genital warts
Relapses after treatment of external genital warts are more frequent in HIV-positive patients than in HIV-negative controls.

De Panfilis G, Melzani G, Mori G, Ghidini A, Graifemberghi S.

Department of Dermatology, Brescia Hospital, Brescia, Italy.

BACKGROUND: Recurrences of cervical lesions associated with human papillomavirus are more frequent in HIV-infected (HIV+) than in HIV- women. Recurrences of external genital warts were investigated in HIV+ patients and HIV- control subjects. GOAL: To compare relapses after treatment of external genital warts between HIV+ and HIV- patients. STUDY DESIGN: At the sexually transmitted disease (STD) center in Brescia, Italy, 1336 patients (241 HIV+ and 1095 HIV-) with external genital warts were examined in the decade 1990 to 1999. Various local treatments were used. RESULTS: Treatments generally triggered recovery from the lesions. The relapses observed up to 1 year after the response, examined by survival analysis, were significantly (P < 0.001) more frequent in the HIV+ (160 cases; 66.4%) than in the HIV- (294 cases; 26.8%) subjects. Multiple relapses observed up to 1 year after treatment occurred in 69 of 241 HIV+ patients, as compared with 14 of 1095 HIV- control subjects (P < 0.001). CONCLUSION: According to the study findings, HIV infection can be considered a risk factor for the development and recurrence of external genital warts. Multiple relapses should drive patients to HIV testing.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11875372&dopt=Abstract genital wart


genital warts
Treatment of genital warts - what's the evidence?

Wilson J.

Department of Genitourinary Medicine, The General Infirmary at Leeds, Great George Street, Leeds LS1 3EX, UK.

Genital warts are usually asymptomatic, and rarely cause discomfort. Once the patient is aware of them the main symptom is their cosmetic appearance and resultant psychological consequences. The ideal treatment outcome would be complete viral eradication, but this is not possible. Treatments focus on the removal of exophytic warts, leaving the surrounding subclinical and latent human papillomavirus (HPV) infection as areas of possible transmission and recurrence. Effective treatment does reduce HPV viral load, so the infection is reduced if not completely eradicated. Treatment is often painful, inconvenient, and may produce poor clearance rates and frequent recurrences. The treatment chosen should be no worse or more dangerous than the disease itself, and should be tailored to the patients' disease and needs as well as to the available resources. Genital warts are highly infectious and sexual partners may well already be infected when a patient presents for treatment. There are no published studies showing that condom use reduces transmission of HPV from people with genital warts. However, if the sexual partner is uninfected; using a condom may protect against HPV lesions and genital warts. Condom use should be encouraged in new relationships.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11886604&dopt=Abstract genital wart


genital warts
Information-giving to patients with genital warts at a genitourinary medicine clinic: a baseline assessment.

McClean H, Weaver S.

Lansdowne Clinic for Sexual Health, Hull & East Riding NHS Hospitals Trust, Royal Infirmary, Hull, UK.

Aspects of information-giving to patients with a first episode of genital warts attending a large UK genitourinary medicine clinic on three or more occasions were assessed using a questionnaire survey employing correlational and between-groups analyses. The main outcomes measured were levels of, and interrelationships between, patients' perceptions of information received about genital warts, accuracy of knowledge, quality of interaction with clinic personnel, written information, patients' level of anxiety and demographic variables. Patients with genital warts have good basic knowledge about this condition, although understanding about several complex issues is poor. Educational level was positively correlated with accuracy of knowledge about genital warts. Although ease of communicative interaction with information-givers was positively correlated with perceived information given, no relationship was found between the latter and actual knowledge about genital warts. Anxiety levels and receiving written information were largely uncorrelated with accuracy of knowledge about genital warts. This study suggests that while patients' perception of information received may relate to more satisfactory interaction with information-givers, actual knowledge may be a more important measurable outcome. More interventional work is needed to determine how the information-giving process for genital warts can be optimized.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11886605&dopt=Abstract genital wart


genital warts
Imiquimod 5% cream in the treatment of anogenital warts in female patients.

Buck HW, Fortier M, Knudsen J, Paavonen J.

Watkins Memorial Health Center, University of Kansas, USA. hbuck ku.edu

OBJECTIVE: To investigate the efficacy and safety of imiquimod 5% cream in the treatment of anogenital warts in a female population. METHODS: In two open-label studies, female patients with anogenital warts applied imiquimod 5% cream three times a week for up to 16 weeks. Patients who cleared their warts were monitored for a 6-month follow-up period. Patients could be re-treated with imiquimod 5% cream for up to an additional 16 weeks if their warts recurred or new warts developed during the follow-up period. The treatment period could also be extended for up to an additional 16 weeks if patients only experienced partial clearance during the initial 16-week treatment period. RESULTS: Of the female patients who applied imiquimod 5% cream, 75% (449/600) experienced complete clearance of their warts (treatment failure analysis). This includes 46 patients who experienced total clearance when they applied imiquimod for longer than 16 weeks as their warts had only partially cleared in the initial 16 weeks of therapy. During the 6 months of follow-up after the initial treatment period, 15% of patients had recurrent warts. Thirty-nine (75%) of those patients experienced total clearance again after they re-applied imiquimod for up to an additional 16 weeks. The most frequently observed local skin reaction was erythema. CONCLUSION: In these studies, imiquimod 5% cream was an effective and well-tolerated treatment for anogenital warts in females and continued to be safe and effective in the small proportion of patients who needed to re-apply imiquimod after wart recurrence.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12065134&dopt=Abstract genital wart


genital warts
The epidemiology and treatment of anogenital warts in Singapore: a retrospective evaluation.

Chan YC, Ng KY, Chan RK.

National Skin Centre, 1 Mandalay Road, Singapore 308205.

INTRODUCTION: A retrospective study in the referral centre for sexually transmitted infections (STIs) in Singapore to describe the epidemiology and treatment outcome of patients with anogenital warts. SUBJECTS AND METHODS: We reviewed the case records of 301 patients with anogenital warts who were seen over a 1-year period (1999). We also attempted to interview every patient by telephone to find out if they had any clinical recurrences for which treatment was sought elsewhere. RESULTS: There were 255 males and 46 females with a mean age of 34 years. Two hundred and nineteen (72.8%) presented with symptoms lasting 12 weeks or less. In males, warts occurred most frequently in the preputial cavity (52.5%) and on the penile shaft (40.8%). In females, they occurred most frequently on the external genitalia (91.3%). Two hundred and thirty-five males were treated with cryotherapy and 69% (95% CI, 62.6% to 74.8%) achieved clinical resolution after a mean of 6 treatment cycles. Seven males were treated with podophyllin 0.25% in ethanol and 71% (95% CI, 29.0% to 96.3%) were clinically cured after a mean of 4 treatment cycles. Thirty-nine females were treated with cryotherapy and 67% (95% CI, 49.8% to 80.9%) achieved clinical cure after a mean of 4 treatment cycles. Of the 290 patients treated at the centre, 212 (73%; 95% CI, 67.3% to 77.8%) patients (184 males, 28 females) achieved clinical cure after a mean of 7 weeks (range, 1 to 34 weeks); 90% (95% CI, 86.0% to 93.2%) of them by 15 weeks. Seven-two patients defaulted follow-up and 6 responded partially to treatment. Of the 212 patients who achieved clinical cure, 195 were interviewed by telephone, on an average, 17.7 months after clinical resolution. Thirty-seven (19%; 95% CI, 13.7% to 25.2%), all males, relapsed clinically after a mean of 100 days (range, 5 to 329 days); 90% (95% CI, 84.6% to 93.6%) relapsed by 228 days. CONCLUSIONS: Podophyllin 0.25% in ethanol was the most cost-effective treatment for males. One in 5 patients had a recurrence of their warts and most had their recurrence within 8 months of initial resolution.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12161888&dopt=Abstract genital wart