genital warts
Is oral contraceptive associated with genital warts?

Ross JD.

Department of Genitourinary Medicine, Edinburgh Royal Infirmary, UK.

OBJECTIVE: To measure the association between oral contraceptive use and the prevalence of genital warts in women. METHODS: Cross sectional case control study comparing oral contraceptive use in women with and without genital warts attending a city centre genitourinary medicine clinic controlling for recent sexual activity, the presence of other sexually transmitted infections, socio-economic class and history of pregnancy using a multivariate logistic regression model. RESULTS: After controlling for potential confounding variables women with genital warts were significantly more likely to be current users of the oral contraceptive pill (OR 1.7, 95% CI 1.3-2.2). CONCLUSION: The study suggests that women taking the oral contraceptive may be at increased risk of presenting with genital warts. Previously published papers provide some support for this hypothesis and potential biological mechanisms are discussed.

PIP: A cross-sectional case-control study suggested that oral contraceptive (OC) users may be at increased risk of genital warts. Cases included 429 women who presented to a genitourinary medicine clinic in Edinburgh, Scotland, in 1994 with a diagnosis of first episode genital warts; 418 women presenting to this clinic during the same period with no history of genital warts served as controls. A multivariate logistic regression model controlled for recent sexual activity, the presence of other sexually transmitted diseases (STDs), socioeconomic class, and pregnancy history. Current OC use was reported by 204 cases (48%) and 153 controls (37%). The odds ratio for genital warts was 1.7 (95% confidence interval, 1.3-2.2) for OC users compared to non-users. Even when controls were introduced for genital herpes (more common among controls than cases), the odds ratio remained 1.7 (95% confidence interval, 1.3-2.1). Genital warts were more common in women in the 21-25 year age group compared to older or younger women. Women with genital warts were also less likely to report having a sexual partner in the previous 3 months and were half as likely to have a concurrent STD. Recommended, to confirm the OC-genital warts association detected in this study, are large prospective trials that control for other factors that may influence the prevalence of genital warts and act as confounders for OC use.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8976847&dopt=Abstract genital wart


genital warts
The association of smoking and risk of condyloma acuminatum in women.

Feldman JG, Chirgwin K, Dehovitz JA, Minkoff H.

Department of Preventive Medicine, State University of New York, Health Science Center at Brooklyn, USA.

OBJECTIVE: To determine the relation between cigarette smoking and the incidence of genital warts in a cohort of human immunodeficiency virus (HIV)-infected women (without AIDS-defining conditions) (n = 148) and in HIV-negative women (n = 428). METHODS: Women were recruited between March 1990 and December 1993 from an urban, inner-city medical center and nearby community health centers. Woman initially free of genital warts (n = 576) were followed prospectively for up to 37 months, with an average of 14 months. RESULTS: The observed incidence of genital warts per 100 person-years was almost three times higher in smokers than in non-smokers, both in HIV-positive (13.3 versus 5.0, respectively) and HIV-negative women (1.5 versus 0.5, respectively). In a Poisson regression model adjusting for variables significantly related to genital warts, including sexual activity, current smokers were 5.2 times (95% confidence interval 1.02, 26.0) more likely to develop genital warts. The prevalence of human papillomavirus (HPV) by polymerase chain reaction at baseline examination and the incidence of other sexually transmitted diseases were similar is smokers and non-smokers. CONCLUSIONS: Our findings are compatible with the hypothesis that the rate of progression of symptomatic exophytic HPV disease is increased in smokers.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9052582&dopt=Abstract genital wart


genital warts
Comparison of risk factors for four sexually transmitted infections: results from a study of attenders at three genitourinary medicine clinics in England.

Hughes G, Catchpole M, Rogers PA, Brady AR, Kinghorn G, Mercey D, Thin N.

PHLS Communicable Disease Surveillance Centre, London. ghughes phls.nhs.uk

OBJECTIVE: To compare the risk factors for four common sexually transmitted infections (STIs) in attenders at three large urban genitourinary medicine (GUM) clinics in England. METHODS: Clinical, demographic, and behavioural data on attenders at two clinics in London and one in Sheffield were collected. Risk factors associated with first episodes of genital warts and genital herpes simplex virus (HSV), and uncomplicated gonorrhoea and chlamydia were investigated using the presence of each of these STIs as the outcome variable in separate multiple logistic regression analyses. RESULTS: Using data on the first attendance of the 18,238 patients attending the clinics in 1996, the risk of a gonorrhoea or chlamydia diagnosis was strongly associated with teenagers compared with those aged over 34, with black Caribbeans and black Africans compared with whites, and increased with the number of sexual partners. The risk of genital warts or HSV diagnosis was lowest in black Caribbeans and black Africans compared with whites and was not associated with the number of sexual partners. While genital warts were associated with younger age, odds ratios were much lower compared with those for the bacterial infections. Genital HSV diagnoses were not associated with age. CONCLUSIONS: This study of GUM clinic attenders suggests a reduction in the incidence of bacterial STIs may be achievable through targeted sexual health promotion focusing particularly on black ethnic minorities, teenagers, and those with multiple sexual partnerships. Viral STIs were less clearly associated with population subgroups and a broader population based approach to sexual health promotion may be more effective in controlling these infections.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11026880&dopt=Abstract genital wart


genital warts
Isolation and characterization of human papillomavirus type 6-specific T cells infiltrating genital warts.

Hong K, Greer CE, Ketter N, Van Nest G, Paliard X.

Department of Virology and Vaccine Development, Chiron Corporation, Emeryville, California 94608, USA.

The potential role of T cells in the control of human papillomavirus type 6 (HPV-6) infections is an appealing premise, but their actual role has been sparsely investigated. Since HPV-6 infections are confined to the epithelium, such an investigation should focus on the T cells present at the site of infection (i.e., the warts). Therefore, we isolated wart-infiltrating lymphocytes (WIL) from patients with clinically diagnosed anogenital warts. These WIL were characterized by their phenotype and their specificity for E7 and L1 proteins of HPV-6. The phenotype of WIL varied drastically from patient to patient, as determined by their expression of CD4, CD8, T-cell receptor alpha/beta chain (TCR alpha beta), and TCR gamma delta. Despite this heterogeneity in phenotype, HPV-6 E7 and/or L1-specific WIL, as determined by lymphoproliferation, could be isolated from more than 75% of the patients studied. Among all L1 peptides recognized by WIL, peptides 311-330 and 411-430 were the most consistently detected, with seven of nine patients for whom L1 peptide reactivity was observed responding to at least one of them. Moreover, the HPV-6 epitopic peptides recognized by WIL differed to some extent from those recognized by peripheral T cells.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9261360&dopt=Abstract genital wart


genital warts
Anogenital warts and condom use--a survey of information giving.

McClean HL, Hillman RJ.

Department of Genitourinary Medicine and Sexual Health, Royal Infirmary University NHS Trust, Glasgow.

OBJECTIVE: To examine information giving by genitourinary medicine (GUM) consultants about the use of condoms for patients with anogenital warts (AGW). METHOD: 228 GUM consultants in the UK and Ireland were sent a questionnaire concerning the information about condom use which they usually discuss with patients with AGW. The survey was carried out in 1994. RESULTS: There was a 46% response rate. Most consultants indicated giving information specifically with regard to the prevention of transmission of human papilloma virus (HPV), and not only in the context of safe sex. With regard to current AGW, consultants were more likely to discuss, than not to discuss, use of condoms with patients with regular sexual partners in terms of benefit, uncertain benefit, or no benefit. However, no significant difference in the likelihood of discussing, or not discussing, these issues was found for current AGW for patients without regular partners. For both groups, benefit of using condoms for current AGW was more likely to be discussed than no benefit. The majority of consultants indicated that they would discuss condom use after disappearance of AGW as being of uncertain benefit. However, many consultants also indicated discussing use of condoms for a specific period or an indefinite period of time, including many of those who specific discussing uncertain beneficial use of condoms after disappearance of AGW. The most common duration of condom use chosen for discussion was until 3 months after disappearance of AGW. CONCLUSION: GUM consultants vary in the information they give about condom use specifically to prevent transmission of HPV. This survey suggests a need for evaluation by GUM physicians of management guidelines relating to information given about condom use for AGW, including utilising the available scientific evidence as well as dealing with issues of uncertainty.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9306902&dopt=Abstract genital wart