Men's Health Education: Symptom Recognition and Treatment Guidelines for Genital Warts and Trichomoniasis

Genital warts

Gentle warts are caused by the human papillomavirus (HPV) and commonly occur as wart-like growths on the external genitalia, around the anus, perineum, and rectum. The HPV that transmits genital warts is not sensitive to disinfectants such as ether, and is not easily killed by cold or dryness.

(I) Epidemiology and Transmission

This disease is more common in young adults. The source of infection is infected individuals, primarily through sexual contact and indirect contact. Infected mothers can transmit the disease to their infants during childbirth. Currently, genital warts are recognized as a sexually transmitted disease.

This disease is currently more common in Western countries such as the UK and the US. In the UK, the incidence rate was 47.36 per 100,000 people in 1976, and 60.63 per 100,000 people in 1980. In the US, the incidence rate was 0.2% in 1975, 0.54% in 1976, and 1.92% in 1977. In recent years, it has been found that genital warts can occur in people of almost any age. There is also an increasing trend of condyloma acuminata on the external genitalia and perianal area of ​​children, mainly due to indirect infection through infected adults.

(II) Clinical Manifestations The incubation period varies, ranging from 2 weeks to 8 months, with an average of 3 months. In the early stages, the clinical manifestations are small, soft, pale red wart-like papules, which gradually increase in size and number, with an uneven surface and no discomfort. Continued proliferation can lead to papillary or cauliflower-like growths, some of which may merge into large masses. The surface of the warts is rough, and secretions may occur when infected or ulcerated. At this time, local pain and itching may occur. Rectal warts may cause pain and a feeling of needing to defecate.

In men, condyloma acuminata can occur anywhere on the penis, but is most common in the coronal sulcus and glans. These areas are easily damaged during sexual activity, and the virus easily infects from these sites.

This disease also frequently affects the male urethral mucosa, causing papillary growths that can obstruct the urethra and lead to difficulty urinating. When complicated by infection, it can cause clinical symptoms such as hematuria, urinary frequency, urgency, and dysuria. Some believe that condyloma acuminata can become malignant, forming a malignant tumor locally.

(III) Diagnosis Early on, asymptomatic cases are generally difficult to diagnose; condyloma acuminata is usually only discovered after it appears. Typical cases can be diagnosed based on clinical manifestations. For cases with doubt, pathological examination of the local growths or cytological examination of the local mucosal tissue can be performed. If necessary, immunohistochemical examination can be used to clarify the diagnosis. Condyloma acuminata within the genital tract requires endoscopic examination for a definitive diagnosis.

(IV) Treatment
1. Surgical treatment: excision of the lesion under local anesthesia.

2. Cryotherapy.

3. Laser therapy.

4. Electrocautery.

5. Local chemotherapy: 1%–5% 5-FU ointment or 25% podophyllin applied topically. 6. Early-stage patients can use 1% phthalimide ointment topically.

7. A few stubborn and refractory cases may be treated with interferon.

Trichomoniasis

Trichomoniasis is a disease caused by the flagellated protozoan Trichomonas vaginalis, primarily affecting the female vagina, but can also infect the male urinary tract through sexual intercourse.

(I) Pathogen
The Trichomonas vaginalis is pear-shaped or spherical, 10–30 μm long. It has an elliptical nucleus at the anterior part of the body, four flagella at the apex, and a wavy membrane at the body. An axon penetrates the body and extends from the tail, allowing the trichomonas to move freely. The trichomonas has only a trophozoite stage and reproduces by longitudinal fission, without a cyst stage. However, the trophozoite is highly adaptable to different environments, able to grow and reproduce at 25–42°C, survive for 21 days at 3–5°C, and survive for 6 hours in a semi-dry state. Therefore, the trichomonas remains infectious after leaving the human body.

After Trichomonas vaginalis parasitizes the human body, its pathogenicity and invasiveness are related to the virulence of the parasite and the physiological condition of the host. The invasion and movement of Trichomonas vaginalis between cells damages epithelial tissue. The toxins released by the parasite can stimulate an inflammatory response in the tissue. Furthermore, Trichomonas vaginalis consumes glycogen in vaginal epithelial cells, hindering the production of lactic acid by lactobacilli, thus reducing the pH in the vagina and making it more alkaline, which is conducive to the growth and reproduction of other pathogenic bacteria, leading to vaginal inflammation.

(II) Infection and Epidemiology
Trichomoniasis is one of the most common sexually transmitted diseases worldwide. Its incidence rate is second only to vaginal candidiasis, with an estimated incidence of 10%–25% in women and about one-fifth in men. This disease is distributed worldwide, in various climates and among different social groups.

Trichomoniasis is transmitted in two ways: one is direct transmission. Most men who have sexual contact with infected women also have urotrichomoniasis, and Trichomonas vaginalis is often found in their semen, thus becoming carriers of the parasite. Another form of transmission is indirect transmission, mainly through public baths, foot basins, towels, shared swimsuits, toilets, and contaminated medical equipment.

(III) Clinical Manifestations After a 4-28 day incubation period, women infected with Trichomonas vaginalis develop vaginitis symptoms.

1. Increased vaginal discharge. Characteristics: grayish-yellow, thin, sometimes frothy, and foul-smelling. When complicated by pyogenic bacterial infection, the discharge becomes yellowish-green and purulent. In severe cases, vaginal mucosal bleeding may result in bloody discharge.

2. Vulvar and vaginal itching, burning, or a crawling sensation. Prolonged exposure to vaginal discharge can lead to vulvar dermatitis.

3. Congestion and edema of the vaginal and cervical mucosa, often with scattered small bleeding points, resembling strawberry-like protrusions. Tenderness is felt during examination or intercourse.

4. When Trichomonas vaginalis invades the urinary system, symptoms such as lower abdominal pain, urinary frequency, and dysuria may occur. Male patients often experience mild symptoms or even no symptoms. Symptoms include mild itching and discomfort in the urethra, more pronounced during urination. In severe cases, it can lead to urethritis, cystitis, prostatitis, and epididymitis. Symptoms may include purulent discharge and difficulty urinating.

(IV) Diagnosis
Clinically, a preliminary diagnosis can be made based on the patient's medical history, symptoms, and the presence of typical vaginal discharge during examination. However, a definitive diagnosis is only confirmed when Trichomonas vaginalis is found in the discharge. Laboratory diagnostic methods:

1. Hanging drop test: A small amount of discharge is collected from the posterior fornix of the vagina in women and immediately mixed with a small amount of warm saline solution on a glass slide for direct microscopic examination. The procedure should be rapid (keeping warm is important in winter). Active parasites and flagella can be observed. In men, urethral discharge can be collected for examination, and the sediment can be examined after centrifugation of the urine sample. This method is quick and simple and is often used as an outpatient examination.

2. Smear staining method. 1. Smear secretions onto a glass slide to form a thin film, stain with Giemsa solution, and examine under an oil microscope.** This method has a higher detection rate than the hanging drop method, and can not only detect Trichomonas vaginalis but also other vaginal microbial infections simultaneously.

2. Culture Method:Secretions are placed in a liver infusion or egg yolk infusion culture medium and incubated at 37°C for 48 hours before microscopic examination. The detection rate can reach 93%, aiding in the diagnosis of mild cases, carriers, or chronic patients, and serving as a basis for monitoring treatment efficacy.

(V) Treatment

1. Restoring the Physiological State of the Vagina:Enhance the vagina's defense capabilities by using acidic or acid-producing drugs, such as 0.5%–1.0% lactic acid, acetic acid solution, or 1:5000g potassium permanganate solution for vaginal irrigation, or by adding glucose powder into the vagina, to restore normal vaginal acidity, inhibit Trichomonas vaginalis reproduction, and stop the onset of the disease.

2. Vaginal Antitrichomonal Drugs:The main treatment involves arsenic-containing preparations, commonly using arsenic-containing suppositories such as Divex and Carbazin. One suppository is inserted deep into the vagina each night for 10 days as one course of treatment. Alternatively, metronidazole can be made into 1% suppositories, 200mg each night for 7-10 days as one course of treatment.

3. Oral anthelmintics can simultaneously eliminate trichomonas parasitizing the urinary system, intestines, and deep within glands, making it the most effective treatment method. Currently, metronidazole is the first choice. The adult dose is 200mg three times daily for 7 days as one course of treatment. Combined with vaginal administration of 200mg each night, the effect is even better. For children, the dose is 15mg/(kg·d), divided into three oral doses for 7 days. The US Centers for Disease Control and Prevention recommends an adult dose of 2g, taken once daily, to ensure patient treatment while minimizing dosage and side effects. Both of these methods can achieve a 90% cure rate. Because metronidazole has the potential to cause birth defects, pregnant women should avoid its use in early pregnancy.

4. During treatment, maintain local hygiene and avoid sexual intercourse. For a complete cure, both partners should be treated simultaneously. For patients with recurrent episodes, it is especially necessary for the husband to also take metronidazole orally. Trichomoniasis often recurs after menstruation due to changes in vaginal pH; therefore, those who have recovered should be followed up for examination, and it is best to continue topical medication for 3 months to consolidate the therapeutic effect.