely.
2. Genital warts’ infection caused by HPV that has spread from a different part of the body.
As mentioned earlier, in the process of laser therapy and surgery treatments, lesions tissue containing HPV is likely to contaminate other parts of the body, for example, genital warts caused by HPV infection that has spread from mucous membranes surrounding and remote lesions tissue of genital warts.
- Something contaminated by HPV.
The indirect mode of transmission have been described in the article of “transmission of genital warts”, which may be one of the factors leading to relapse of genital warts. For example, patients’ towels, etc. are HPV contaminations with which are not treated, if touched them once again, may cause recurrent genital warts. Bergeron have also found that underpants contaminated by HPV may cause recurrence of genital warts.
- Sexual partners infected with HPV or suffering from genital warts.
If patients’ sexual partners were infected with HPV or suffering from genital warts and not definitive treatment, patients after treatment could relapse once having the sexual contact with them.
- Subclinical symptoms of genital warts and latent infection with HPV.
Subclinical symptoms of genital warts and latent infection with HPV are the most important factors that cause genital warts and their recurrence. Erpenbach and his assistant have reported that, subclinical symptoms of genital warts and latent infection with HPV could cause recurrence of genital warts, and the possibility is 30% ~ 70%.
- The integrity of the body’s immune system
As mentioned earlier, changes of patient’s immune system play an important role in the occurrence development and fadeaway of genital warts. Consequently, the various internal and external factors, which cause the immune function decline, induce the regulation of the immune response to disorder, and eventually lead to a balance disorder or defect of cell immune system, as is a very important factor that causes a vicious cycle of recurrent of genital warts.
- Other factors
There’re many other factors causing recurrent of genital warts, such as bad health habits of individual patients, male’s redundant prepuce, all kinds of women’s vaginal infections and the local moist environment caused by their increasing secretions.
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