WS 235-2003 Diagnostic criteria and management principles for condyloma acuminatum
Some standard content:
Chapter 2 of this standard is mandatory, and the rest are recommended. WS235—2003
Condyloma acuminatum is one of the most common STDs, and currently ranks second in the number of STDs in my country. This disease is mainly caused by human papillomavirus infection. This standard is specially formulated to provide reliable diagnosis and reasonable treatment for patients with condyloma acuminatum, as well as to understand the prevalence and trend of condyloma acuminatum and provide a reliable basis for prevention and treatment. In the process of formulating this standard, the "Diagnostic Criteria and Treatment Program for STDs (Provisional)" formulated by the Ministry of Health of my country in 1991 was carefully studied, and the diagnostic criteria for condyloma acuminatum revised by the Centers for Disease Control of the United States in June 1996, as well as the "Guidelines for the Treatment of Sexually Transmitted Diseases" in 1998 and the relevant contents of the Trial STD Diagnosis and Treatment Standards of the Ministry of Health in 2000 were consulted. Appendix A and Appendix B of this standard are normative appendices, and Appendix C is an informative appendix. This standard was proposed by the Department of Disease Control of the Ministry of Health. The drafting unit of this standard: Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College. The main drafter of this standard: Han Guozhu.
This standard is entrusted by the Ministry of Health to the Office of Supervision and Administration of Communicable Disease Prevention and Control of the Ministry of Health for interpretation. 1
1 Scope
Diagnostic criteria and treatment principles for condyloma acuminatum
This standard specifies the diagnostic criteria and treatment principles for condyloma acuminatum. This standard is applicable to medical and health care institutions, health and epidemic prevention institutions and STD prevention and control institutions at all levels across the country. 2 Diagnostic criteria
2.1 History of contact
History of non-marital sexual behavior or history of infection by spouse or indirect infection. 2.2 Clinical manifestations
2.2.1 Symptoms and signs
2.2.1.1 This disease is caused by human papillomavirus (HPV) infection, with an incubation period of 3 weeks to 8 months, with an average of 3 months. WS 235--2003
2.2.1.2 In males, it is more common in the coronal sulcus, foreskin, frenulum, glans penis and perianal area, followed by urethral orifice, penis body and scrotum; in females, it is more common in labia majora and minora, posterior symphysis, clitoris, cervix, vaginal wall and perianal area. It can occasionally occur in areas other than genitalia and perianal area, such as armpit, groin, under breast and oral cavity.
2.2.1.3 Initially, it is a small red, light brown or dark brown papule, the size of a needle tip to mung bean. Later, it protrudes upward, gradually increases in size and number, with a rough and uneven surface, spreading to the surrounding area and spreading. According to the morphology of the wart, it is divided into papular type, nipple type, cauliflower type, cockscomb type and mushroom type. A few of them are giant condyloma acuminatum with papilloma-like proliferation, namely Buscke-loewenstein giant condyloma acuminatum. The wart is white, red or dirty gray.
2.2.1.4 Generally, there is no sensation. Some patients may feel a foreign body, itch or pressure, or may break, soak or erode due to friction, bleed during sexual intercourse, or ooze due to infection. Female patients may often have vaginitis. 2.2.1.5 Clinically, condyloma acuminatum needs to be differentiated from penile pearly papules, villous labia minora (pseudo-condyloma acuminatum), flat condyloma acuminatum, Bowenoid papulosis and squamous cell carcinoma.
2.2.2 Acetic acid white test (see Appendix A)
Apply 5% acetic acid solution to the lesions. After 3 to 5 minutes, the surface of the lesions will turn white. This is an auxiliary diagnostic method. 2.3 Histopathological examination
Typical pathological manifestations are hyperkeratosis with parakeratosis, thickened stratum acanthum, elongated spikes, pseudoepitheliomatous hyperplasia, characteristic concave cells in the stratum acanthum, nuclei of different sizes, darkly stained and pyknotic, cytoplasmic vacuolation around the nucleus, dermal edema, vascular dilation and inflammatory cell infiltration (see Appendix B).
2.4 Case classification
2.4.1 Clinical diagnosis cases have indicators 2.1 and 2.2. 2.4.2 Confirmed cases have indicators 2.4 in addition to indicators 2.1 and 2.2. 3 Treatment principles
There are many methods for treating condyloma acuminatum. The appropriate treatment plan should be selected according to the location, size, number, morphology, treatment cost, patient compliance, side effects, etc. of the warts (see Appendix C). Patients should be treated immediately after being diagnosed with condyloma acuminatum. At the same time, their spouses and sexual partners should be mobilized to receive examination and treatment. Sexual life should be prohibited during treatment to avoid reinfection or transmission to new sexual partners. Follow-up should be conducted after the treatment. 4 Clinical cure
The judgment standard is that the warts visible to the naked eye are removed. It usually takes 2 to 3 weeks from the wound surface after treatment to the healing of epithelial hyperplasia and concretion. 1
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Within 3 months after treatment, no new warts at the treatment site are judged to be basically cured. Management and prevention
After discovering patients with genital warts, reasonable treatment should be provided to the patients in a timely manner to promote their recovery. 2 Notify spouses and sexual partners to come to the clinic for examination and treatment. 5.2
For the first visit recipients, the epidemic situation should be reported to the epidemic prevention department based on the clinical diagnosis and (or confirmed results). Stop sexual life during the treatment period and before the wound is completely healed. Stop sexual life for 3 months after clinical recovery (condoms can be used if necessary). 5.4
Pay attention to personal hygiene and do not use public towels, bathtubs, toilets and other appliances. 5.5
Advise patients to keep themselves clean after recovery and not to have extramarital sex A.1 Method
Appendix A
(Normative Appendix)
Acetic acid white test
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A.1.1 Apply 5% acetic acid solution to the surface of the skin lesion with a cotton swab, or apply gauze soaked in 5% acetic acid solution to the skin lesion for wet compress.
Generally, wet compress can be observed for about 5 minutes, while perianal skin lesions require 10 minutes to 15 minutes. A. 1.2
A, 1.3 Most results can be observed directly with the naked eye. Intravaginal lesions and small lesions can be observed more clearly with the help of a colposcope or a magnifying glass. A.2 Results
The site of human papillomavirus infection shows white changes, which are uniformly white. White changes can appear in clinically suspected lesions or clinically no lesions. The diameter is several millimeters to several centimeters, and the shape is regular or irregular. The boundaries may be clear or not very clear. A.3 Clinical significance
This method is simple, economical, fast and easy to use. It has high sensitivity. It is helpful for the diagnosis of clinical atypical lesions and subclinical infections. It is used before treatment to determine the treatment range, which is helpful to prevent or reduce recurrence after treatment. However, the specificity of this method is not high. Some chronic inflammations, such as candidal vaginitis, genital trauma and non-specific False positive results may occur due to thickening of mucosal epithelium caused by sexual inflammation.
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B.1 Preparation of pathological sections of specimensbzxZ.net
Appendix B
(Normative Appendix)
Histopathological examination of condyloma acuminatum
B.1.1 Sampling: Sampling can be done by drilling, surgery or scissoring. B.1.2 Fixation: The biopsy tissue is fixed in 10% neutral formalin solution. Dehydration: The tissue is dehydrated in 70%, 80%, 95% to 100% ethanol for 45min~1h each. B.1.3
Transparency: Transparency in xylene.
Wax immersion: Place the transparent tissue in paraffin and wax it for 2h~3h. Embedding: Pour hot paraffin into the box, wait for the paraffin on the bottom to solidify slightly, place the tissue in the center of the box in a certain direction, and wait for it to solidify. B. 1. 6
Slice: Stick the slices on the slides and bake. B. 1.7
Specimen staining
Slices are dewaxed in xylene for 10 min~15 min. Transfer to 100%, 95%, 80% gradient ethanol for dehydration for 1min-2min each, then rinse with waterB.2.2
B.2.3 Stain in hematoxylin solution for 10min~15min. Rinse with tap water for more than 15min. The water flow should not be too large and should not be directly rinsed on the slices. B.2. 4
B.2.5 Differentiate in hydrochloric acid for 5min~10min, then rinse with water. B. 2. 6
Stain with 5% eosin for 1min~3min, stain the cytoplasm. Wash with 95% ethanol to remove excess red, then place in 100% ethanol for 3min~5min. B. 2.71
Put it in a mixture of xylene and ethanol and soak it for 3min~5min, then put it in two cups of pure xylene solution and soak it for 3min~5min respectively.
B.2.9 After taking it out, wipe off the excess xylene and seal it with a drop of gum. B.3 Reading results
He staining sections show blue nuclei and red cytoplasm. Hyperkeratosis, accompanied by incomplete keratinization, epidermal acanthosis, papilloma-like or warty hyperplasia, basal cell hyperplasia, increased layers, vascular dilation in the superficial dermis, and inflammatory cell infiltration mainly composed of lymphocytes can be seen in HPV-infected tissues. The characteristic change is the appearance of vacuolated cells (concave cells) in the granular layer and the upper part of the spinous cell layer. The cells are large, the nuclei are often darkly stained, the morphology is irregular, and different degrees of vacuolation can be seen around the nucleus. In mild cases, there is only a vacuolated halo around the nucleus, and in severe cases, the entire cytoplasm undergoes vacuolation, and there may be reticular or flocculent changes in the cytoplasm. These vacuolated cells can be focal, flaky or scattered, which is an important basis for histological diagnosis of HPV infection.
C.1 Local drug treatment
Appendix C
(Informative Appendix)
Recommended treatment plan for condyloma acuminatum
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C.1.10.5% podophyllotoxin, also known as 0.5% podophyllotoxin, is applied to the warts twice a day for 3 consecutive days and then stopped for 4 days. This is one course of treatment. During this period, the warts are observed to fall off. The total area of the warts should not exceed 10cm, and the total amount of medication used per day should not exceed 0.5mL. If there are residual warts, one more course of treatment can be used, and 1 to 3 courses of treatment can be used. The drug can be taken home by the patient for self-use. C.1.210%~25% podophyllotoxin is applied topically to warts once a week. The application area should not exceed 10cm each time, and the amount of liquid medicine should not exceed 0.5mL. After 2~4 hours of application, the residual liquid medicine should be washed off with clean water. When using the medicine, care should be taken to protect the normal skin or mucous membrane around the wart. If the wart is not healed after 6 applications, other treatment methods should be used. C.1.350% trichloroacetic acid solution is applied topically to warts once a week. It destroys the wart by chemically coagulating epithelial cell proteins. If the wart is not healed after 6 applications, other treatment methods should be used. C.1.45% 5-fluoroadenine (5-Fu) ointment is applied topically once a day. When applying the medicine, care should be taken to protect the normal skin and mucous membrane around the wart. C.1.55% imiquimod cream is applied topically to the warts at night before going to bed, 3 times a week, for a maximum of 16 weeks. After 6 to 10 hours of use, wash the application site with neutral soapy water. Most patients will have their warts fall off after 8 to 10 weeks or earlier. This drug is an external immunomodulator that works by stimulating the local production of interferon and other cytokines. C.2 Physical therapy
C.2.1 Laser therapy uses carbon dioxide laser therapy to remove warts in one visit, and is suitable for multiple warts and urethral warts. C.2.2 Cryotherapy uses liquid nitrogen freezing to dissolve cells at low temperatures, thereby destroying the warts. It is suitable for urethral warts and smaller warts in other parts of the body.
C.2.3 Surgical excision can remove warts in one visit, and is suitable for single and giant condyloma acuminatum. C.3 Supplementary explanation
C.3.1 The above treatment options are not arranged in order of selection. The choice of treatment options should be based on the patient's wart distribution, number, size, morphology, treatment costs, patient compliance, side effects, etc. C.3.2 0.5% podophyllotoxin, 10%-25% podophyllotoxin and 5% 5-fluorouracil ointment are teratogenic and are contraindicated for use by pregnant women; the safety of 5% imiquimod cream for pregnant women has not yet been determined. Pregnant women with genital warts can choose 50% trichloroacetic acid solution for external use, laser treatment, cryotherapy or surgical treatment; genital warts are not an indication for termination of pregnancy. Caesarean section should only be considered when the genital warts are so large that they block the birth canal or cause severe bleeding. C.3.3 0.5% podophyllotoxin, 5% fluoropyrimidine ointment and 0.5% imiquimod cream are generally safe to use. Patients can take them home for self-use. If possible, the first treatment should be demonstrated by the doctor in the clinic to teach the patient the correct method of medication. This is very helpful for improving the treatment effect and reducing the occurrence of adverse reactions. C.3.4 10%~25% podophyllotoxin and 50% trichloroacetic acid solution for external use and all physical therapies require doctors to operate and treat, and require skilled operation techniques. Or have certain equipment conditions. C.3.5 Regardless of the treatment plan, once the warts are removed, if there is infection, topical antibiotic ointment should be applied, and oral antibiotics can be taken if necessary to prevent secondary bacterial infection.
C.3.6 Male prepuce is the inducing and recurring factor of genital warts on the coronal sulcus, foreskin, glans penis and urethral orifice. There are reports that circumcision after the healing of genital warts can prevent recurrence. C.3.7 Some patients will experience relapses, which usually occur within the first three months after treatment. Re-treatment or switching to other treatments will still be effective. Requiring the patient's sexual partners to undergo examination and treatment can reduce relapses. 5
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Art Examination Literature
[1] Department of Epidemic Prevention, Ministry of Health of the People's Republic of China. Manual of Prevention and Control of Sexually Transmitted Diseases. Second Edition. Nanjing: Jiangsu Science and Technology Press, 1994: 7277[2] Xu Wenyan. Clinical Management of Sexually Transmitted Diseases. Beijing: Science and Technology Press, 2001, 120～124[3J Center for Disease Control and Prevention. 1998 Guidelines for Treatment of Sexually Transmitted DiseasesMMWR1998;47(NoRR-1),8895[4J Holmes KK, Mardh PA, Sparling PE, et al. Sexually transmitted diseases. New York, McCrow-Hal1,1999,335~346.347-359
Clinical Effectiveness Group (Association of Genitourinary Medicine and Medical Sociaty for the[5]
study of venereal deseases). National quideline for the management If anogenital warts. SexTransm inf. 1999,75(Suppl1) : SS71~-75L6J LCDC Expert working Group on Canadian Guidelines for Sexually Transmitted Diseases. Cana-dian STDlines Guide.Health Canada,Ottawa.1998;1671721 Laser treatment uses carbon dioxide laser treatment, which can remove warts in one visit. It is suitable for multiple warts and urethral warts. C.2.2 Cryotherapy uses liquid nitrogen freezing to dissolve cells at low temperatures, thereby destroying the warts. It is suitable for urethral warts and other smaller warts.
C.2.3 Surgical excision can remove warts at one time, and is suitable for single and giant condyloma acuminatum. C.3 Supplementary explanation
C.3.1 The above-mentioned various treatment options are not arranged in order of selection. The choice of treatment options should be based on the distribution, number, size, morphology, treatment costs, patient compliance, side effects, etc. of the patient's warts. C.3.2 0.5% podophyllotoxin, 10%-25% podophyllotoxin and 5% 5-fluorouracil ointment have teratogenic effects and are prohibited for use by pregnant women; the safety of 5% imiquimod cream for pregnant women has not yet been determined. Pregnant women with condyloma acuminatum can choose 50% trichloroacetic acid solution for external use, laser treatment, cryotherapy or surgical treatment; condyloma acuminatum is not an indication for termination of pregnancy. Caesarean section should only be considered when the warts are so large that they block the birth canal or cause severe bleeding. C.3.3 0.5% podophyllotoxin, 5% fludolidine ointment and 0.5% imiquimod cream are generally safe to use. Patients can take them home for self-use. If possible, the first treatment should be demonstrated by a doctor in the clinic to teach patients the correct method of medication, which is very helpful for improving the treatment effect and reducing the occurrence of adverse reactions. C.3.4 10%~25% podophyllotoxin and 50% trichloroacetic acid solution for external use and all physical therapies require doctors to operate and treat, and require skilled operation techniques. Or have certain equipment conditions. C.3.5 Regardless of the treatment plan, once the warts are removed, if there is infection, topical antibiotic ointment should be applied, and oral antibiotics can be taken if necessary to prevent secondary bacterial infection.
C.3.6 Male prepuce is a predisposing and recurring factor for condyloma acuminatum on the coronal sulcus, foreskin, glans penis and urethral opening. Some reports suggest that circumcision after the healing of condyloma acuminatum can prevent recurrence. C.3.7 Some patients will have recurrences, which usually occur within the first 3 months after treatment. Re-treatment or switching to other regimens will still be effective. Asking the patient's sexual partners to be examined and treated can reduce recurrences. 5
WS235--2003
Art Examination Literature
[1] Department of Epidemic Prevention, Ministry of Health of the People's Republic of China. Manual of Prevention and Control of Sexually Transmitted Diseases. Second Edition. Nanjing: Jiangsu Science and Technology Press, 1994: 7277[2] Xu Wenyan. Clinical Management of Sexually Transmitted Diseases. Beijing: Science and Technology Press, 2001, 120～124[3J Center for Disease Control and Prevention. 1998 Guidelines for Treatment of Sexually Transmitted DiseasesMMWR1998;47(NoRR-1),8895[4J Holmes KK, Mardh PA, Sparling PE, et al. Sexually transmitted diseases. New York, McCrow-Hal1,1999,335~346.347-359
Clinical Effectiveness Group (Association of Genitourinary Medicine and Medical Sociaty for the[5]
study of venereal deseases). National quideline for the management If anogenital warts. SexTransm inf. 1999,75(Suppl1) : SS71~-75L6J LCDC Expert working Group on Canadian Guidelines for Sexually Transmitted Diseases. Cana-dian STDlines Guide.Health Canada,Ottawa.1998;1671721 Laser treatment uses carbon dioxide laser treatment, which can remove warts in one visit. It is suitable for multiple warts and urethral warts. C.2.2 Cryotherapy uses liquid nitrogen freezing to dissolve cells at low temperatures, thereby destroying the warts. It is suitable for urethral warts and other smaller warts.
C.2.3 Surgical excision can remove warts at one time, and is suitable for single and giant condyloma acuminatum. C.3 Supplementary explanation
C.3.1 The above-mentioned various treatment options are not arranged in order of selection. The choice of treatment options should be based on the distribution, number, size, morphology, treatment costs, patient compliance, side effects, etc. of the patient's warts. C.3.2 0.5% podophyllotoxin, 10%-25% podophyllotoxin and 5% 5-fluorouracil ointment have teratogenic effects and are prohibited for use by pregnant women; the safety of 5% imiquimod cream for pregnant women has not yet been determined. Pregnant women with condyloma acuminatum can choose 50% trichloroacetic acid solution for external use, laser treatment, cryotherapy or surgical treatment; condyloma acuminatum is not an indication for termination of pregnancy. Caesarean section should only be considered when the warts are so large that they block the birth canal or cause severe bleeding. C.3.3 0.5% podophyllotoxin, 5% fludolidine ointment and 0.5% imiquimod cream are generally safe to use. Patients can take them home for self-use. If possible, the first treatment should be demonstrated by a doctor in the clinic to teach patients the correct method of medication, which is very helpful for improving the treatment effect and reducing the occurrence of adverse reactions. C.3.4 10%~25% podophyllotoxin and 50% trichloroacetic acid solution for external use and all physical therapies require doctors to operate and treat, and require skilled operation techniques. Or have certain equipment conditions. C.3.5 Regardless of the treatment plan, once the warts are removed, if there is infection, topical antibiotic ointment should be applied, and oral antibiotics can be taken if necessary to prevent secondary bacterial infection.
C.3.6 Male prepuce is a predisposing and recurring factor for condyloma acuminatum on the coronal sulcus, foreskin, glans penis and urethral opening. Some reports suggest that circumcision after the healing of condyloma acuminatum can prevent recurrence. C.3.7 Some patients will have recurrences, which usually occur within the first 3 months after treatment. Re-treatment or switching to other regimens will still be effective. Asking the patient's sexual partners to be examined and treated can reduce recurrences. 5
WS235--2003
Art Examination Literature
[1] Department of Epidemic Prevention, Ministry of Health of the People's Republic of China. Manual of Prevention and Control of Sexually Transmitted Diseases. Second Edition. Nanjing: Jiangsu Science and Technology Press, 1994: 7277[2] Xu Wenyan. Clinical Management of Sexually Transmitted Diseases. Beijing: Science and Technology Press, 2001, 120～124[3J Center for Disease Control and Prevention. 1998 Guidelines for Treatment of Sexually Transmitted DiseasesMMWR1998;47(NoRR-1),8895[4J Holmes KK, Mardh PA, Sparling PE, et al. Sexually transmitted diseases. New York, McCrow-Hal1,1999,335~346.347-359
Clinical Effectiveness Group (Association of Genitourinary Medicine and Medical Sociaty for the[5]
study of venereal deseases). National quideline for the management If anogenital warts. SexTransm inf. 1999,75(Suppl1) : SS71~-75L6J LCDC Expert working Group on Canadian Guidelines for Sexually Transmitted Diseases. Cana-dian STDlines Guide.Health Canada,Ottawa.1998;167172
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