genital warts
Rate and predictors of new genital warts claims and genital warts-related healthcare utilization among privately insured patients in the United States.

Koshiol JE, Laurent SA, Pimenta JM.

Department of Epidemiology, The University of North Carolina, Chapel Hill, North Carolina 27709-3398, USA. jill.e.koshiol gsk.com

BACKGROUND: Little non-clinic-based data are available on incident genital warts rates and related healthcare use. GOAL:: The goal of this study was to describe the incidence and predictors of genital warts and associated healthcare utilization patterns among a group of privately insured patients in the United States. STUDY: Health claims were evaluated prospectively from 5,914,107 privately insured individuals. RESULTS: The rate of new genital warts claims per 100,000 person-years at risk, age-standardized to the 2001 U.S. privately insured population, increased from 117.8 in 1998 to 205.0 in 2001. The highest rates were among 20- to 29-year-olds. The majority of claims came from dermatology and obstetrics/gynecology. CONCLUSIONS: The incidence of genital warts, as measured by the rate of new claims, appears to be rising. Age associations with the rate of new genital warts claims differed by gender; these associations may be influenced by changes in health-seeking behavior, potentially driven by health awareness.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15608590&dopt=Abstract genital wart


genital warts
Application of viable bacille Calmette-Guerin topically as a potential therapeutic modality in condylomata acuminata: a placebo-controlled study.

Metawea B, El-Nashar AR, Kamel I, Kassem W, Shamloul R.

Department of Andrology and Sexually Transmitted Diseases, Cairo University Hospital, Cairo, Egypt.

OBJECTIVES: To evaluate the efficacy of topical application of viable bacille Calmette-Guerin (BCG) as a primary line of treatment in patients with condylomata acuminata. METHODS: We recruited 50 patients from the Department of Andrology and Sexually Transmitted Diseases, Cairo University Hospital complaining of genital warts. Patients were divided into two groups. Group 1 consisted of 25 patients who received BCG as a weekly topical treatment for 6 consecutive weeks. If still resistant, another intensive three-times-a-week course for 3 consecutive weeks was given. Group 2 consisted of 25 patients who received 0.9% saline solution as a placebo solution with the same procedure and follow-up as for group 1. All patients were followed up for 6 consecutive months. During the treatment course, the local response, wart state and size, and any side effects were reported. RESULTS: A complete response with the disappearance of all condylomata acuminata was achieved in 20 (80%) of the 25 patients after a maximum of six BCG applications. Three patients (12%) needed another, more extensive, course, resulting in complete clearance 3 weeks later. Only 2 patients (8%) did not achieve a full response even after application of the intensified BCG course. No response was detected in the placebo group, with no improvement during follow-up. No recurrence developed in any responder. Minimal side effects, such as transient erythema and fever, were recorded during the study. CONCLUSIONS: Topical BCG in the treatment of genital warts attained a high success rate in our study compared with the placebo solution, with insignificant side effects and no recurrence.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15708031&dopt=Abstract genital wart


genital warts
The cost effectiveness of patient-applied versus provider-administered intervention strategies for the treatment of external genital warts.

Langley PC, Tyring SK, Smith MH.

University of Colorado Health Sciences Center, Denver, USA. paul.langley UCHSC.edu

OBJECTIVE: External genital warts are one of the fastest growing sexually transmitted diseases in the United States today. Two forms of therapy are available: provider-administered and patient-applied. In the most widely used provider-administered ablative therapies, sustained clearance rates range from 18.5% to 40.1%. With nonablative, patient-applied therapies, which are typically more acceptable to patients, sustained clearance rates range from 19.6% with podofilox gel to 44.0% with imiquimod cream. The purpose of this study, given the range of therapies available, their cost differences, and clinical trial-reported differences in rates of sustained clearance, is to determine which therapy modalities, from the providers' perspective, are the most cost effective and which are likely to be the most acceptable to the patient population. STUDY DESIGN: We consider the cost effectiveness of the two patient-applied therapies as first-line therapy followed by provider-administered ablative treatment as second-line therapy. A decision-analytic model framework is developed, with data drawn both from clinical trials and from previously published studies. RESULTS: When considering a two-stage therapy model, with an average sustained clearance rate of 30% assumed for provider-administered ablative therapies, estimated costs per sustained cleared patient are $1265 for patients initially treated with imiquimod and $1304 for patients initially treated with podofilox gel. CONCLUSIONS: Initial treatment with imiquimod is the preferred intervention option as it yields a 39% greater sustained clearance rate than podofilox gel while being 3% less costly per successful outcome.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10345969&dopt=Abstract genital wart


genital warts
Detection of human papillomavirus types 6 and 11 in pubic and perianal hair from patients with genital warts.

Boxman IL, Hogewoning A, Mulder LH, Bouwes Bavinck JN, ter Schegget J.

Department of Virology, Academic Medical Center, 1105 AZ, Amsterdam, The Netherlands. i.l.boxman amc.uva.nl

Genital human papillomavirus (HPV) types 6 and 11 are of clinical importance due to their role in the development of anogenital warts. A pilot study was performed to investigate whether DNAs from HPV types 6 and 11 are present in hairs plucked from the pubic and perianal regions and eyebrows of patients with genital warts at present and patients with a recent history of genital warts. Genital HPV DNA was detected in 9 of 25 (36%) pubic hair samples and in 11 of 22 (50%) perianal hair samples by the CPI/CPIIg PCR. After sequencing of 17 of 20 samples, HPV type 6 or 11 was detected in 6 of 25 (24%) hair samples from the pubis and 8 of 22 (36%) hair samples from the perianal region. These types were not detected in plucked eyebrow hairs. In contrast, the HPV types associated with epidermodysplasia verruciformis were detected in similar proportions (62%) in both samples of pubic and eyebrow hairs. Moreover, HPV type 6 and 11 DNAs were detected in pubic hairs plucked from two patients who had been successfully treated and who did not show any lesion at the time of hair collection; this finding is an argument that HPV DNA may persist in this region. The presence of genital HPV types in plucked pubic and perianal hair suggests that there is an endogenous reservoir for HPV which may play a role in the recurrences of genital warts.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10364596&dopt=Abstract genital wart


genital warts
The immunology of genital human papilloma virus infection.

Stanley M.

Department of Pathology, University of Cambridge, Tennis Court Road, Cambridge CB2 1QP, England.

This paper reports a presentation by Margaret Stanley, Reader in Epithelial Biology, at the University of Cambridge, in which she reviews the evidence to date regarding the immunology of human papilloma virus (HPV) infection in genital warts. In this she explains that investigations into the immunology of genital wart infections indicate that the replication cycle of papilloma viruses is tightly linked to keratinocyte differentiation - a strategy for immune evasion. While the papilloma virus infects primitive basal cells, viral replication and viral assembly are confined to differentiating superficial epithelial cells. Viral replication and release are confined to cells destined for death and are not associated with inflammation. Such findings suggest that the immune system is ignorant or indifferent to the infection. Evidence from regressing genital warts in humans and animal models suggests that HPV is a cell-mediated immune response of the Th1 type offering a strategy for immunotherapy in benign disease. This is supported by evidence from trials with immunomodulatory agents. While strategies to elicit cytotoxic responses are required for malignant HPV associated lesions, the problems of immune evasion associated with these approaches should not be underestimated. Present optimal therapeutic strategies for genital human papilloma viruses infection would therefore appear to require the induction of a virus specific immune response, either by immunomodulatory agents and/or immunisation with the relevant viral antigens.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10387957&dopt=Abstract genital wart