genital warts
Hand-genital transmission of genital warts? An analysis of prevalence data.

Fairley CK, Gay NJ, Forbes A, Abramson M, Garland SM.

Department of Social and Preventive Medicine, Monash University Alfred Hospital, Victoria, Australia.

The role of hand-genital transmission in the aetiology of genital warts is unclear. However this route is suggested by a number of observations including the relatively high proportion of genital warts in children which contain HPV types 1-4 (15% for children and 2% for adults). We compared two transmission models; one which assumes that hand-genital transmission occurs and one that it does not, and determined the conditions in which each model can reflect the available prevalence data. Hand-genital transmission provides a simple explanation of the observed differences in the proportions of genital warts containing HPV types 1-4 and 6/11 in children and adults. If hand-genital transmission does not occur, the observed difference could only be explained by an eightfold greater probability of transmission to children of types 1-4 than types 6/11, or by an eightfold greater duration of infection with types 1-4. Our findings provide support for the view that genital warts may be transmitted by hand-genital contact.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7641831&dopt=Abstract genital wart


genital warts
A study of the prevalence of male intrameatal warts using meatoscopy in a genitourinary medicine department.

Nathan PM, Thompson VC, Sharmacharja G, Hawkswell J, Fogarty B.

Department of Genitourinary Medicine, Doncaster Royal Infirmary, UK.

A cross-sectional study is undertaken to determine the prevalence of male intrameatal and distal urethral warts, using meatoscopy. A group of 169 patients presenting for anogenital warts and a group of 74 unselected patients attending the Department for a variety of reasons during the study period, were examined. Twenty-one patients (13.5%) out of 155 patients with anogenital or related warts had external warts at the meatus. Of these 21 cases, 12 (57.1%) had further extension of their warts into the distal urethra. Fifteen other cases of intrameatal and distal urethral warts were detected in the absence of external warts at the meatus. Twenty-three cases out of 107 males with genital warts (21.5%) were found to have intrameatal or distal urethral warts, thus reflecting the common occurrence of these lesions. A highly significant association between the presence of intrameatal/distal urethral warts and the presence of male genital warts was found (P = 0.003). One hundred and fifty-three repeat meatoscopic examinations were carried out, 6 weeks after their first examination. Three new cases of intrameatal/distal urethral warts were found. Intrameatal and distal urethral warts occurred from a depth of 5 mm to 25 mm. One hundred and eighty-three female partners of the study patients were examined. An association between the presence of intrameatal/distal urethral warts and female anogenital warts was found (P = 0.028). No corroborating association between the presence of male and female anogenital warts was found (P = 0.47). This observation may have a bearing on disease transmission and control. The detection of intrameatal/distal urethral warts will be important in achieving successful treatment of male anogenital warts.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7647121&dopt=Abstract genital wart


genital warts
Relation of p53 tumor suppressor protein expression to human papillomavirus (HPV) DNA and to cellular atypia in male genital warts and in premalignant lesions.

Ranki A, Lassus J, Niemi KM.

Department of Dermatology and Venereal Diseases, University of Helsinki, Finland.

Functional disturbance of p53 tumor suppressor protein contributes to uncontrolled cell growth. Human papillomavirus (HPV) E6 oncoproteins bind to wild-type p53 and abrogate its function. Our objective was to elucidate the relation of aberrant p53 protein expression to HPV DNA and cellular atypia in male genital warts and premalignant lesions. Immunohistochemically detectable p53 protein expression was studied in 35 male anogenital warts with low-level or no keratinocyte atypia (histologically confirmed condylomata acuminata), in 25 lesions with bowenoid papulosis (BP; carcinoma in situ) histology, and in 10 non-condyloma lesions using immunostaining with three established antibodies recognizing full-length wild-type accumulated p53 protein, or its conformational mutants. HPV DNA specific for HPV 6/11, 16/18, or 31/33/35 was identified by in situ hybridization or by polymerase chain reaction (PCR) - based amplification. Both nuclear and cytoplasmic keratinocyte immunostaining for p53 protein was detected in 41% of condylomata with no keratinocyte atypia and in 42% of condylomata with slight nuclear atypia or with bowenoid papulosis histology. No association of aberrant p53 expression with any specific HPV type or with HPV DNA was observed. Normal skin and some other penile dermatoses were negative for p53 immunostaining. In the follow-up biopsies of 16 BP patients, treated with CO2 laser, recurrence of atypia was seen exclusively in lesions initially positive for both HPV DNA and p53 protein. Our results show that a few cells in male genital warts even with no cellular atypia may express abnormally sequestered or loss-of-function p53 protein, and that concomitant presence of any type of HPV DNA is associated with recurrencies or progression of premalignant changes.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7653176&dopt=Abstract genital wart


genital warts
Oral cimetidine for the management of genital and perigenital warts in children.

Franco I.

Section of Pediatric Urology, Department of Urology, New York Medical College, Valhalla, New York, USA.

PURPOSE: It is believed that most warts are self-limiting and generally require little or no treatment. When numerous or almost complete infestation of the perineum, genital area and groin is encountered it can be distressing and a difficult problem to treat in children. Multiple treatments with caustic agents are sometimes necessary, and treatment of perigenital warts may require use of anesthesia for multiple procedures. Cimetidine is a histamine receptor antagonist that has been used mainly to treat peptic ulcer disease. Recently it has been reported to be useful for the treatment of mucocutaneous candidiasis, herpes simplex, herpes zoster and verruca because of its immunomodulatory effects. Several studies have been published indicating its effectiveness in the treatment of warts. MATERIALS AND METHODS: We treated 4 children with extensive condylomata acuminata of the genital and perigenital areas with high doses of cimetidine in an attempt to eradicate the condyloma and avoid recurrence in 2 and as primary treatment in 2. All patients were treated with 30 to 40 mg./kg. cimetidine daily in 3 divided doses during a 3-month period. RESULTS: All patients are free of condyloma at 24 months following treatment. CONCLUSIONS: Our results show that cimetidine is useful for primary and adjunctive treatment of condyloma in young children. It also appears to be effective as first line therapy.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10958744&dopt=Abstract genital wart


genital warts
Comparison of women with cervical human papillomavirus infection and genital warts. I. Some behavioural factors and clinical findings.

Hellberg D, Borendal N, Sikstrom B, Nilsson S, Mardh PA.

WHO Collaborative Centre for STD and their Complications, Uppsala University, Sweden.

OBJECTIVE--To determine if behavioural factors, other than sexual, differ between women with cervical human papillomavirus infection (CHPI) and those with genital warts (GW). DESIGN--A structured, personal in-depth interview which included details on sexual behaviour, hygiene, gynaecological complaints, and demographical characteristics and a gynaecological examination which included vaginal culture and human papillomavirus (HPV) typing with Southern blot. SUBJECTS--Women (n = 972) who had attended two family planning clinics and one youth clinic for contraceptive advice. RESULTS--Out of this female population 66 (6.8%) were found to have CHPI, 39 (4.0%) had genital warts (GW), and 30 (3.1%) women reported genital warts within the last two years. The women with CHPI had had significantly less education, were more often immigrants, had a vaginal flora change more frequently and were more often smokers than the women with GW. The women with GW reported lower abdominal pain significantly more often, had a leucocyte dominance in the vaginal secretion more often and favoured bathing in a bathtub more than the women with CHPI. After adjustment for sexual behavioural factors the significant difference between the two groups for bathing in a bathtub and lower abdominal pain remained. CONCLUSION--Although both conditions are caused by HPV, there are behavioural differences between women with CHPI and women with CA.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7744420&dopt=Abstract genital wart