genital warts
A morphologic, pathologic, and virologic study of anogenital warts in men.

Rock B, Shah KV, Farmer ER.

Department of Dermatology, Johns Hopkins Medical Institutions, Baltimore, MD.

BACKGROUND AND DESIGN--Infection with human papillomavirus (HPV) in the anogenital region is associated with benign papillomas (condyloma acuminatum), subtle verrucous changes, subclinical infection, and malignant lesions. Although both men and women are affected, much of the investigation has been directed toward women in the study of cervical and vulvar carcinoma. The current investigation focuses on HPV infection in men. This study was undertaken to correlate the clinical spectrum of disease in our population of male patients with histopathologic features, immunoperoxidase staining for viral capsid antigen, and viral typing. Genital lesions from 26 patients were examined and tested prospectively over a 1-year period. RESULTS--The 26 lesions examined demonstrated variable morphologic features with regard to location, size, surface characteristics, and color. Histopathologic features were consistent with the diagnosis of venereal warts, but not necessarily diagnostic. Three of five standard histopathologic criteria were present in only 71% of the specimens. Despite the morphologic variability and the indeterminant histopathologic findings, 20 of 23 lesions positive for the genital tract HPV types tested contained HPV types 6 and/or 11. CONCLUSIONS--We conclude that the morphologic appearance of anogenital warts does not necessarily correlate with HPV type. Histopathologic study is helpful in excluding other diagnoses but may be indeterminant in the diagnosis of venereal warts. All men with anogenital warts should be counseled, treated, and undergo follow-up regardless of HPV type.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1316102&dopt=Abstract genital wart


genital warts
Human papillomavirus DNA detection in primary anogenital warts and cervical low-grade intraepithelial neoplasias in adults by in situ hybridization.

Handley JM, Maw RD, Lawther H, Horner T, Bharucha H, Dinsmore WW.

Department of Genitourinary Medicine, Royal Victoria Hospital, Belfast, Northern Ireland.

In this study, 58 consecutive patients with primary anogenital warts were selected from patients attending a genitourinary clinic. Patients were grouped on the basis of clinical lesion site, i.e. patients with genital warts only, patients with perianal or anal canal warts only, and patients with concurrent perianal and genital warts. Of these patients, 38% of the men (12/31) and 33.3% of the women (9/27) had other anogenital infections, such as nonspecific urethritis (NSU) or nonspecific genital infection, which were the most common. Of the patients who had perianal warts, 37% of the men (7/19) and 25% of the women (4/16) also had warts in the anal canal. Of the women who had anogenital warts, 63% (17/27) had concurrent subclinical low-grade cervical intraepithelial neoplasia (CIN) lesions. Human papilloma virus (HPV) DNA (either 6 or 11, 16 or 18, or 31 or 33 or 35) was detected in 53.3% (40/75) of the anogenital wart biopsy samples, and in 35.2% (6/17) of the low-grade CIN lesions. HPV types 6 or 11 were the most common types in anogenital warts (45.3%); and in CIN lesions HPV types 6 or 11 and 16 or 18 were found with equal frequency (17.6% each). There were no significant differences in HPV types between patients with genital warts and patients with perianal and anal canal warts. Anogenital infection with HPV is multicentric; external anogenital warts and subclinical CIN lesions often exist concurrently. The low prevalence of HPV DNA detected in anogenital warts and CIN biopsy samples may be due to insensitivity of the in situ hybridization technique used in this study.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1329237&dopt=Abstract genital wart


genital warts
Human papillomavirus, genital warts, Pap smears, and cervical cancer: knowledge and beliefs of adolescent and adult women.

Mays RM, Zimet GD, Winston Y, Kee R, Dickes J, Su L.

Schools of Nursing and Medicine, Indiana University, 1111 Middle Drive, NU 433, Indianapolis, IN 46202, USA. rmays iupui.edu

The high prevalence of genital warts, human papillomavirus (HPV), and the virus's cancer-causing potential warrant that women be well informed about these conditions and measures to prevent them. The purpose of this descriptive study was to examine women's knowledge and beliefs about genital warts, HPV, cervical cancer, and Pap tests. We interviewed 40 women recruited from health clinics in Chicago (20 adults) and Indianapolis (20 adolescents) about these issues. Audiotapes of the interviews were transcribed and analyzed. Among both the adults and adolescents there was a good deal of misunderstanding about symptoms associated with genital warts, about the purpose of Pap smears, and about the association of genital HPV with abnormal Pap smears and cervical cancer. The gaps in women's understanding about this potentially deadly infection suggest the need for more comprehensive education about preventing genital HPV, the infection's possible sequelae, and the significance of Pap screening for cancer detection and prevention.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11261107&dopt=Abstract genital wart


genital warts
Chromosomal changes in Chinese hamster AA8 cells caused by podophyllin, a common treatment for genital warts.

Ferguson LR, Pearson A.

Cancer Research Laboratory, University of Auckland Medical School, New Zealand.

Podophyllin, a plant derivative of variable composition, is used widely within New Zealand as a treatment for genital warts. One local source of podophyllin has been tested for ability to cause mutagenic effects in Salmonella typhimurium as well as for effects on chromosomes of Chinese hamster AA8 cells. Although only weakly mutagenic in one strain of Salmonella, podophyllin caused structural aberrations as well as changes in chromosome number in the Chinese hamster cells. The range of aberrations was similar to those caused by teniposide, a close structural relative of the major component, which was used as a positive control in the Chinese hamster cell experiments. A literature review revealed that podophyllin was shown to cause changes of chromosome number in the mouse cervix in vivo, although aberrations were not studied. Patients treated with podophyllin will usually possess one form of the papilloma virus, and this itself may have some oncogenic potential. We suggest that podophyllin could potentiate these effects and question its continued widespread use.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1373833&dopt=Abstract genital wart


genital warts
Multiple partners and partner choice as risk factors for sexually transmitted disease among female college students.

Joffe GP, Foxman B, Schmidt AJ, Farris KB, Carter RJ, Neumann S, Tolo KA, Walters AM.

Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor 48109-2029.

Multiple sexual partners and partner choice are believed to increase the risk of sexually transmitted disease (STD), but these behaviors had not previously been assessed outside of clinical populations. In this study, a cross-sectional survey among single, white, female students in their senior year of college was conducted to measure the association between behavioral risk factors and the acquisition of self-reported STDs during college. The usable response rate was 47.2% (n = 467). The combined prevalence of chlamydial infection, gonorrhea, genital herpes, human papillomavirus (HPV) infection, syphilis, and trichomoniasis during a 3.5-year period was 11.7%. There was a strong association between number of sexual partners and having an STD: those women with 5 or more sexual partners were 8 times more likely to report having an STD than those with only 1 partner, even after adjusting for age at first intercourse (odds ratio = 8.1; 95% confidence interval = 1.99, 32.64). The prevalence of a history of STDs increased with more causal partner choice and earlier age at first intercourse, but neither factor was independently associated with a history of STDs. Of the respondents, 23% always used condoms. Future research should focus on identifying ways of effectively changing high-risk sexual behavior.

PIP: In 1990, researchers analyzed data on 467 19-22 year old white female seniors at the University of Michigan to examine partner choice and other behavioral risk factors in relation to sexually transmitted diseases (STDs). 369 (79%) had had sexual intercourse. 43 (11.7%) had at least 1 STD while at the university. The most frequently reported STDs were chlamydia infection (6.3%) and genital warts (5.2%). Other STDs made up 2% of women with at least 1 STD: trichomoniasis, human papillomavirus infection, genital herpes, gonorrhea, and syphilis. Mean age at 1st intercourse stood at 17.7 years. Number of sexual partners while attending university ranged from 1 to 107 (mean 4.4). 70% had 1 partner and 33% =or5 partners. 44% had sex only within a steady relationship. 34% had sex with at least 1 casual partner and 23% with at least 1 nonsteady partner but no casual partners. 77% used condoms at least sometimes. Just 23% always used them. Students who had had an abnormal PAP smear were 8.36 times more likely to have had an STD than those without an abnormal PAP smear. The prevalence of STDs increased significantly with number of sexual partners (p.001). This was also true for chlamydia and genital warts (p.001). Prevalence of these 2 STDs rose as did the number of nonsteady and casual partners (p=.003 and p=.007, respectively). The odds ratio (OR) for women with at least 5 partners was 8.07. STD prevalence rose as the age at 1st intercourse fell (OR=2.19 for =or15 years; p=.035). The trend was similar for chlamydia (p=.002), but not so for genital warts. Even though the percentage of students who had had an STD was greatest among those with at least 1 casual partner (21.5% vs. 3.2% for only steady partners), the association was not significant. Women who always used condoms had the lowest STD prevalence (7.1%), but those who never used condoms had STDs (10.9%) less often than those who did some of the time (15.8%) or most of the time (12.3%). More research is needed to determine means to effectively change high risk sexual behavior.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1411843&dopt=Abstract genital wart