Is HPV laser treatment effective?

Don’t be scared when you hear about HPV infection. In fact, HPV infection can be divided into two types of infection: high-risk and low-risk. Some HPV viruses have a greater impact on the human body. For example, cervical cancer in women is caused by HPV. Some diseases caused by HPV are not so serious, such as genital warts and plantar warts. Many people say that HPV must be treated with laser to be effective. Is this true?

HPV infection has high-risk and low-risk infections. High-risk is a simple viral infection that does not grow anything and does not require laser treatment. It can be treated with medication and can turn negative. Low-risk infection causes genital warts, which can grow on the external genitalia, perianal area, anal canal and other places of men and women. Laser can only remove warts but cannot completely eliminate the virus. To completely cure it, the virus must be completely eliminated.

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Because this disease has a certain degree of self-limitation and is prone to recurrence after treatment, and there is currently no way to eradicate HPV, although there are many treatment methods, the main one is to remove local hyperplastic warts. The basic principles for selection are still effectiveness, simplicity, safety, and no scarring. For subclinical infection areas, they can be treated according to the methods of treating clinical infection under the guidance of acetic acid white test; for latent infection, should it be treated or how to treat it? There is no unified view yet. In addition, sexual partners and other possible sexually transmitted diseases should also be diagnosed and treated promptly and effectively. Some people have observed that patients with genital warts combined with other sexually transmitted diseases have a higher recurrence rate. In addition, protective measures should be taken to avoid transmitting the disease to others.

1. Local treatment

It is the most commonly used method at present, and its curative effect is more certain. If combined therapy is used appropriately, more satisfactory curative effect can be achieved.

1. 0.5% podophyllotoxin tincture (trade names: Eutoxin, Verrucoside) can inhibit epidermal cell mitosis and cause tissue necrosis with little side effects. Clean the affected area and dry it before using the medicine. Apply the medicine twice a day. One course of treatment is 3 days. Repeating the medicine should be done after an interval of 4 days or more. Domestic reports show that the cure rate of the first course of treatment is 54.8%, the cure rate of the second course of treatment is 32.1%, and the cure rate of the third course of treatment is 13.1%. The main side effects are local mild erythema, edema, erosion, and pain.

2. The mechanism of action of 10% to 25% podophyllotoxin benzoin tincture (or ethanol solution) is the same as that of podophyllotoxin, but it is more irritating and can cause toxic reactions by systemic absorption. Before applying the medicine, use vaseline to protect normal skin and mucous membranes. Wash the affected area with soapy water 2 hours after application. Do this once a week. The dosage each time should be limited to less than 0.5 ml and the application area should be less than 10 cm2. It is forbidden to use in pregnant women and children.

3. 5% 5-fluorouracil (5-FU) blocks DNA synthesis by blocking the methylation of deoxyuridine to thymine, thereby inhibiting viral replication. Apply ointment or cream topically or seal with waterproof tape, change it every 24 hours, and use it for 4 weeks, while paying attention to protecting normal skin. When used to treat male urethral warts, inject 12 ml of cream with a spray tube after the bladder is empty or apply it with a cotton swab, 4 times a day. After treatment, dilate the urethra to avoid adhesion. When used for vaginal warts, soak gauze with 5% of the drug solution, insert it into the vagina, and remove it after 2 hours.

4. 25% to 50% trichloroacetic acid solution has chemical exfoliation, hemostasis and astringency effects. Take once a day for 4 to 6 consecutive days, and then use again after a week. The solution should only be applied to the warts, and unreacted acid should be removed with talcum powder or sodium bicarbonate powder.

5. 3% phthalamide ointment is an α-aldehyde ketone thiourea derivative and has satisfactory therapeutic effects on viral skin diseases. Apply externally 2 to 3 times a day, 4 weeks as a course of treatment.

6. 5% acyclovir ointment inhibits the replication of viral DNA. 3 times a day.

7. Solcnderm is a composite external preparation containing nitric acid, acetic acid, lactic acid, oxalic acid and other acids. Use the applicator stick to apply to the entire wart 1-3 times until it turns grayish white or slightly yellow. Check again in 3-5 days and repeat once.

8. Compound geranium oil contains volatile oils and extracts of various traditional Chinese medicines such as geranium and Brucea javanica, which has the effect of exfoliating and stimulating wart tissue. Apply the medicine three times a day, taking care to protect the surrounding normal skin and mucous membranes. One course of treatment is 2 weeks, and another course can be applied after one week.

9. Dinitrochlorobenzene (DNCB) stimulates local delayed-type hypersensitivity reactions through sensitization. After use, the local burning sensation and eczema-like reaction are more severe, and it may be potentially carcinogenic, so it should be used with caution. It is recommended to use it in combination with laser to obtain more satisfactory results.

(ii) Physical therapy

1. Laser uses its thermal effect to vaporize the diseased tissue due to high temperature. Be careful not to over-treat, otherwise it will easily lead to scar formation. CO2 laser can be used to treat warts anywhere on the body. Rb-YAG laser is particularly suitable for warts in the proximal 2/3 of the urethra and some mucosal lesions. Some people use CO2 laser superficial coagulation to treat subclinical infected lesions and the 2 cm area around the warts while using CO2 laser to treat genital warts, which can reduce the recurrence of genital warts.

2. Electrocautery or electrodrying can cause cell degeneration and necrosis to remove warts. Electrodrying is prohibited for patients with pacemakers or warts close to the anal verge.

3. Liquid nitrogen is generally used for freezing, but CO2 dry ice can also be used to cause necrosis of the wart tissue until all skin lesions are frozen into ice balls and a frozen skin halo is seen at the base. The effect will be better if the freezing range is extended to 1-2 cm of normal skin around the wart. Mucosal freezing should be performed with extreme caution to prevent serious complications such as ulcers.

4. Isotope: 90Sr, 5 Gy each time, for 5 times in total, followed by 10 Gy each time thereafter, up to 55 Gy as a course of treatment.

5. Microwave local anesthesia: Use the needle-shaped radiator of the therapeutic device to insert into the base of the wart. The microwave output power is 40-50W, and each point lasts for 2 seconds. The tissue will coagulate and turn white, and the growth will be removed.

(III) Surgical treatment

1. Surgical resection is used for larger lesions, but it is prone to recurrence. And pay attention to reducing scar formation. Some people believe that circumcision of patients with prepuce hyperplasia can help prevent or reduce the recurrence of genital warts.

2. Scrape and disinfect routinely, perform basic anesthesia with 2% procaine, then quickly scrape the wart with a surgical curette, apply pressure to stop bleeding and immediately apply 40% trichloroacetic acid.

3. The clipping method is used to treat warts with less than 4 warts and a lesion diameter of less than 10 mm. It is more effective for warts around the anus or inside the anal canal. The operation is performed under local anesthesia, and the wart is cut off along the base of the wart, from back to front, to avoid exudate and blood affecting the progress of the operation.

(IV) Local injection

1. Interferon has antiviral, antiproliferative and immunomodulatory effects. It is recommended to use а-2a genetically engineered interferon for treatment. Dilute 1 million U with 0.5-1 ml of injection water or normal saline and inject evenly at the base of each lesion. Inject every other day, 3 times a week, for a total of 9 injections.

2. Bleomycin inhibits DNA synthesis and partially inhibits RNA synthesis. Inject 0.1% solution into the base of the wart, with the total amount limited to 1 ml each time.

3. Routine disinfection with 5-fluorouracil, inject 125 mg of the solution into the base, and then apply the ointment to the wart.

(V) Systemic treatment is currently often used in combination with local treatment and can serve as an adjuvant treatment. Polymyxin B, interferon, thymosin, and ribavirin can be used as appropriate and injected intramuscularly daily or every other day, or subcutaneously at the site of local lesions. You can also take Xiangru polysaccharide orally. The efficacy of levamisole is still controversial.

(VI) Genital warts in pregnant women According to surveys, the prevalence of genital warts in pregnant women is 1.5% to 2.5%. Others have reported that genital warts in pregnant women account for 11.33% of female patients. Genital warts proliferate faster during pregnancy, and the wart tissue is larger and more brittle. Some people believe that this is related to the increase in estrogen and progesterone in the blood of pregnant women. Large warts can interfere with delivery, and the trauma of warts during delivery can cause heavy bleeding and infection. The main treatments are freezing, laser, microwave, surgery, and topical trichloroacetic acid. Avoid using drugs such as podophyllotoxin, 5-fluorouracil, and interferon. If the warts are large enough to block the birth canal or may cause heavy bleeding, a cesarean section is appropriate; cesarean section is not recommended to prevent HPV infection in newborns. Please note that newborns can be infected with viruses through the birth canal, which may cause laryngeal papillomavirus in the newborn. There have been reports of deaths from throat obstruction and suffocation in China.

(VII) Traditional Chinese Medicine Treatment

1. Oral medication: The main syndrome of this disease is damp-heat toxicity, which accumulates in the skin. The treatment should be to clear away heat, remove dampness, detoxify and resolve blood stasis. The prescription uses 15g of Artemisia capillaris, 10g of Phellodendron chinense, 10g of Gentiana scabra, 30g of raw Job's tears, 30g of Poria cocos, 30g of Isatis root, 30g of Portulaca oleracea, 30g of Pearl, 10g of Safflower, 10g of Cyperus rotundus, 10g of Achyranthes bidentata, and 10g of fried Sophora japonica.

2. Topical medications

(1) External wash: After taking the above prescriptions, boil the residue again and wash the affected area with it after it is warm. Or use the following decoction in water, fumigate first and then wash the affected area: Isatis root 30g, Cibotium barometz 30g, Kochia scoparia 15g, Equisetum arvense 15g, Cyperus rotundus 30g, Stemona 15g, Sichuan pepper 15g, Alum 10g, Ligusticum chuanxiong 15g, Safflower 15g, and fried Sophora japonica 20g.

(2) External application: Apply Brucea javanica oil to the affected area, taking care to protect the surrounding skin and mucous membranes.

3. Acupuncture therapy for local disinfection, use a 2-inch silver needle to insert straightly from the top of the wart to the bottom, twist quickly 30 times, and at the same time perform the "draining needle" technique. After removing the needle, bleed 2-3 drops, then insert the needle parallel to the skin surface along the long axis of the wart base, and perform the same technique once every 2 weeks.

(VIII) Issues regarding the recurrence of genital warts: Recurrence of genital warts is the biggest problem in treatment. Some believe that the lowest recurrence rate is 25% within 3 months. Currently, all treatments cannot completely prevent the recurrence of genital warts. Some speculate that HPV infection may leave the virus dormant for life. Several things to note to reduce and prevent the recurrence of genital warts:

1. Thorough treatment, including overt infection and subclinical infection. Pay attention to the treatment of other affected sites, including the cervix, vagina, anus, rectum, and urethra.

2. Other possible sexually transmitted diseases should also be diagnosed and treated promptly, effectively and thoroughly.

3. Go to the outpatient clinic for regular check-ups and receive treatment as early as possible.

4. Mobilize sexual partners to get checked and treated to prevent reinfection.

5. Combined treatment to eliminate HPV virus as much as possible.

6. Circumcision for patients with excessive foreskin