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CO2 laser resection of giant condylomata acuminata of the penis, histologically confirmed, was successfully achieved with excellent cosmetic results in a 58-year-old man, penis amputation having previously been advised. Postoperative recurrence has been prevented, for six months so far, with low-dose, systemic administration of alpha-2b interferon.
5-Fluorouracil (5-FU) cream was compared with podophyllin 25 percent in alcohol for treating genital and urethral condylomata acuminata. The cure rate after four weeks was found to be 6 of 18 patients treated with 5-FU and 10 of 19 treated with podophyllin. By changing the treatment for those not cured, warts regressed after four weeks in four more patients in each group. Patients were followed up for four to nine months; 10 of 27 treated with 5-FU and 14 of 31 treated with podophyllin remained in remission. It is not possible to support earlier reports on the successful treatment of meatal warts using 5-FU cream. More than half of the patients given 5-FU reported side effects after 10 to 14 days' treatment, which in some cases led them to stop using the cream. Twenty-one men considered to be treatment failures or relapses were examined by urethroscopy. No intraurethral condylomata were found but three cases of warts in the fossa navicularis were doscovered; this prompted us to introduce an instrument to examine the urethral meatus and the fossa navicularis.
We have identified and mapped a number of RNA species of human papillomavirus types 6 and 11 from condylomata acuminata by the electron microscopic R-loop technique. Each of the early (E)- and late (L)-region open reading frames (ORFs) deduced from the DNA sequences was represented in one or more transcripts. In addition, RNA species that could encode the modulator of DNA replication and the repressor of transcription, functions recently identified in the genetically similar bovine papillomavirus type 1, were also detected. Some ORFs were 5' proximal in one or more transcripts, whereas others were not 5' proximal in any species, suggesting that internal initiation of translation might be required to gain access to these latter ORFs. Virtually all transcripts had their 5' ends located in the E region and were polyadenylated at one of two sites, i.e., at the end of the E region or at the end of the L region. The great majority of the RNAs were derived from the E region of the genome, with one species approximately 50 to 100 times more abundant than the others. For most of the RNAs, the 5' end mapped near nucleotide 700; minor populations had 5' ends near nucleotide 100 or 1200. By correlating our mapping data with the genomic DNA sequences as well as available RNA structures and cDNA sequences of several papillomaviruses, we predict a number of mRNA splice donor and acceptor sites and suggest that the papillomaviruses have sophisticated usage of ORFs through alternative promoters, mRNA splice sites, and polyadenylation sites.
We describe an 8-year-old male with perianal nodules and papules mistaken for condylomata acuminata by the referring physician, raising the question of sexual abuse. Examination and histology at the Department of Dermatology supported the diagnosis of perianal pseudoverrucose papules and nodules (PPPN).
Recombinant alpha-Interferon can be used in primary therapy of condylomata acuminata. In our patients we found a response rate of 53%. Besides use in primary therapy the significant low rate of recurrences is important, thus offering the possibility of adjuvant interferon therapy after primary surgical treatment, where laser-vaporisation is best applied. Possible applications for primary and secondary treatment are shown. The rate of additional infections is of great importance; besides common agents for vaginal infections we found an elevated rate of HPV 16/18 with 47%.
A study on cellularly mediated immune reaction in male patients aged between 18 and 30 years and suffering from condylomata acuminata (C.A.) revealed immune suppression particularly of the cellularly mediated system. As compared with the normal population, our study proved a significantly increased portion of hypergic patients and a clear decrease of the various groups of lymphocytes.
The first results of laser therapy in treatment of condylomata acuminata of male reproductive organs are reported. Between November 1991 and December 1993 in Department of Reproduction, Institute of Gynecology and Obstetrics, Karol Marcinkowski University School of Medical Sciences, Poznań in nine patients with condylomatous changes of reproductive organs CO2-laser therapy under colposcopic control was done. In 7 of them the healing was achieved. In two patients second laser therapy was done. All patients are still under control in Department of Reproduction and there was no recurrence diagnosed.
Between July 1986 and May 1987 23 patients suffering from anal condylomata acuminata were treated at the University Hospital of Zurich. The influence of HIV-infection on the disease is described. An almost equal frequency of recurrencies between positives and negatives was observed in a three year follow-up time. However, in positive patients recurrence was earlier and much more extensive. A two-stage procedure which sometimes is advocated in very extensive lesions gave very bad results in HIV positives. We use a radical excision by electrocoagulation on the mucosa and perianally and avoid circular necrosis in the lower anal canal only. Infectious complications are not to be feared except in patients with symptomatic HIV-infection resulting in the recommendation for a antibiotic prophylaxis in such cases.
PURPOSE: The purpose of this study was to analyze the postoperative follow-up of HIV-positive patients with anal condylomata acuminata, associating recurrence to the AIDS status. METHODS: Ninety-seven male, homosexual patients with anal condylomata were submitted to surgical treatment from August 1992 to December 1997. Specimens were obtained for histologic investigation of Ki-67 cell proliferation marker and for polymerase chain reaction to define the human papillomavirus type. The patients were advised to return weekly during the first month, and monthly up to the sixth month, to evaluate recurrence. Patients with high-grade anal intraepithelial neoplasia remain in follow-up. RESULTS: Histology revealed low-grade anal intraepithelial neoplasia in 81.44 percent of patients and high-grade lesions in 18.56 percent. The results showed that high-grade lesions were not more frequent in late-stage AIDS patients. Ki-67 expression, a cell proliferation marker, was greater in high-grade than in low-grade anal intraepithelial neoplasia, but had no association with AIDS status. Nononcogenic human papillomavirus 6 and 11 were the commonest types. Comparing papillomavirus types and anal intraepithelial grade, we noticed that both oncogenic and nononcogenic types were responsible for high-grade lesions. All patients healed and 51 (52.6 percent) had recurrence up to the sixth month. AIDS status and papillomavirus type were not associated with recurrence. However, high-grade anal intraepithelial neoplasia patients had more recurrence than those with low-grade lesions. Topical treatment failed in 20 patients (41.6 percent), and these were submitted to new surgical treatment. All of them were in the late stage of AIDS. Three who had high-grade lesions in the first operation had low-grade lesions in specimens from the second surgery. The same histologic pattern was observed in 17 patients who had low-grade lesions in warts removed in the first operation. Other patients with high-grade lesions had no recurrence or evolution to invasive carcinoma from five to ten years of follow-up. CONCLUSION: High-grade anal intraepithelial neoplasia and late-stage AIDS are risk factors for recurrence of anal condylomata.
In 30 male patients suffering from recurrent condylomata acuminata, immediate hypersensitivity parameters (total IgE, PTT and prick tests) and delayed hypersensitivity against seven recall antigens (multi test) were studied. Thirty healthy male volunteers, matched in age, were the controls. Significantly higher immediate hypersensitivity activity was shown in the patient group. Qualitative evaluation of delayed type hypersensitivity showed that controls had a positive test 16 times more often than patients. A rather homogeneous suppression of delayed type hypersensitivity was found in the patient group mainly as regards the presumably most common antigens vs. the control group. This suppression was proved to be related to disease duration. The hypothesis of a CD4+ Th-2 lymphocyte predominance in recurrent condylomata, owed to longstanding or repetitive antigenic stimulation seems to adequately explain the findings of the present study.
An immunohistological study of four men whose perianal warts were undergoing spontaneous regression was undertaken, and the results compared with those obtained from non-regressing condylomata from six men. CD4+ and CD8+ cells were noted in the stroma of each wart, but there was no clear difference in the density of the infiltrate between regressing and non-regressing warts. Natural killer cells (CD16+ and CD57+) were only noted in the stroma and epidermis of regressing warts. Possible immunological mechanisms of regression of condylomata acuminata are discussed.
Hanson, Albert W. (Communicable Disease Center, Atlanta, Ga.), and George R. Cannefax. Isolation of Borrelia refringens in pure culture from patients with condylomata acuminata. J. Bacteriol. 88:111-113. 1964.-Borrelia refringens was isolated from five of ten clinical specimens by use of a modification of the Noguchi technique. An enriched anaerobic medium is described for the cultivation of B. refringens with retention of morphological characteristics.
A case of a 16-month-old child who had had perianal condylomata acuminata since the age of 3 months, born to a 20-year-old mother who had had extensive anorectal and vulvovaginal condylomas during her pregnancy and delivery, is presented. The probable mode of transmission of the condyloma virus and its application to this case are discussed.
The presence of 7 human papillomavirus (HPV) types in genital condylomata acuminata (GCA) from 94 otherwise healthy women was detected by in situ hybridization, employing 3 different DNA probe cocktails (6/11, 16/18 and 31/35/51). HPV+ and HPV- GCA did not differ significantly as to the multiplicity and site of lesions, nor the prevalence of younger age, previous pregnancies or abortions, oral contraception, concurrent vaginal infection, aspecific PAP-test abnormalities and cutaneous hypo-anergy. Of note is that 13/18 HPV+ GCA (72.2%) lodged HPV types (16, 18, 31, 35, 51) which are more commonly related to dysplastic and neoplastic lesions of the female genital tract.
A two-part study was done to assess the value of human fibroblast interferon (IFN-beta) in the treatment of condylomata acuminata. The first part was an open study of different IFN-beta preparations, which showed that intramuscular injection was the most suitable mode of administration of IFN-beta. In the double-blind placebo section 22 patients were given injections of 2 X 10(6) units IFN-beta or placebo for 10 consecutive days and followed up for 3 months. In 9 of the 11 in the IFN-beta group and 2 in the placebo group lesions disappeared from about 5 weeks after completion of the course of injections. After 3 months 8 of the non-responders were given a course of IFN-beta and all responded to treatment. None of those who had responded has had a recurrence, the disease-free period now being 12 months. Changes in (2'-5')oligo A synthetase levels in white blood cells confirm that intramuscular injections of IFN-beta produce a systemic response.
Cervical specimens from 531 consecutive cases were reviewed to determine the frequency of cervical condylomata acuminata (CLA) and their association with cervical intraepithelial neoplasia (CIN). CLA and CIN were subclassified into three groups based on the criteria previously established in the literature. Our data indicate that CLA was present in 103 (19%) cases and that 44 (43%) of these had CIN as well. The total number of cases of CIN in this series was 146 (27%) with 44 of these (30%) having associated CLA. Of the eight CIN cases in women under 20 years of age, seven (99.6%) had associated CLA. The mean age of patients with CIN alone was 31 years; patients with CIN and CLA were younger, with a mean age of 24 years. These findings indicate that cervical CLA is a common lesion affecting young women and that there is a significant association of CLA with CIN. Women with CLA appear to be at significant risk for development of CIN.
This study seeks to evaluate two candidate regimens (5-fluorouracil and interferon) as adjuvants to optimally performed laser surgery in the treatment of condylomata acuminata. Skillful laser ablation can remove any volume of human papillomavirus-associated vulvar disease but cannot prevent reactivation of the surrounding latent viral reservoir during postoperative healing. Conversely, interferon and 5-fluorouracil are relatively ineffective as primary therapies. This study involves 118 evaluable patients: 32 in the laser-CO2 group, 34 in the 5-fluorouracil group and 52 in the interferon group. At assessment of final outcome, it was found that 43 of 52 (82%) assessable patients in the adjuvant interferon arm were controlled by a single laser ablation as compared with only 17 of 34 (50%) in the 5-fluorouracil group and 13 of 32 (40%) in the laser alone group. There was no statistical difference in outcome within the 5-fluorouracil and laser only arms. Conversely, a relatively low dose of recombinant interferon, used in combination with effective surgical deleulking, can markedly reduce the risk of postoperative recurrence.
The safety and efficacy of intralesionally administered interferon alfa-2b were assessed in 11 patients suffering from condylomata acuminata for four to 10 months for whom application of podophyllum resin had proved unsuccessful. Three warts from each patient were injected with 10(6) IU interferon alfa-2b three times a week for three weeks. Treatment was followed by a 13 week observation period. Interferon alfa-2b treatment resulted in a highly significant (p less than 0.0001) reduction in the mean size of the treated warts, which decreased from an initial size of 29 mm2 to 2-3 mm2 by week 16. In six out of the 10 patients completing the trial, both the test condylomata and adjacent control warts cleared completely; a recurrence was observed in one of these six patients. Influenza like symptoms (headache and myalgia) were the most common side effects reported, though they were mild in nature and not disabling. These results corroborate those of previous trials with interferon preparations and indicate that its antiviral activity makes it a possible treatment for this sexually transmitted disorder.