[Cytological picture and differential cytology of condylomata acuminata].
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A 50-year-old female developed extensive condylomata acuminata in the genitoanal region over a period of 12 years. She presented with multiple, verrucous lesions involving the whole genitoanal area plus the adjacent perineum and gluteal region which made it impossible to identify the anatomical structures. Proctoscopy was normal. Serology for infectious diseases was negative. Several biopsies showed no signs of malignant transformation. Tumor excision under general anaesthesia was incomplete. Therefore, adjunctive therapy with immunomodulatory agents was administered, utilizing local application of imiquimod cream (3 x weekly) for 3 months and subcutaneous injections of interferon-alpha-2a (3 million IU 3 x weekly) for 5 months. This treatment regimen resulted in complete remission of all skin lesions with only discrete superficial scarring but no significant loss of anatomical structures or functions. During a 1-year follow-up the patient showed no sign of relapse.
Human lymphoblastoid interferon (Wellferon) was administered parenterally to two prepubertal girls as primary therapy for genital condylomata acuminata. One child probably had contracted the disease as the result of sexual molestation. Both patients experienced minimal side effects during therapy and underwent complete remission within six weeks. These cases support use of interferon as primary therapy in young patients with extensive condylomata and in those who may have contracted the disease as the result of sexual abuse.
To identify the papillomavirus types associated with condylomata acuminata in children and to evaluate their mode of transmission, we studied 32 children with anogenital warts. External condylomata were found in 12 of their mothers and in 10 of their fathers. Ten mothers, including two without external lesions, had cervical condylomata. Blot hybridization studies disclosed a genital human papillomavirus (HPV) in 14 of 27 children (HPV-6 in 12 and HPV-11 in two) and in 8 of 14 patients (HPV-6 in all). HPV-6 was found in another child by the polymerase chain reaction technique. Infection occurred most likely at birth or from nonsexual contact, but sexual abuse could not be excluded in one 11-year-old girl. Cutaneous HPV-2 was found in seven children and as yet uncharacterized papillomaviruses were found in two children. Three mothers of HPV-2-infected children had common hand warts, and two children had subungual warts. This study shows the frequent nonsexual transmission of genital papillomaviruses in children and the unexpectedly high association of children's condylomata with papillomaviruses responsible for skin warts, possibly transmitted by heteroinoculation or autoinoculation.
CO2 laser was used in the treatment of 35 women with vulvar condylomata acuminata. The mean age of the patients was 31.6 years. Isolated lesions were removed as well as extensive conglomerates involving the whole vulva and clitoris and anal region. Small condylomata were evaporated. Large ones were cut off at the base and additionally evaporated. After one laser application cure was obtained in 87.5% of cases, while after repeated procedure 93.8% of the patients were cured. The tolerance of laser procedures was good in all cases. Healing was rapid, no scars and hyperpigmentation were noted. The possibility of application of laser in pregnant women is another advantage of this method.
Within a period of 15 months, 134 patients suffering from condylomata acuminata were investigated with regard to simultaneous infection with HIV. 3 of these patients--2 showing warts in the anal region, 1 on the glans penis--were found positive for anti-HIV antibodies.
The therapeutic effectiveness of the carbon dioxide laser was evaluated in 55 women with condylomata acuminata, particularly of the vulva but also of the urethral meatus and anal region, and in 11 women with multicentric vulvar intraepidermal neoplasia. The rates of persistence and recurrence were 13% and 5% respectively for condylomata and were both 9% for intraepidermal neoplasia. Perioperative and postoperative complications occurred in 6 of the 66 cases (9%) and all were managed on an outpatient basis. Laser beam therapy is recommended as an effective and safe means of treating extensive condylomata and intraepidermal neoplasia of the external urogenital region and anal mucous membrane.
An infant was born with condylomata acuminata by caesarean section to a mother who had the same disease during the antenatal period. Prior to delivery amniocentesis done to obtain fluid for surfactant test revealed meconium stained amniotic fluid (MSAF). There was no history of premature rupture of membranes neither did the infant get into direct contact with maternal lower genital tract. The circumstances here suggest congenital (prenatal) transmission of the human papilloma virus (HPV). This is the only documented case of such transmission with fetal membranes remaining intact upto the time of delivery. The baby was noticed to have hydrocephalus at delivery. This raises a possible association between congenital transmission of HPV and this congenital anomaly. Confirmation of this however, must await more case reports and further scientific validation.
To determine the correlation between deoxyribonucleic acid (DNA) loads of human papillomavirus (HPV) and recurrence of condylomata acuminata (CA), 31 cases of primary CA and 32 cases of recurrent CA were assayed for the HPV6/11 and HPV16/18 DNA loads by real-time fluorogenic quantitative PCR. The results showed 62 of the 63 cases were HPV6/11 DNA positive (98.4%). The ranges of HPV6/11 DNA contained in primary and recurrent CA were 1.4 x 10(3)-6.7 x 10(7) and 1.2 x 10(4)-3.6 x 10(8) copies/mL, respectively. Of the 62 cases which were HPV6/11 DNA positive, seven cases were also HPV16/18 DNA positive (11.3%). The ranges of HPV16/18 DNA levels in primary and recurrent CA were 1.9 x 10(3)-1.6 x 10(4) and 1.4 x 10(5)-1.7 x 10(7) copies/mL, respectively . The HPV6/11 and HPV16/18 DNA loads in recurrent CA were statistically higher than that found in primary CA (P = 0.041 and 0.023, respectively). The DNA loads of HPV6/11 were correlated with the duration, extent of the disease and frequency of recurrence. There is a significant correlation between loads of HPV DNA and recurrence of CA. These findings have important implications for the treatment of CA.
A therapeutic trial of 5% 5-Fluoro-uracil in cream form was conducted in 40 men with condylomata acuminata unresponsive to other therapeutic measures. Sixty per cent of the condylomata on the genital and/or anal mucosa showed complete regression. The most promising results were recorded in the cases of condylomata affecting the urinary meatus. These lesions disappeared in 13 of 14 cases after an average of 3 weeks' treatment with subjectively few side effects. With regard to this type of condylomata it may be said that a great therapeutical advance has been achieved. The treatment of other condylomata involving the genital or anal mucosa often causes intolerable discomfort to the patients. The method should in these cases therefore be attempted only when the lesions prove to be refractory to other methods of treatment. In its present form the application of 5-FU cream is difficult to confine solely to the condylomata itself. The cream appears to have little or no effect on condylomata at sites other than the mucosa.
Two cases of melanocytic lesion occurring in condylomata acuminata are described. In situ hybridization with human papillomavirus (HPV) DNA probes specific for 6b, 11, 16, 18 revealed positivity with HPV6 and 11, in the non-dysplastic condylomata, and HPV 18 positivity in the case showing severe dysplasia. The HPV localization was confined to the superficial parakeratotic zones, remote from the melanocytic proliferation. The relationship between human papillomavirus and the melanocytic lesions is discussed.
The number of cases of the sexually transmitted diseases chlamydia and condylomata acuminata continues to increase. An overview of the diagnosis, treatment, possible disease sequelae, and patient education is presented as an update for the nurse practitioner.