genital warts
Have a nice day -- do a wart audit.

Wildman GM, Tang A.

Department of Genitourinary Medicine, Royal Berkshire Hospital, London Road, Reading RG1 5AN, UK.

We performed an audit of the treatment of genital warts at our clinic by reviewing the case notes of 302 patients who presented with a first episode of genital warts. 186 were suitable for inclusion, of whom over 90% were clear of warts within three months. However, even after just one month of treatment, 84.9% of men and 60.2% of women were clear of warts. On the basis of this information, we can be more optimistic when advising patients about the likely duration of treatment.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14596776&dopt=Abstract genital wart


genital warts
[The follow-up of anogenital warts in a specialized consultation: study of patients lost to follow-up]

[Article in French]

Pelisse M, Barasso R.

Cabinet de Dermatologie, Paris. mpelisse club-internet.fr

INTRODUCTION: The treatment of condylomata acuminata relies on prolonged management, partly related to the need for repeated applications with regard to destructive therapeutic measures and the clinical supervision because of the high prevalence of relapses. This implies that patients are ready to consult their doctor at regular intervals during a relatively prolonged period of time. We wanted to assess the patients lost to follow-up in a population of patients exhibiting anogenital warts together with the factors associated with the loss to follow-up. PATIENTS AND METHODS: This was a prospective observational study conducted in France among dermatologists and gynecologists between May and December 2000. The physicians were free to prescribe the treatment of their choice. The social data of the patients and the classical characteristics of the condylomata acuminata were assessed. A patient was considered as lost to follow-up when he/she no longer came in for the consultation assessing the treatment. The data of the patients lost to follow-up were compared to those of the other patients. RESULTS: Two hundred ninety-seven cases, with 57 p. 100 men, were included during the study period. The mean age of the patients was of 33.8 +/- 11.4 years, with 43 p. 100 of patients aged under 30. In 40 p. 100 of cases, the lesions had existed for more than 3 months and were symptomatic in 30 p. 100 of cases. At the end of the study, 28.3 p. 100 of patients were considered as lost to follow-up. With multivariate analysis, the loss to follow-up appeared related to the patients' age (more frequent, the younger the patient; p<0.04) and not to the fixing of a precise appointment at the end of treatment (p<0.001). The asymptomatic nature of the lesions, recognized as a loss to follow-up risk factor in univariate analysis, was at the limit of significance in multivariate analysis (p=0.06). DISCUSSION: Clinicians should be particularly attentive with young and asymptomatic patients that they treat for condylomata acuminata, and attempt to reduce the rate of lost to follow-up and improve the quality of their management.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14724533&dopt=Abstract genital wart


genital warts
Anogenital human papillomavirus in non-abused preschool children.

Myhre AK, Dalen A, Berntzen K, Bratlid D.

Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway. arne.k.myhre medisin.ntnu.no

AIM: To estimate the prevalence of human papillomavirus (HPV) in anogenital samples from children selected for non-abuse. METHODS: A letter of invitation was sent to 2731 girls and 1042 boys, all of them aged 5 or 6 y. Inclusion was based on self-selection, whereby parents who did not suspect any occurrence of sexual abuse of their child gave informed consent to participate. Several mechanisms were undertaken to exclude abused children. A complete examination was done of each child, including anogenital examination with a colposcope and microbiological sampling from the genitals and anus. Polymerase chain reaction (PCR) using primers MY09 and MY11 was used to identify HPV, and sequencing was done on each positive amplicon. RESULTS: PCR was performed on 325 adequate specimens from 211 children enrolled. Seven samples from 5 girls were HPV-positive, making 2/161 (1.2%) of the anal and 5/164 (3.0%) of the genital specimens positive. HPV was not detected in any of the boys. In four girls strong associations with HPV 6 genotypes were found, while one girl probably had a mixed infection with HPV 6 and 16. Three girls (1.8%) had clinically detectable anogenital warts. CONCLUSION: Since our results are comparable with a prevalence reported from allegedly abused children, and higher rates have been reported from the oral cavity in healthy children, we find detection of HPV unreliable as an indicator of sexual abuse in 5-6-y-old children. The rate of anogenital warts found in our study is comparable with a rate reported in abused children.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14971797&dopt=Abstract genital wart


genital warts
Closing the feedback loop: an audit of the use of imiquimod for the treatment of genital warts.

Brady S, Wilson JD.

Department of Genitourinary Medicine, The General Infirmary at Leeds, Great George Street, Leeds LS1 3EX, UK. sophie.brady leedsth.nhs.uk

A retrospective case-note audit of 74 patients with 81 treatment episodes of anogenital warts with imiquimod from April 1999 until July 2000 was performed. The majority of patients had failed to clear their warts with other treatments, had recurrences after other treatments, or had other medical problems complicating their genital wart treatment. The overall clinically confirmed complete clearance rate was 33%. This is lower than other published data, but may be so because it includes patients with immunosuppression and difficult-to-treat warts. The complete clearance rate in immunocompetent patients was 37%. In addition, in this audit of clinical practice 17% of the patients did not return for full response to be assessed. The complete clearance rate in those who were able to tolerate treatment and who returned for follow-up was 45%. Based on the results of the audit we have extended the indications for the use of imiquimod in the clinic treatment guidelines. Patients are now offered imiquimod if six or more episodes of other treatments fail to give a good response. Earlier treatment with imiquimod is also offered to those patients with recurrent anogenital warts, and it is recommended as a first-line therapy for patients with multiple keratinized warts.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15096142&dopt=Abstract genital wart


genital warts
Patient assessment of anogenital warts and the success of treatment with home applied therapy.

Carey FM, Quah SP, Dinsmore W, Maw RD.

Department of Genito-Urinary Medicine, Royal Victoria Hospital, Grosvenor Road, Belfast BT12 6BA, UK.

Home treatment with podophyllotoxin or imiquimod are commonly prescribed therapies for anogenital warts. It is important to ascertain if patients are locating all lesions for treatment and if they know when they are clear of them. We set out to assess patients' ability to determine the number and location of their genital warts and compare their observation with that of their examining doctor or nurse. Following instruction on the use of home treatment and being given an instruction leaflet patients were reviewed in four weeks' time. One hundred and fifty-five patients enrolled in the study--31% (48) male, 69% (107) female. At initial assessment 62.5% (30) of male patients and 59.8% (64) of female patients underestimated the extent of their disease: 10.5% (5) of male patients and 10.3% (11) of female patients overestimated their disease burden with some mistaking skin tags for genital warts. At review 29.4% (5) of male patients and 44.4% (20) of female patients still underestimated the extent of their infection. Patients undertaking home treatment for warts not only need detailed instruction on its use but should be reviewed to assess the success of treatment.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15117500&dopt=Abstract genital wart