The recurrence rate of CA is very high, reaching 100% in some studies(7, 8). This fact constitutes a main challenge in CA treatment. CA causes numerous physiological and psychological problems due to its high likelihood of recurrence(9, 10). In most cases, patients visit medical centers to seek better and faster cures for GW, but recurrent viral infections usually cause considerable frustration. Such persistent behavior of CA makes it a crucial disease to address in the modern era(11). Different types of treatment, such as imiquimod, immunotherapy, CO2 laser therapy, PDT, and cidofovir isotretinoin, are used to treat CA, but frequent therapies are required to address recurrent attacks.
Our study ultimately revealed the enormous impact of this virus on the lives of many HPV-infected individuals and improved treatment methods by preventing repetitive disease. The principle behind autotransplantation is to trigger cell-mediated immunity, which is unaffected by HPV infection, by introducing a larger amount of the same antigen at a site where a robust immune response can take place. A single wart is completely removed, and the minced particles are subsequently inserted into a dermal pocket. Planting of incised pathogens in the same infected person will lead to a scenario of resistance against that particular viral infection and cessation of further growth. This method is similar to vaccination in that weak or identical disease pathogens are given to individuals to create antibodies against the required disease(12, 13).
In this study, we planned to establish immunity from previous viral lesions to further decrease disease manifestations. After pathogens are propagated to the subcutaneous fat, the infection cannot be established in the subcutaneous area due to the structural and pathogenic capacity of the fungus in the subcutaneous region(14–16). On the other hand, body immunity works more efficiently when the pathogen is in a mute state, producing antibodies against it. Later, these antibodies are transferred to the blood and slowly circulate to all body areas even over the genital tract so that secondary attack will be terminated much easier and faster. This methodology also facilitates body immunity against other identical viral attacks, as has just been demonstrated in other studies.
Our results indicated that seven patients (77.8%) were negative for recurrent HPV infection after the initial surgical implantation of pathogens in inguinal sites, while the remaining (22.2%) patients were positive for recurrent HPV infection. During our study, we reviewed existing treatment modalities for CA and their recurrence rates. Our technique’s recurrence rate was relatively low in comparison to other treatment options such as Imiquimod (50–73%), podophyllin(46—60%), podophyllotoxin(approximately 38%),Carbon dioxide laser(2.5–77%), trichloroacetic acid(18–36%),5-Flurouracil(50%),Interferon(9–69%)(7–9, 17–22). The findings of this study exhibited improved outcomes in contrast to the findings of Shiva Kumar et al., in which a significant 73.3% of warts were completely cleared, with the majority of them (91%) experiencing clearance within a span of two months(23). Nischal et al. used this therapy in the treatment of multiple recurrent palmoplantar warts, for which the clearance rate was 74.1%. Our results are also higher than those of similar techniques used for nongenital warts, for which 60.6% of the procedures were successful. Various studies have shown that subcutaneous embedding of autologous warts improves immune function and antiviral ability. It can effectively prevent the early recurrence of GW and has good clinical efficacy in the treatment and prevention of GW; thus, it is worth promoting clinical efficacy(5, 24, 25).
All patients were advised to maintain the operative sites clean and dry to attain effective results. Throughout their treatment interval, no patients received any physical ablative medication or any other photodynamic therapy (PDT) over the lesional sites. It is a low-priced experimental treatment used to treat and control CA, whereas other therapies cost more money and time. Other procedures, such as PDT and repeated CO2 laser surgeries, are more painful than our experimental procedure is. Our methodology of transplanting the pathogen to subcutaneous fat will limit all extra expenses and decrease patient discomfort.
Recurrent attacks in those two individuals can be explained by either failure to maintain the postoperative sanitary atmosphere or persistent viral exposure. Moist skin is known to be more favorable for virus growth and the production of warts(26). This is the reason why it is important to maintain postoperative hygiene, and a dry environment decreases the vulnerability of viruses to attack. Another reason why a patient experienced a single recurrent attack in one week can be presumed to be that the new wart may indeed have arisen from previous lesion sites or scars that were not visualized during the first surgery or during CO2 laser therapy. These viruses may reside in the skin epithelium in the latent stage and cause disease when they reach a suitable environment. After secondary CO2 laser treatment, no recurrent lesions were recorded.
Once this technique is used in the local health care system, we expect that the recurrence rate of typical HPV infection will be reduced and that the burden of expenditure on patients can also be minimized compared to that of other therapeutic methods. As many countries’ health systems still do not involve HPV vaccination in the local medical system, implantation of such techniques would be favorable and decrease the incidence of HPV in local populations.
After explaining our treatment technique, some patients did not consent to this surgical technique, and the number of participants was not high. To obtain the maximum results from this new technique, a larger sample size and longer follow-up may support the discoveries of the present work.