genital warts
Cervical biopsy specimens and human papilloma virus positivity in patients with external genital warts.

Akdeniz S, Yaldiz M, Akdeniz N.

Cervical biopsy specimens were taken from 16 women with external genital warts in order to diagnose concomitant cervical human papillomavirus (HPV) infection and cervical intraepithelial neoplasia (CIN) according to pathology. Positive HPV infection was detected 56% (9/16) of the patients. Among those patients 66% (6/9) had concurrent subclinical low-grade CIN lesions. One of those patients had a high-grade CIN lesion. It is concluded that cervical HPV infection was rather common in women with external genital warts and it is valuable to examine cervical HPV infection by biopsy to detect concomitant CIN.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12440827&dopt=Abstract genital wart


genital warts
[Management of external genital warts by dermatologists: a French survey]

[Article in French]

Mahe E, Descamps V, Bouscarat F, Crickx B.

Service de Dermatologie, Groupe Hospitalier Bichat-Claude Bernard, Assistance Publique des Hopitaux de Paris, 46, rue Henri Huchard, 75018 Paris, France. emmanuel.mahe bch.ap-hop-paris.fr

BACKGROUND: External genital wart is the most frequent sexually transmitted disease. While there are guidelines for management and treatment, no data about primary care of this viral disease is available in France. So, we conducted a survey on French dermatologists'management of external genital warts. METHODS: In July and August 2001, a questionnaire - including questions on physicians and patients, sexually transmitted diseases, partners, clinical and viral evaluations, treatments, and follow-up - was mailed to 652 French dermatologists (randomization of 20 p. 100 of French dermatologists). RESULTS: Three hundred and fifty (53 p. 100) responses were returned. Dermatologists were mainly exclusively office practitioners (58 p. 100). Thirty-six percent of them were taking care of more than 3 patients per month with external genital warts. Patients were essentially men and immunocompetent. Only 52 p. 100 of physicians systematically performed a sexually transmitted disease evaluation, 38 p. 100 a partner evaluation, and 17 p. 100 a local evaluation for external genital warts. Biopsy was occasionally performed by 48 p. 100 of physicians, mainly in order to confirm diagnosis. Viral genotyping was rare. Cryotherapy (84 to 93 p. 100) and podophyllotoxin (40 to 55 p. 100) were the two treatments used as first line therapy, while laser (61 to 71 p. 100), and imiquimod (39 to 48 p. 100) were second line therapies. Sixty-three percent of physicians proposed a systematic clinical control after clinical recovery. CONCLUSION: This large survey represents an overview on general practice concerning external genital warts among French dermatologists. Our study points out the lack of global management (loco-regional, partner, and STD evaluation) of the disease by dermatologists.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12442096&dopt=Abstract genital wart


genital warts
[Photodynamic therapy of benign viral vulvar lesions]

[Article in Czech]

Uhlir M, Jirsa M, Otcenasek M, Halaska M, Feyereisl J.

Gynekologicko-porodnicka klinika, UK, 1. LF a FN Na Bulovce, Praha.

OBJECTIVE: The aim of the study was to evaluate the use of the photodynamic effect in the treatment of genital warts in women. DESIGN: Prospective study. SETTING: Department of Obstetrics and Gynecology, Hospital Na Bulovce, 1st Faculty of Medicine, Charles University, Prague. METHODS: Twenty-five women with genital warts (HPV infection), which were verified by biopsy, were involved into the study. The affected area was treated by ten milligrams of the 5-aminolevulinic acid in three milliliters of gel for 8 hours. Red light with the 630 nanometers wavelength was applied for 15 minutes, with calculated energy intake 30 J/cm2. RESULTS: All women were free of symptoms and had negative colposcopy in the followed period of 3 to 12 months. On average 3.8 sessions were necessary to reach the remission. It was possible to repeat the session after two weeks time. During the application of light, 17 (68%) of the patients felt either no or slight burning sensation, 6 (24%) had unpleasant but bearable sensation and 2 patients had to be treated in short intravenous anesthesia. CONCLUSION: Photodynamic therapy (PDT) is a promising modality in the treatment of HPV vulvar lesions and can be considered to be a method of choice.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12661368&dopt=Abstract genital wart


genital warts
Condyloma in pregnancy is strongly predictive of juvenile-onset recurrent respiratory papillomatosis.

Silverberg MJ, Thorsen P, Lindeberg H, Grant LA, Shah KV.

Department of Epidemiology, Baltimore, Maryland 21205-2179, USA. msilverb jhsph.edu

OBJECTIVE: To assess the risk of juvenile-onset recurrent respiratory papillomatosis conferred by a maternal history of genital warts in pregnancy, and to identify additional cofactors such as the method of delivery (cesarean versus vaginal) and procedures or complications during pregnancy. METHODS: A retrospective cohort design was used to evaluate maternal and infant characteristics associated with respiratory papillomatosis among Danish births between 1974 and 1993. Using data from Danish registries, we identified 3033 births with a maternal history of genital warts during pregnancy. Fifty-seven respiratory papillomatosis cases were identified by review of medical records from ear, nose, and throat departments. RESULTS: Seven of every 1000 births with a maternal history of genital warts resulted in disease in the offspring, corresponding to a 231.4 (95% confidence interval 135.3, 395.9) times higher risk of disease relative to births without a maternal history of genital warts. In women with genital warts, delivery times of more than 10 hours were associated with a two-fold greater risk of disease. Cesarean delivery was not found to be protective against respiratory papillomatosis, and no other procedures or complications during pregnancy were observed to increase the risk of respiratory papillomatosis. CONCLUSION: A maternal history of genital warts in pregnancy is the strongest risk factor for respiratory papillomatosis in the child. Future studies should examine the efficacy of genital wart treatment for the prevention of disease.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12681865&dopt=Abstract genital wart


genital warts
Risk factors associated with genital warts in HIV-positive Brazilian women.

Goncalves MA, Burattini MN, Donadi EA, Massad E.

Division of Clinical Immunology, Department of Medicine, School of Medicine of Ribeirao Preto, University of Sao Paulo, Sao Paulo, Brazil. epigin uol.com.br

AIMS AND BACKGROUND: In Brazil, the female population has been increasingly infected with human immunodeficiency virus (HIV), and uterine cervix carcinoma now represents the second highest cause of mortality. Although HIV infection among women is associated with an increased prevalence of cervical cancer precursors, the co-infection with human papillomavirus (HPV) is considered to be a necessary but not sufficient factor to induce genital lesions. This study was conducted to identify risk factors associated with the history of genital warts among HIV-positive women. METHODS: A comparative cross-sectional evaluation was applied to 141 HIV-positive women. All patients were submitted to colposcopy, smear cytology, directed biopsy, and HPV-DNA detection. The chi-square, Fisher's exact test, and the odds ratio (OR, 95%; confidence interval, CI) were used to evaluate associations between history of genital warts and risk factors. RESULTS: A history of genital warts presented associations with: a) age at first sexual intercourse < or = 17 years (OR, 0.42; CI, 0.16-1.11); b) history of genital warts in sex partners (OR, 11.39; CI, 4.21-30.76), especially with recurrent episodes (OR, 6.60; CI, 2.69-16.12); c) drug addiction (OR, 2.38; CI, 1.09-5.19), especially in crack users (OR, 5.34; CI, 1.64-17.41); d) cervical HPV infection (OR, 2.75; CI 1.09-6.90); e) cervical infection caused by only one HPV type (OR, 2.77; CI 1.06-7.20); f) perianal HPV infection (OR, 2.30; CI, 0.70-7.56), associated with negative results for undetermined risk HPV (OR, 8.41; P = 0.04); and g) no antiretroviral therapy (OR, 3.41; P = 0.07). CONCLUSIONS: Evaluation of behavioral risk factors associated with a genital wart history is an important tool to prevent and reduce persistent HPV infection, and consequently genital cancer precursors in HIV infected women.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12729354&dopt=Abstract genital wart