1-
ABSTRACT: Anogenital warts and mollusca
contagiosum are virally induced, benign skin tumors for which there is
no single preferable therapy. Treatments include physical and chemical
destruction, surgical removal, and biological response modifiers to
enhance the natural immune response. The choice of therapy is an art,
and depends upon patient preference, finances, number of lesions, and
lesional morphology. However, the therapy of these lesions can sometimes
be very painful and expensive, and therapy should not be worse than the
disease.2-Keywords:
Abstract
Cancer-associated
human papillomavirus (HPV) types are detected in genital warts removed
from immunosuppressed individuals more commonly than from those
occurring in otherwise healthy individuals. The prognosis of genital
warts containing cancer-associated HPV types is not known. Because it is
assumed that genital warts are benign lesions, they are usually treated
by destructive therapies without prior knowledge of histopathology. The
aim of the present study was to determine whether genital warts from
individuals with or without human immunodeficiency virus (HIV) contain
high-risk HPV types or areas of dysplasia. The study design was a
nonrandomized analysis of genital warts removed by excision biopsy from
15 HIV-infected patients and 15 HIV-negative patients. The tissue was
analyzed for HPV DNA by hybrid capture, and microscopic sections of each
biopsy were examined for areas of dysplasia. Genital warts from
HIV-infected patients contained cancer-associated (“high risk”) HPV
types in 9 of 15 cases, including 1 that contained only a high-risk
type. High-grade dysplastic abnormalities were present in 2 of the 15
lesions from this group, both of which contained high-risk HPV types.
Four genital warts removed from HIV-negative patients contained
high-risk HPV types, but none contained dysplastic abnormalities. It is
concluded that genital warts from HIV-infected patients often contain
high-risk HPV types. Such lesions may exhibit dysplastic changes. The
frequency of dysplastic changes in genital warts from HIV-infected
patients is not known. Biopsy of genital warts may be indicated prior to
additional therapy in HIV-infected patients, and surgical removal
should be considered as a preferred treatment option in these patients. J. Med. Virol. 54:69–73, 1998. © 1998 Wiley-Liss,Inc.3-Keywords:
ABSTRACT
Genital
human papillomavirus (HPV) is a common, usually transient, dermatologic
infection transmitted by genital contact that can cause a variety of
anogenital diseases, including warts (condyloma), dysplasia (cervical,
vaginal, vulvar, anal), and squamous cell carcinoma. A number of
treatment modalities are available to treat anogenital warts, both
patient- and provider-applied.
Treatment
is efficacious, but lesions can recur. Bivalent and quadrivalent
vaccines are approved to prevent HPV infection. Both are indicated to
prevent cervical cancer, while the quadrivalent vaccine is also approved
to prevent vaginal/vulvar cancers as well as genital warts in males and
females. Providers should clearly explain the natural history and
potential sequelae of HPV disease, counsel patients on prevention
strategies, and recommend vaccination as an effective method of
prevention to their patients.
4-
t
Background. Genital warts is a
common sexually transmitted disease treated by a variety of medical
specialists. Standard therapies offer symptomatic relief but cannot
ensure lasting remission. Using the clinical literature, claims
databases, and a panel of experienced practitioners, the relative
efficacy, cost, and cost effectiveness of five common treatments for
genital warts were assessed in this study.
Methods.
We reviewed the clinical literature for the following genital wart
therapies: podofilox, podophyllin, trichloroacetic acid, cryotherapy,
and laser therapy, focusing on their relative efficacy. Physicians
experienced in treating genital warts defined standard treatment
protocols for men and women patients with moderate wart burdens. Using
national claims data and protocols developed by physicians, we derived
three economic models based on provider charges, third-party payments,
and a resource-based relative value scale, respectively.
Results.
The literature review demonstrated highly variable success and
recurrence rates among treatment methods and failed to show that one
treatment provides consistently superior efficacy. In the economic
models, treating women generally proved more costly than treating men
per episode of care. This was due to the need for more extensive
follow-up visits in the treatment of women. Total costs were highest for
cryotherapy and lowest for a patient-applied therapy that reduced the
need for follow-up visits.
Conclusions.
Clinicians should consider both clinical and cost issues when choosing
the appropriate treatment for patients with genital warts.5-
ABSTRACT: Warts are caused by human
papilloma viruses (HPV) and more than 80 types of HPV have been
described. Although some HPV types in the anogenital area can lead to
dysplasia and cancer, most HPV infections cause histologically benign
warts. Clinically, warts produce much morbidity, mainly due to their
resistance to most standard therapies. Although the choice of therapy
depends partly on the location of the warts, i.e., anogenital vs.
non-anogenital, most treatments in the past have been anti-wart but not
antiviral. Therefore, removal of the wart was often followed by a
recurrence in a few weeks due to sub-clinical or latent HPV infections
surrounding the wart. Such non-antiviral therapies included a variety of
acids, podophyllin, podophyllotoxin, chemotherapeutic agents,
retinoids, topical sensitizers, a spectrum of surgical techniques, and
cryotherapy. Two drugs approved for anogenital warts have antiviral and
immunomodulatory activity, interferon and imiquimod, although imiquimod
is much more convenient to use. While neither of these antiviral agents
is approved for non-anogenital warts, they do appear to have efficacy in
these warts when used as adjunctive therapy. Experimental therapies for
warts are currently under study and include topical cidofovir and both
prophylactic and therapeutic HPV vaccines.6-
It
was formerly axiomatic that all clinical types of wart were caused by
the same virus, the morphology of a wart being conditioned only by the
type of epidermis which this virus infected. This was the ‘unitary’
theory, which was formulated after a series of experimental transfers of
warts from one part of the body to another had been performed in the
early years of this century. According to the ‘unitary’ theory, genital
warts were a special kind of skin wart, modified in appearance by the
thinness of the genital epithelium and by the warm moist conditions
prevailing in the area. Sexual contact was regarded as only one of many
ways in which the wart virus could reach the genitals. Feelings ran high
on the natural history of genital warts, and after Barrett, Silbar
& McGinley (1954) suggested that they should be regarded as a
venereal disease, one outraged physician went so far as to circularise
336 dermato-venereologists in various countries to ask whether this view
was correct, and 94% answered‘no'. Recent advances have necessitated a
revision of these opinions.7-
ABSTRACT: Anogenital warts and mollusca
contagiosum are virally induced, benign skin tumors for which there is
no single preferable therapy. Treatments include physical and chemical
destruction, surgical removal, and biological response modifiers to
enhance the natural immune response. The choice of therapy is an art,
and depends upon patient preference, finances, number of lesions, and
lesional morphology. However, the therapy of these lesions can sometimes
be very painful and expensive, and therapy should not be worse than the
disease.2-Keywords:
- human papillomavirus;
- dysplasia;
- genital warts
Abstract
Cancer-associated
human papillomavirus (HPV) types are detected in genital warts removed
from immunosuppressed individuals more commonly than from those
occurring in otherwise healthy individuals. The prognosis of genital
warts containing cancer-associated HPV types is not known. Because it is
assumed that genital warts are benign lesions, they are usually treated
by destructive therapies without prior knowledge of histopathology. The
aim of the present study was to determine whether genital warts from
individuals with or without human immunodeficiency virus (HIV) contain
high-risk HPV types or areas of dysplasia. The study design was a
nonrandomized analysis of genital warts removed by excision biopsy from
15 HIV-infected patients and 15 HIV-negative patients. The tissue was
analyzed for HPV DNA by hybrid capture, and microscopic sections of each
biopsy were examined for areas of dysplasia. Genital warts from
HIV-infected patients contained cancer-associated (“high risk”) HPV
types in 9 of 15 cases, including 1 that contained only a high-risk
type. High-grade dysplastic abnormalities were present in 2 of the 15
lesions from this group, both of which contained high-risk HPV types.
Four genital warts removed from HIV-negative patients contained
high-risk HPV types, but none contained dysplastic abnormalities. It is
concluded that genital warts from HIV-infected patients often contain
high-risk HPV types. Such lesions may exhibit dysplastic changes. The
frequency of dysplastic changes in genital warts from HIV-infected
patients is not known. Biopsy of genital warts may be indicated prior to
additional therapy in HIV-infected patients, and surgical removal
should be considered as a preferred treatment option in these patients. J. Med. Virol. 54:69–73, 1998. © 1998 Wiley-Liss,Inc.3-Keywords:
- anogenital;
- condyloma;
- cervical cancer;
- genital warts;
- HPV;
- human papillomavirus;
- vaccine
ABSTRACT
Genital
human papillomavirus (HPV) is a common, usually transient, dermatologic
infection transmitted by genital contact that can cause a variety of
anogenital diseases, including warts (condyloma), dysplasia (cervical,
vaginal, vulvar, anal), and squamous cell carcinoma. A number of
treatment modalities are available to treat anogenital warts, both
patient- and provider-applied.
Treatment
is efficacious, but lesions can recur. Bivalent and quadrivalent
vaccines are approved to prevent HPV infection. Both are indicated to
prevent cervical cancer, while the quadrivalent vaccine is also approved
to prevent vaginal/vulvar cancers as well as genital warts in males and
females. Providers should clearly explain the natural history and
potential sequelae of HPV disease, counsel patients on prevention
strategies, and recommend vaccination as an effective method of
prevention to their patients.
4-
t
Background. Genital warts is a
common sexually transmitted disease treated by a variety of medical
specialists. Standard therapies offer symptomatic relief but cannot
ensure lasting remission. Using the clinical literature, claims
databases, and a panel of experienced practitioners, the relative
efficacy, cost, and cost effectiveness of five common treatments for
genital warts were assessed in this study.
Methods.
We reviewed the clinical literature for the following genital wart
therapies: podofilox, podophyllin, trichloroacetic acid, cryotherapy,
and laser therapy, focusing on their relative efficacy. Physicians
experienced in treating genital warts defined standard treatment
protocols for men and women patients with moderate wart burdens. Using
national claims data and protocols developed by physicians, we derived
three economic models based on provider charges, third-party payments,
and a resource-based relative value scale, respectively.
Results.
The literature review demonstrated highly variable success and
recurrence rates among treatment methods and failed to show that one
treatment provides consistently superior efficacy. In the economic
models, treating women generally proved more costly than treating men
per episode of care. This was due to the need for more extensive
follow-up visits in the treatment of women. Total costs were highest for
cryotherapy and lowest for a patient-applied therapy that reduced the
need for follow-up visits.
Conclusions.
Clinicians should consider both clinical and cost issues when choosing
the appropriate treatment for patients with genital warts.5-
ABSTRACT: Warts are caused by human
papilloma viruses (HPV) and more than 80 types of HPV have been
described. Although some HPV types in the anogenital area can lead to
dysplasia and cancer, most HPV infections cause histologically benign
warts. Clinically, warts produce much morbidity, mainly due to their
resistance to most standard therapies. Although the choice of therapy
depends partly on the location of the warts, i.e., anogenital vs.
non-anogenital, most treatments in the past have been anti-wart but not
antiviral. Therefore, removal of the wart was often followed by a
recurrence in a few weeks due to sub-clinical or latent HPV infections
surrounding the wart. Such non-antiviral therapies included a variety of
acids, podophyllin, podophyllotoxin, chemotherapeutic agents,
retinoids, topical sensitizers, a spectrum of surgical techniques, and
cryotherapy. Two drugs approved for anogenital warts have antiviral and
immunomodulatory activity, interferon and imiquimod, although imiquimod
is much more convenient to use. While neither of these antiviral agents
is approved for non-anogenital warts, they do appear to have efficacy in
these warts when used as adjunctive therapy. Experimental therapies for
warts are currently under study and include topical cidofovir and both
prophylactic and therapeutic HPV vaccines.6-
It
was formerly axiomatic that all clinical types of wart were caused by
the same virus, the morphology of a wart being conditioned only by the
type of epidermis which this virus infected. This was the ‘unitary’
theory, which was formulated after a series of experimental transfers of
warts from one part of the body to another had been performed in the
early years of this century. According to the ‘unitary’ theory, genital
warts were a special kind of skin wart, modified in appearance by the
thinness of the genital epithelium and by the warm moist conditions
prevailing in the area. Sexual contact was regarded as only one of many
ways in which the wart virus could reach the genitals. Feelings ran high
on the natural history of genital warts, and after Barrett, Silbar
& McGinley (1954) suggested that they should be regarded as a
venereal disease, one outraged physician went so far as to circularise
336 dermato-venereologists in various countries to ask whether this view
was correct, and 94% answered‘no'. Recent advances have necessitated a
revision of these opinions.7-
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| ملخص | Human papillomavirus (HPV) infection of the genital tract is one of the most common sexually transmitted diseases (STDs), and a subset of genital tract HPVs are etiologically associated with cervical cancer. The prevalence of HPV infection is highest among adolescents and young adults. This study was undertaken to explore first year college students’ knowledge about HPVs and to determine whether there were gender differences in this knowledge. An anonymous survey was distributed to all first year students at a private university. The results were analyzed by gender. We found that 96.2% of males and 95.4% of females had heard of genital warts, although only 4.2% of males and 11.6% of females knew that HPV caused genital warts. Although there was a greater awareness of genital warts than HPV in this population, students were uncertain about modes of transmission of both genital warts and HPVs, and unclear about the importance of HPV infection relative to other STDs. For both men and women (87% and 87.4%, respectively), health education classes were the major source of information about STDs. We conclude that health education should be reconceptualized to incorporate a better understanding of STDs, including HPV infection, by engaging adolescents and young adults in exploring the biological and social context of STDs, their public health importance, strategies for prevention, and the uncertainty of our scientific knowledge. |
