genital warts
Genital warts.

Oriel JD.

Human papillomaviruses have not been propagated in tissue culture, so they cannot be studied by the procedures of classical virology. Recently, DNA hydridization techniques and restriction enzyme analysis have revealed that multiple strains of human papillomaviruses exist. It is now accepted that genital warts are a sexually transmitted disease; other routes of infection are possible, but unusual. An association between maternal warts during pregnancy and the development of vulval warts and laryngeal papillomatosis in infants and young children has been shown. The epidemiology of anal warts in homosexual men is not well understood. The flat condyloma, visible on colposcopy, is a human papillomavirus-containing lesion with a wart-like histology. It is a common condition which in the past may have been mistaken for dysplasia. Flat condylomas may regress spontaneously, or develop into condylomata acuminata. A link between these lesions and some cases of cervical carcinoma has been suggested.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=6277022&dopt=Abstract genital wart


genital warts
Anogenital warts in children: sexual abuse or unintentional contamination?

de Jesus LE, Cirne Neto OL, Monteiro do Nascimento LM, Costa Araujo R, Agostinho Baptista A.

Hospital Universitario Antonio Pedro, Universidade Federal Fluminense, Niteroi, RJ, 24033-900, Brasil.

Anogenital warts (AGW) were recently recognized in children, and their significance as an index of childhood sexual abuse is controversial. We report our transdisciplinary approach (including a pediatric surgeon, psychologist, social worker, ethics expert, and occasionally law enforcement agents) and its results in a group of 17 children with AGW treated at the public pediatric referral hospital in Rio de Janeiro, Brazil, during a 3-year period (1996-1999). All children were treated by electrocauterization of the warts, tested for other STDs, and submitted to perineal examination under anesthesia. Families received psycho-social counseling as necessary and cases were referred to child protection and law enforcement agents when indicated according to Brazilian legislation. We identified a high incidence of sexual abuse (8 children, 5/7 > 5 years old), with 3 patients inconclusive as to sexual abuse and 7 cases of perinatal transmission (5/8 < 4 years old). We conclude that AGW are indeed a strong sign of suspicion for sexual abuse in children, especially but not exclusively > 5 years of age. However, strong support and a transdisciplinary approach to the children and their families is necessary to identify it.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11784899&dopt=Abstract genital wart


genital warts
Genital warts and cervical neoplasia: an epidemiological study.

Franceschi S, Doll R, Gallwey J, La Vecchia C, Peto R, Spriggs AI.

Cervical carcinoma and cervical intra-epithelial neoplasia (CIN) are likely to be associated with all sexually transmitted diseases (STDs). To help discover which (if any) of the recognised STDs might actually cause these conditions, a key question is whether one particular such association is much stronger than the others. The present study is therefore only of women newly attending an STD clinic, and compares the prevalences of cytological abnormalities of the cervix among 415 women attending with genital warts, 135 with genital herpes, and 458 with trichomoniasis or gonorrhoea. Significantly more genital wart patients (8.1%) than trichomoniasis or gonorrhoea patients (1.9%) showed dyskaryotic changes (adjusted relative risk (RR) = 5.8 with 95% limits 2.5-13.5) at, or a few months before, first attendance, while no excess whatever was seen in women with genital herpes. Moreover, half the women had a subsequent smear (at an average of 3-4 years after first attendance) and, although the diagnosis at first attendance was not related to the onset rate of dyskaryotic changes observed in these subsequent smears, it was related to the onset rate of grade III cervical intra-epithelial neoplasia (CIN III), which was found in 7 previous genital wart patients, in 2 previous trichomonas patients, but in 0 previous genital herpes patients. Thus, our findings suggest that herpes is not directly relevant to dyskaryotic change, but that one or more of the human papilloma viruses that cause genital warts may be.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=6688952&dopt=Abstract genital wart


genital warts
Capture ElISA and in vitro cell binding assay for the detection of antibodies to human papillomavirus type 6b virus-like particles in patients with anogenital warts.

Peng S, Qi Y, Christensen N, Hengst K, Kennedy L, Frazer IH, Tindle RW.

Centre for Immunology and Cancer Research, University of Queensland, Princess Alexandra Hospital, Woolloongabba, Australia.

To investigate human papillomavirus (HPV) virus-like particle (VLP)-specific antibody responses among anogenital warts patients, a VLP-based capture ELISA was established. Twenty-six percent (35/134) of control subjects and 50.0% (39/78) of patients with current anogenital warts showed IgG seropositivity to HPV 6b VLPs. HPV 6b VLP-specific antibody responses recognised native VLPs only, and had no cross-reaction with HPV type 16 VLPs. No differences in reactivity were observed between L1 and L1 + L2 VLPs, suggesting that L2 contributes little to the total immunogenicity of the papillomavirus virion. A VLP-cell binding assay was also established. Some sera from patients with anogenital warts specifically inhibited VLP binding to the surface of epithelial cells, suggesting that these antibodies might be functionally neutralising. These data show that serological responses to HPV 6b VLPs were induced among some but not all patients with anogenital warts, and give a proportional estimate of infection in the community.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10643018&dopt=Abstract genital wart


genital warts
A retrospective analysis of costs and patterns of treatment for external genital warts in The Netherlands.

van der Meijden WI, Notowicz A, Blog FB, Langley PC.

Erasmus University Hospital, Rotterdam, The Netherlands.

BACKGROUND: External genital warts (EGWs) are one of the most common sexually transmitted infections, but little is known about the treatment patterns or resources used in the management of this condition. OBJECTIVE: The purpose of this retrospective analysis is to examine the patterns of treatment, resource utilization, and costs for EGWs in 3 dermatology clinics in the Netherlands. METHODS: A total of 530 completed episodes of care for EGWs were analyzed to identify patterns of treatment and resources used. Costs of care were calculated based on 4 cost components for each visit: labor costs, material costs, indirect costs, and extra costs. RESULTS: Across the 3 sites, men required an average of 5.78 clinic visits to achieve a completed episode of care; women required an average of 6.52 visits. The distribution of visits is highly skewed, however, with a median of 4.56 visits for men and 5.55 for women. More than 80% of patients were initially treated with monotherapy. Podophyllin and cryotherapy were the principal choices for initial therapy. The mean cost, in euros, of completing an episode of care was 221.34 euro for men and 292.29 euro for women. The cost per completed or successful episode of care was 395.92 euro for men and 485.05 euro for women. The distribution of costs was also skewed, with a relatively small group of patients accounting for a considerable proportion of overall costs. Although only 31.4% of male patients recorded > or = 6 visits for a completed episode of care, this group accounted for 57.3% of the total costs of treatment for male patients. Among female patients, 43.4% had > or = 6 visits, which accounted for 73.9% of the total costs of care for female patients. Costs also varied markedly by therapy sequence chosen. Patients who remained on their initial monotherapy or combination therapy had the lowest costs; the extent to which patients switched therapies substantially affected overall costs. For those patients initially treated with podophyllin, the mean total costs of treatment, taking into account the proportion who required a change in therapy, were 204.84 euro for men and 386.38 euro for women. For those initially treated with cryotherapy, the mean cost of treatment was 193.60 euro for men and 169.23 euro for women. CONCLUSION: Current treatment options for EGWs do not appear to minimize resource utilization or help achieve complete episodes of care at the lowest possile cost.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11833831&dopt=Abstract genital wart