As with all sexually transmitted diseases, total abstinence remains the only 100% assured way of avoiding this condition. Having a monogamous sexual relationship with a partner known to be disease-free is the most practical way of avoiding sexually transmitted diseases.

According to the American Cancer Society and the Centers for Disease Control, recent research has shown that condoms, “rubbers”, cannot protect against infection with HPV.
This is because HPV can be transmitted with any skin-to-skin contact with any HPV-infected area of the body, such as the skin of the genital or anal area which are not covered by a condom. Condoms are still recommended, however, as they may prevent the transmission of other sexually transmitted diseases that may coexist with HPV.

The absence of visible warts cannot be used to decide whether caution is warranted, since HPV can be passed on to another person even when there are no visible warts or other symptoms. HPV can be present for years with no symptoms.

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The conditions that can cause genital warts can be summarized as one pathogeny and three inducements.

The pathogeny is HPV (human papilloma virus), carried by the patients with genital warts. Usually, genital warts that our eyes can see are only a small part of human papilloma virus infections, in the skin around the warts, there are still majority infections are latent or subclinical states. They cannot be seen with the naked eye. Doctors or the patient’s own using ordinary medical to treat, only the visible wart could be removed, but there’re still residual virus, so it will be very difficult to avoid the recurrence, and the recurrence rate would be up to 50% or so. Therefore, the treatment using of WARTROL can effectively avoid this problem, because WARTROL is mild and non-corrosive to the skin, you can use a large area around the warts so that subclinical infection can be cure at the same time, the recurrence rate of genital warts will reduce.

Three inducements are also very important to the attack of genital warts, specifically as follows:

First, the inoculation: the genital skin abrasions and exfoliations, brought along with sexual intercourse, even if very small, but also can provide the conditions for the virus inoculation. When people are infected with the cells containing virus particles, genital warts will attack after a delitescence of 3 months or so.

Second, the humidity: HPV must be breeding in wet environments.

Third, the temperature: in the appropriate temperature, HPV will breed and grow.

Once a virus attacks, coincidentally there are three inducements, genital warts can occur. In the healing process, if the virus has not been completely removed, and the inducements are not eliminated, the recurrence of genital warts will be also inevitable.

Implementing best tips to prevent relapse of genital warts

What ways can completely cure the genital warts? Contrapose the reasons and conditions for the incidence of genital warts, we can aptly call the prevention step of recurrence as “1 +3 projects.”

“1″ is to eliminate the pathogeny:

For the medium-sized warts that can be seen and touched in genital area, each wart is less than 0.5 cm, and the number of warts is below 15, generally, we can use drugs for external (such as WARTROL) to scratch them for treatment.

If the size and number of warts exceed the above criteria, laser treatment can be used and the interferon also can proper be injected for adjuvant treatment when needed (only for patients with recurrent repeat). Before using the above method, it is best to make acetic acid white test to find out the scope of subclinical infection so as to treat together and reduce the possibility of recurrence. In treatment process, wash genital area every day, avoid infection, and keep the wound dry. Once found a small new wart or recurrence, use WARTROL to rub in time. If patients’ sexual partners do not suffer from genital warts, they may also carry the virus, therefore, sex life should be forbidden in treatment and recovery period in order to avoid re-infection.

“2″ is to remove the inducements:

To treat a variety of women diseases which can possible cause inoculations, such as cervicitis, vaginitis, and vulvitis. Treatment of phimosis must be pay attention too, because the warm and humid environment inside the Foreskin and Coronal provides a good condition for the propagation of HPV.

Remember genital warts do not mean incurable diseases. As long as patients follow the doctor’s advices, boost confidences, and actively remove the pathogeny and inducements with patience, the relapse troubles of genital warts will be able to get rid of finally.

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In fact, sexual behavior is an important factor leading the relapse. The more sexual partners are, the higher the recurrence rate is. The morbidity and recurrence rate of male commercial sex workers are higher than prostitutes’ and homosexuals’. The morbidity and recurrence rate of people, whose age having the first sexual behavior were younger than 19, are higher than others’. The risk factors of those women to suffer from Anogenital warts, whose ages having the first sexual behavior were less than 25-year-old, are increased.

Smoking and drinking are risk factors of the morbidity and recurrence of various sexually transmitted diseases, because smoking and drinking can reduce the body’s immune function, and people who often smoke and drink have more sexual partners than those who do not smoke and drink. Some survey found that the opportunity for the relapse of genital warts of those people, who smoke more than a decade, increased marked. Moreover, alcohol can inhibit the central nervous system, reduce anxiety, and enhance libido and even prostitution that can result in an increase in sexual partners. At the same time, the increase in violent sexual behavior and the decrease in the use of condoms after drinking increased the extents and opportunities of genital damage, therefore, the morbidity and recurrence of genital warts increased.

Marital status also related to the morbidity and recurrence of the disease, for example, divorcee, the separated couple, widowed and unmarried persons, couples whose married life are disharmony and so on,  all those above people, due to increasing in high-risk sexual behavior, will increase the chances of the morbidity and recurrence of genital warts.

Other sexually transmitted diseases, such as genital herpes, gonorrhea, trichomoniasis, syphilis, HIV, fungal infections and so on, could reduce the ability to resist HPV infection through destroying mucosal barrier; otherwise, those diseases could make the local environment around the genitals humid, as is conducive to the propagation and growth of HPV. Various sexually transmitted diseases and other viral or fungal infections significantly reduce the body’s resistance to diseases, so the morbidity and recurrence’s risk of genital warts have doubled and redoubled.

The morbidity and recurrence risk of genital warts will increase in the immunocompromised hosts, such as cancer patients, patients with SLE (System lupus erythematosus), patients with renal transplants, chemotherapy and so on, besides, they have much bigger warts.

Keeping the affected area dry could reduce the recurrence rate of genital warts; some people believe that circumcision can reduce the opportunity of the incidence and recurrence of genital warts, because the warm, humid environment under the foreskin is more conducive to the virus’ survival and reproduction.

In addition, the lifestyle, eating habits, individual fat or thin, psychology, education, economic empowerment, and their own health condition are so different that the situation of incidence and recurrence of genital warts are not the same. Those people, who are eating spicy food, fat and sebum secretion, middle-aged, high education level, lower incomes and who pay no attention to health, could get genital warts again easily.

Recurrence is not terrible, as long as you can correctly understand the dangers of genital warts, avoid premature sexual intercourse, control excessive sexual behavior, select the appropriate methods of contraception, insist on using condoms, no smoking, no drinking, pay attention to rest, do not stay up all night, optimism, remove the negative factors, improve the body’s resistance, genital warts will gradually disappear.

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It is one important factor causing recurrence of genital warts, that subclinical infection has not been completely removed. Some scholars have found 45% of patients still existing latent HPV infection after spontaneous regression or treatment of wart removal, and 67% of which appear relapse. This indicates that HPV is not completely cleared by the body, and residual lesions of genital warts or latent HPV infection are the main reasons 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. Another reason is that the virus is not completely removed by the body.

In short, it is the most fundamental reason leading to the recurrence of genital warts that subclinical infection has not been completely removed;   therefore, the treatment with subclinical infection should be reckoned with.

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1. It is conducive to diseases using immune enhancer, such as poly-muscle cell, interferon, transfer factor etc., to improve the body’s immunity along with local treatment.

2.Wartrol can be used along with local treatment to make warts off, which can play a role in preventing relapse of genital warts.

3. If suffering from redundant prepuce, male should do circumcision; and if having vaginitis, cervicitis, or other inflammations, women should also treat them actively along with local treatment of genital warts.

4. To strike a proper balance between work and leisure, to intensify nutritional support and to take exercise so as to improve the body’s immunity.

5. If Sexual partners have some discomfort, they should also be checked. If they were found in both male and female in couples, such as erythemas, nodules, proliferators, ulcers, increased secretions, inflammations and so on, it is immediately to go to hospital for treatment.

6. Keeping optimistic and healthy can adjust the body’s internal system, and it is conducive to cure the disease.

7. During treatment, it should be banned that drinking, smoking, eating seafood products (fish, crabs, shrimp, etc.), spicy food, beef, mutton, “Sukiyaki”,  ”Shabu-Shabu” and so on.

8. During treatment, the absolute prohibition of sex life is necessary. It must be done to wash hands before and after using the toilet and before meals. Separate articles for daily use with other people, do not to abuse other people’s daily necessities, and pay attention to disinfection and isolation.

9. Some edible mushrooms, which contain large amounts of polysaccharide materials and can effectively improve the patient’s cellular immune function, should be eat so as to reducing the recurrence rate of genital warts.

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1. 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

1. 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.
2. 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.
3. 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.

1. 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.

1. 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.

1. 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%.

1. 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.

1. 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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Methods: Select 54 cases of patients suffering from genital warts with redundant prepuce and 32 cases of patients with normal prepuce or the ones who have circumcision treatment before suffering from genital warts. Remove warts using electric cauterization, and one intramuscular injection of 1 million units interferon-α daily. After one week of continuous use, asked the patients to review once monthly in order to observe the recurrence.

Results: The differences both in the recurrence rate and the recurrence time between patients with redundant prepuce and the normal group are significant meaning.

Conclusion or Consequence: Redundant prepuce has some connection with the recurrence tare of genital warts, and the circumcision can reduce the recurrence of genital warts.

Keywords: Genital warts   Redundant prepuce   Recurrence

Genital warts caused by HPV (human papillomavirus) infection is a kind of sexually transmitted diseases. The difficult problem in the treatment of genital warts is mainly the high recurrence rate themselves. The author observed that there are different recurrence rates between genital warts patients who are suffering from redundant prepuce and patients with a normal length of the foreskin. Thus, the author observed and compared that the recurrence occurs whether or not and its time both in patients who are suffering from redundant prepuce and patients with a normal length of the foreskin after treatment. Now the report is as follows:

A)   Grouped data

86 cases of patients suffering from genital warts are all newly diagnosed patients, which are the first time to visit to our hospital. They all aged 17 to 73 years, average age is 28.6 ye. Have the disease duration of 1 ~ 35 weeks. The number of lesions is 1 to 15; and the skin lesions mainly located in Coronal, urethra opening, foreskin, and the front of penis. Their diagnostic system is in line with genital warts diagnostic criteria drawn up by Ministry of Health. HPV (Only patients infection with HPV6, 11 were chose in this study) are found in the fluorescence polymerase chain reaction. Koilocyte or koilocytotisis was found in the biopsy. In these 86 cases, patients suffering from redundant prepuce accounted for 54 cases; the ones with normal foreskin (including the patients who have circumcision treatment before suffering from genital warts) accounted for 32 cases. Course of the disease, skin lesions cases, the sick part are all comparable in the two groups of patients.

B)   Treatment Method

The instrumentation used for the fluorescence polymerase chain reaction is Germany Biometra48 PCR amplification instrument; and the operating steps and the interpretation of the results are according to the instructions given. 5% acetic acid can be applied to acetic acid white test. After diagnosed by using the fluorescence polymerase chain reaction and acetic acid white test, newly diagnosed patients, which are the first time to visit to our hospital, were been under local anesthesia using the mixture of 5ml 2% lidocaine and 1 million units of interferon-α, and then were removed warts using electro-ion burning. Bye the way, before using electro-ion to burn, 5% acetic acid can be coated the warts and around them to find and remove the hidden or dormant tissue of genital warts. After the treatment of electro-ion burning, 1 million units of interferon-α were taken into the body by intramuscular injection once a day for a week. After one week of continuous use, asked the patients to review once a month for three months in order to observe the recurrence. When patients reviewed, in addition to observe whether the warts recurrence, In addition to observing whether the wart recurrence, but also to review using acetic acid white test to find hidden lesions. The appearances of warts and dormant lesions both look as the recurrence of genital warts.

C)   Results

There’re 37 cases of recurrence in the 54 patients suffering from redundant prepuce, the relapse rate of this group was 68.5%; there’re 14 cases of recurrence in other 32 ones with normal foreskin, the relapse rate of this group was 43.8%. Compared the former relapse rate with the latter relapse rate, it could be found that there’re significant differences between them (χ2=5.107,P< 0.05). There’re 16, 11, and 10 cases of recurrence respectively in the first, the second, and the third month in the former group suffering from redundant prepuce; there’re 7, 5, and 2 cases of recurrence respectively in the first, the second, and the third month in the latter group with normal foreskin. Compared the former relapse time with the latter relapse time, it could be found too that there’re significant differences between them (P< 0.05).

Discussions

Genital wart caused by HPV (Human papilloma virus) is a kind of sexually transmitted diseases. HPV6 and HPV11 types account for the majority in the HPV infections. Therefore, genital warts patients infected with HPV6, 11 are mainly selected in this study. The body’s immune response caused by HPV infections is mainly cellular immune response, and the phenomenon exists that cellular immunity is restrained. Since Isaacs and others found interferon in cell culture fluid infected with virus in 1959, it has been confirmed that interferon used to locally lesion can enable lesion tissue and cells and normal tissue and cells adjacent lesion produce anti-viral protein so as to blocking viral replication and enhancing the function and killing activity of NK cell, as can extend the cell division cycle, resulting in anti-proliferative effect. Thus, IFN-α was added in order to achieve the purpose of enhancing the efficacy and the completion of clinical studies in this treatment of patients with genital warts. Contrasting the results of this study, it can be found that, the relapse rate and time of patients suffering from redundant prepuce were both significantly higher than the relapse rate and time of the other group with normal foreskin; and differences between the two were significant after statistical analysis. The reason may be that the local warm and humid environment around the glans and coronal caused by redundant prepuce, and HPV pathogens easily grow and reproduce in the warm humid conditions. In addition, redundant prepuce could affect the eduction of necrotic cells which were shelled by glans, Coronal and foreskin mucous membrane with normal metabolism, and then those necrotic cells could cause smegma so as to producing local minor inflammation; and the long-term stimulation of the inflammation-induced is also a factor of genital warts recurrence. Therefore, in clinical, some scholars often treat patients with electro-ion burning and at the same time using circumcision treatment, which is also regarded as a good way to prevent the recurrence of genital warts.

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a)     Data and Methods

a-a) Clinical Data

There are 29 patients in the group, which are all male, and their ages are from 24 to 45 with an average of 34 year old. All patients were randomly divided into two small groups. The first group composing of 15 patients were treated by using laser therapy or electro-ion to burn warts, and coated with iodine. The second group included 14 cases of patients, in which 6 cases of patients whose warts were smaller were injected 5-Fu directly, the remaining 8 cases can be treated by using laser therapy or electro-ion burning first, and after partial healing, using 5-Fu injections to prevent recurrence.

a-b) Treatment Methods

Select 250mg/10ml Specification 5-Fu injection, 2 ~ 5ml one-off syringe, and small injection needle. For tiny genital warts whose diameters are less than 1mm, the needle can be introduced 5mm away from its roots into intradermal roots of genital warts, then push slow bolus with 0.5～1.0ml 5-Fu so that to the liquid reach radius of 5mm to center around genital warts, and then re-injected 5-Fu about 0.5ml in the same area, pull out the needles, press pinhole for 2 ~ 3min using a cotton bud to prevent bleeding. The treatment is completed until now. 2-3 warts can be treated once at the same time, and several warts from a very close distance can be treated as a big one. Repeat every 3 ~ 4 weeks time, a total of 4 times. Big genital warts whose diameters are larger than 1mm can be treated by using laser therapy or electro-ion burning first, and after partial healing, using local injections of 5-Fu to prevent recurrence according to the above method.

b)    Effect or Result

After following up for 18 months, it was found in the first group that there’re separately 1, 2, 3 and 1 cases of recurrence distributing respectively among the first, the sixth, the twelfth, the eighteenth months. There’s no recurrence in the other group.

c)     The discussions

As a commonly antineoplastic drug, its essential functions are affecting the metabolism of cells which are in proliferating phases trough interfering the biosynthesis of cell VNA and mixing in RNA in the way of the formation of pseudo-metabolites, thereby killing cancer cells.

Warts are directly removed by using chemical methods or heating, as is the traditional method of treating genital warts. In recent years, it was considered that the major reason for high recurrence rate of this disease was that the traditional method of treating genital warts could not eradicate the virus in vivo. 5-Fu can kill HPV by blocking viral VNA replication and the biosynthesis of the capsid protein of virus cells, and thus cure and prevent recurrence of genital.

This method has the following advantages:

c-a) Local use, less dosage, and less impact on the body.

c-b) The swelling of injected site disappears after about 1 day,

c-c) Easy operating.

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a)     Differences of The Scope of The Disease

Pearly penile papules and female pseudo-condyloma are a kind of benign hypoplasia of skin. In the normal population, 10% are suffering from this disease. According to a survey, the prevalence of this disease, which is also very high in the virgins and men never had sexual contact with women, is not infected by sexual contact, and does not belong to the scope of sexually transmitted diseases, but genital warts is infected through sexual contact, and is a kind of sexually transmitted diseases.

b)    Different Performance

Pearly penile papules，which look like small grains of rice, are characterized by tiny papules distributed along the Coronal. Female pseudo-condyloma, whose distribution is dense, is characterized by symmetric papules in the inner labia minora, it can be showed roe-like. This disease may be without any discomfort, without treatment, and non-infectious. However, genital warts, which scattered at external genital organs in both men and women, are characterized by skin warts distributed without regularity, which is very tiny initially, such as needle size, and then was cauliflower-like, cristate (chicken coronary) or papillary. In some special circumstances, there may be itching sense and smell. Genital warts that can be self-bleeding inside the vagina have their own infectious, and can continue to develop growing without treatment, as is the number and size of warts will be both gradually increasing, .

c)     Different therapeutic purposes

Both pearly penile papules and female pseudo-condyloma are without any discomfort and generally don’t require treatment. However, such highly infectious disease as genital wart, which is one of sexually transmitted diseases, must be treated, otherwise the consequences will be more serious. Clinically, pearly penile papules and female pseudo-condyloma may be misdiagnosed as genital warts easily and be worn the hat of sexually transmitted diseases, therefore, doctors must diagnose clearly. Patients should actively cooperate the treatment and sincerely answer doctors’ inquiries, should be designed to exclude the possibility of sexually transmitted diseases, sexually transmitted diseases also do not want missed. It is necessary to rule out the possibility of sexually transmitted diseases, while it cannot be missed at the same time. Both drugs commonly used for the treatment of genital warts and drugs that are selectively destructive to warts can be used for the treatment of genital warts.

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a)     Blind antiviral therapy, blindly seeking for more courses of treatment.

At present, some sexually transmitted diseases prevention and control institutions are apt to with respect to let patients make one after another course of treatment using broad-spectrum antiviral drugs, such as acyclovir, etc., as well as ribavirin, polyinosinic and so on. But these broad-spectrum antiviral drugs are only active against herpes simplex virus, but have poor efficacy on genital warts virus.

b) A lot of effort have been put into enhancing the body’s immunity, as is large dose and multiple courses immunostimulants have been used. In fact, infections caused by genital wart virus in clinical are limited to local mucosal tissue of the skin, not to such an extent as to cause the body’s systemic immunity reducing. In fact, it is the local cellular immunity which play a role in treating genital warts, rather than the systemic immunity, but the pharmacological effects of the immune enhancers used at present are mainly to enhance the body’s systemic immunity, therefore, the effect of the treatment for genital warts is not large.

At present, the better method of treatment for genital warts is using drugs for topical use, such as wartrol.

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