genital warts
Dual infection with human papillomavirus in a population with overt genital condylomas.

Langenberg A, Cone RW, McDougall J, Kiviat N, Corey L.

Department of Laboratory Medicine, University of Washington, Seattle.

BACKGROUND: Multiple human papillomavirus (HPV) genotypes have been demonstrated in individual patients; usually, different genotypes occur in different anatomic sites. OBJECTIVE: Our purpose was to evaluate the prevalence of multiple HPV types from the same anatomic site. METHODS: During the course of a study evaluating topical versus ablative therapy for external genital HPV, sequential biopsies on patients with external genital warts were performed. HPV DNA content was determined by Southern hybridization. Ninety-two specimens from 63 patients (48 women, 15 men) with genital warts were evaluated. RESULTS: Dual infection with two HPV genotypes was documented in each of four specimens (6.3%). Sequential biopsy specimens from the same anatomic site in the same person revealed dual infection in 5 of 12 sampled patients (41%). Overall, 14% of patients had dual genitourinary HPV infection. CONCLUSION: Counseling and follow-up of long-term complications, such as transmission and the risk of subsequent genitourinary carcinoma, should be performed on all patients with HPV because of the possibility of undetected HPV DNA types in the individual patient.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8383148&dopt=Abstract genital wart


genital warts
In vitro evaluation of phosphorothioate oligonucleotides targeted to the E2 mRNA of papillomavirus: potential treatment for genital warts.

Cowsert LM, Fox MC, Zon G, Mirabelli CK.

ISIS Pharmaceuticals, Carlsbad, California 92008.

Papillomaviruses induce benign proliferative lesions, such as genital warts, in humans. The E2 gene product is thought to play a major role in the regulation of viral transcription and DNA replication and may represent a rational target for an antisense oligonucleotide drug action. Phosphorothioate oligonucleotides complementary to E2 mRNAs were synthesized and tested in a series of in vitro bovine papillomavirus (BPV) and human papillomavirus (HPV) models for the ability to inhibit E2 transactivation and virus-induced focus formation. The most active BPV-specific compounds were complementary to the mRNA cap region (ISIS 1751), the translation initiation region for the full-length E2 transactivator (ISIS 1753), and the translation initiation region for the E2 transrepressor mRNA (ISIS 1755). ISIS 1751 and ISIS 1753 were found to reduce E2-dependent transactivation and viral focus formation in a sequence-specific and concentration-dependent manner. ISIS 1755 increased E2 transactivation in a dose-dependent manner but had no effect on focus formation. Oligonucleotides with a chain length of 20 residues had optimal activity in the E2 transactivation assay. On the basis of the above observations, ISIS 2105, a 20-residue phosphorothioate oligonucleotide targeted to the translation initiation of both HPV type 6 (HPV-6) and HPV-11 E2 mRNA, was designed and shown to inhibit E2-dependent transactivation by HPV-11 E2 expressed from a surrogate promoter. These observations support the rationale of E2 as a target for antiviral therapy against papillomavirus infections and specifically identify ISIS 2105 as a candidate antisense oligonucleotide for the treatment of genital warts induced by HPV-6 and HPV-11.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8383937&dopt=Abstract genital wart


genital warts
Vulvar and penile HPV lesions: laser surgery and topic anaesthesia.

Frega A, Di Renzi F, Palazzetti PL, Pace S, Figliolini M, Stentella P.

II Istituto di Clinica Ginecologica e Ostetrica, Universita degli Studi di Roma La Sapienza.

Treatment of genital warts (HPV lesions) by Laser-surgery was performed in 90 patients and 90 male partners under topical anaesthesia with 1-3 gr EMLA cream and in 45 patients and 45 males (control groups) under 1-2 ml 2% Carbocaine infiltration. EMLA cream was applied to warts 5-18 minutes (median = 7) before operation. Pain from application of anaesthetic and Laser surgery was significantly less (p < .001) in the groups treated by EMLA. Side effects were minimal in the EMLA groups. The results suggest that EMLA cream could be the anaesthetic of choice in Laser surgery of genital warts.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8392452&dopt=Abstract genital wart


genital warts
The revival of nitric acid for the treatment of anogenital warts.

Heaton CL, Lichti HF, Weiner M.

Department of Dermatology, University of Cincinnati Medical Center, OH.

The destruction of small lesions by tissue denaturation (fixation) rather than erosion (acid hydrolysis) is accomplished by nitric acid of moderate strength in which nitric acid reduction products are generated by nitric acid oxidation of added organic acids. Such solutions show a temperature-dependent increase or loss of nitrite during storage, with loss of therapeutic activity when nitrite levels decrease after storage at cooler temperatures. Use of a preparation technique that completely consumes all the oxidizable organic components added to generate nitrite results in a stable preparation that is effective, well tolerated, and convenient in the treatment of anogenital warts (condylomata acuminata). Of 50 patients monitored after treatment with a 6.6 mol/L nitric acid preparation with no residual oxidizable organic agents, results were good in 39 patients, satisfactory in four patients, and unsatisfactory in seven patients. These observations lead to a simplified stable preparation of modest nitric acid concentration with adequate nitrate reduction products for efficacy in the topical ablation of small skin lesions such as condylomata acuminata.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8392456&dopt=Abstract genital wart


genital warts
An audit of treatment of genital warts: opening the feedback loop.

Reynolds M, Murphy M, Waugh MA, Lacey CJ.

Department of Genitourinary Medicine, Leeds General Infirmary.

An audit of the treatment of patients (100 men and 90 women) presenting with a first episode of anogenital warts to the Genitourinary Medicine Department at Leeds General Infirmary was performed. Treatment of patients was monitored for a period of 6 months from the time of presentation. The management of patients with genital warts lacked a clearly defined strategy and treatment was unselective and poorly monitored. Excluding patients who defaulted, at follow-up 44 (44%) men and 36 (38%) women still had genital warts at 3 months. Of those patients clear of warts at 3 months, the mean time to remission for men and women was 7.1 and 8.3 weeks respectively. Podophyllin 25% in tincture of benzoin was by far the predominant therapeutic modality used. A total of 96 (96%) men and 76 (84%) women received treatment with podophyllin. Both male and female patients had a mean of 5 treatments with podophyllin 25% (range 1-19 and 1-12 respectively). Physical methods of treatment i.e. cryotherapy and electrocautery, were underutilized, both as primary therapies and when topical agents had failed. Patients saw an average of 3 (range 1-7) doctors over the course of their treatment. Patients with warts affecting 2 or more sites, male patients with anal/perianal warts, and female patients with cervical and vaginal warts had higher failure rates from treatment at 3 months. On the basis of these findings, specific treatment protocols for the management of anogenital warts have been devised.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8399504&dopt=Abstract genital wart