Purpose: the discussion of the relationship between phimosis or redundant prepuce and the recurrence rate of genital warts.
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)Â Â 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)Â Â 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)Â Â 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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