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PubMed1998

Treatment of recurrent penile condylomata acuminata with external application and intraurethral instillation of bacillus Calmette-Guerin.

PURPOSE: Condylomata acuminata are caused by human papillomavirus infection. Despite numerous treatment modalities these patients often demonstrate recurrent disease. We report initial experience with bacillus Calmette-Guerin (BCG) therapy in patients not responding to standard treatment. MATERIALS AND METHODS: Between October 1994 and March 1997, 6 men with rapidly recurrent external and intraurethral condylomata acuminata underwent BCG therapy after initial laser treatment. External application and intraurethral instillation of BCG were performed 6 times in weekly intervals. Followup studies included examination and endoscopic inspection of the urethra and bladder. RESULTS: Of the patients 3 completed 1 course of BCG and had no relapse of condylomata acuminata, 2 underwent a second course of BCG and 1 had relapse, and 1 had relapse after discontinuing therapy due to penile edema. The annual recurrence rate decreased from 3.2 before to 0.75 after BCG therapy (p < 0.05, test of equality of 2 percentages). CONCLUSIONS: Immunotherapy with BCG is accepted treatment for superficial transitional cell carcinoma. The BCG induced immune response appears to reduce the recurrence rate in patients with condylomata acuminata.

Adjuvants, Immunologic↗

PubMed1991

Use of human papillomavirus type 11 virions in an ELISA to detect specific antibodies in humans with condylomata acuminata.

Human papillomavirus types 6 and 11 (HPV-6 and HPV-11) are the major aetiological agents of condylomata acuminata. Serological studies of this disease have been difficult to perform and interpret because native, type-specific antigens have not been available. In particular, since these viruses have not been propagated in vitro and sufficient quantities of virions are not present in lesions, virus particles have been difficult to obtain. In the present study, we used HPV-11 particles, obtained from human tumours produced in athymic mice, as antigen in an ELISA to compare antibody responses between 46 patients with biopsyproven condylomata acuminata and 44 controls. The median [interquartile range] of the absorbance values for the condylomata acuminata and the control groups were respectively 0.324 [0.183, 1.029] and 0.118 [0.047, 0.286] (P = 0.0001). Thirty-three per cent of the absorbance values in the condylomata acuminata group were higher than any of those of the control group. Sera from patients whose biopsies contained the papillomavirus common antigen were more reactive than sera from patients whose biopsies did not contain it (P = 0.0014). This study demonstrates the presence of specific antibodies directed at native HPV-11 viral particles in the sera of patients with condylomata acuminata, and describes a test which can be used in future serological studies of this common sexually transmitted disease.

Adult↗

PubMed2003

In vivo fluorescence kinetics and photodynamic therapy in condylomata acuminata.

BACKGROUND: Topical application of 5-aminolaevulinic acid (ALA) to condylomata acuminata leads to accumulation of protoporphyrin IX (PpIX); therefore ALA-induced photodynamic therapy (ALA-PDT) appears to be a potential treatment. OBJECTIVES: To investigate in vivo the PpIX fluorescence time course after topical application of ALA in order to determine the optimal time for irradiation, and to assess the efficacy of subsequently performed ALA-PDT. METHODS: Fluorescence kinetics was studied in 12 male patients with condylomata acuminata. Confirmation of diagnosis was established with conventional histology and polymerase chain reaction. Lesions were treated with 20% ALA and irradiated at the optimal time with a dose of 70 J cm-2 or 100 J cm-2 light. An additional session with 100 J cm-2 was administered 1 week later to lesions that persisted. RESULTS: The in vivo study of fluorescence kinetics indicated that the optimal time for irradiation varied among patients from 6 to 11 h. The overall cure rate was 72.9%, 12 months after treatment. CONCLUSIONS: Topical ALA-PDT is a potentially effective treatment for condylomata acuminata.

Adult↗

PubMed1986

[Condylomata acuminata. Recent aspects of clinical signs, pathogenesis and therapy].

Condylomata acuminata and its rare variants (bowenoid papulosis and giant condylomata) are caused by human papilloma viruses (HPV), especially by HPV type 6. In spite of radical surgery, a 68-year-old woman suffering from giant condylomata acuminata of Buschke and Löwenstein on her vulva developed several local recurrences. Assuming that patients with recurring condylomata might have a defect in their cellular immunity, we examined subsets of circulating T-lymphocytes in the peripheral blood of ten patients by means of monoclonal antibodies. T-helper cells were decreased in number; the ratio of T-helper and T-suppressor cells was within the lower normal range. As to the common treatment with podophyllin, several precautions have to be considered in order to avoid local or systemic damage (i.e., irritations, contact dermatitis, vomiting, neuropathies, or fever). The use of interferon seems to be a new alternative. A 21-year-old patient, whose condylomata had been surgically removed six times but had always recurred, was treated with interferon recomb A (rA-INF). This patient has now been treated for eight weeks with 18 mill. I. E. every other day, and he did not develop any recent condylomata.

Aged↗

PubMedDate not supplied

Detection of human papillomavirus L1 protein in condylomata acuminata from various anatomical sites.

BACKGROUND AND OBJECTIVES: Though human papillomavirus (HPV) DNA can be detected in the majority of condylomata acuminata, the major capsid protein of HPV (L1 protein) can be detected in only 10% to 50% of lesions in immunohistochemical assays. GOAL OF STUDY: To evaluate the association between anatomic location of genital HPV infections and the ability to detect HPV L1 protein. METHODS: Condylomata acuminata from 49 male and 51 female patients were evaluated for L1 protein by immunohistochemistry. Thirty of these lesions were vulvar; 20 were cervical; 1 was vaginal; 45 were penile; and 4 were perianal. A quantitative analysis of L1-positive nuclei in the lesions was performed. RESULTS: L1 protein was detected in 20 (20%) of all lesions. L1 protein was detected in seven (35%) of the cervical lesions compared to nine (12%) of exophytic condylomata acuminata of males and females (P = 0.038). A statistically significant difference was noted between cervical and exophytic condylomata acuminata lesions (46.6 vs. 7.8) (P = 0.0006). No association between oral contraceptive use and L1 protein detection was found. CONCLUSIONS: The major capsid protein of HPV can be detected in condylomata acuminata of the uterine cervix more often, and in higher quantities, than in lesions of the vulva or penis. Further studies are needed to assess the effects of sex hormones and the anatomic location of the infection as they relate to transmission of HPV.

Biopsy↗

PubMed1990

[Postoperative adjuvant therapy with interferon alfa-2B following laser surgery of condylomata acuminata].

Sexually transmitted diseases caused by human papilloma viruses, such as condylomata acuminata, are increasing in incidence and are often difficult to treat because of their tendency to recur. Many reports in the literature document the usefulness of interferons topically or systemically in these diseases. A randomized study was conducted to evaluate interferon Alfa-2b (Intron A) as adjuvant therapy following CO2 laser surgery of condylomata acuminata. A low-dose regimen was administered (two courses with 1 million I.U. s.c. daily for 6 days with a 2-week interval between the courses) and had hardly any side-effects. The recurrence rate in the therapy group was significantly reduced (42% vs 81%), so routine prophylaxis of recurrence with interferons in condylomata acuminata should be discussed.

Adolescent↗

PubMed1980

Condylomata acuminata with pigmented papular lesions.

5 cases of condylomata acuminata with pigmented papular lesions were examined. By light microscopy, the pigmented papules showed benign basaloid cell proliferation and papillomatosis with only a few vacuolizations of the keratinocytes. Although mitotic figures increased in number, cellular atypia and disorderly arrangement were rarely observed. Electron microscopy revealed only benign epidermal cell proliferation. From these findings, the pigmented papules may be regarded as an initial stage or a forme fruste of condylomata acuminata. These papules are clinically very similar to the lesions of so-called multicentric pigmented Bowen's disease and the relationships between these two conditions are discussed.

Adult↗

PubMed1987

Cervical cryotherapy for condylomata acuminata during pregnancy.

Twenty-eight patients were treated by cryotherapy for cervical condylomata acuminata during the second and third trimesters of pregnancy. Most required two treatment sessions before the condylomata resolved. All women responded favorably and none had residual disease at six weeks' postpartum. No neonate was affected. Cryotherapy for cervical condylomata acuminata had no identifiable adverse effect on pregnancy. There were no cases of rupture of membranes or labor starting as a consequence of treatment. There was no scarring to the cervix and deliveries were normal. We conclude that cryotherapy for cervical condylomata acuminata is an effective and safe procedure during the last two-thirds of pregnancy.

Adult↗

PubMed2001

Condylomata acuminata (genital warts): patient demographics and treating physicians.

BACKGROUND: Condylomata acuminata (genital warts), caused by the human papillomavirus, are common and sexually transmitted. However, the use of healthcare services for condylomata has never been characterized from a national probability sample study. GOAL: To understand better the demographics of patients seen by physicians for this disorder. STUDY DESIGN: Data from office visits for warts, both condylomata and noncondylomatous types, were obtained from the 1994 to 1998 National Ambulatory Medical Care Survey. RESULTS: The age distribution of those treated for condylomata peaked in 20- to 39-year-olds, with more than 70% of patients in this age category. A younger and wider age distribution was seen in patients with noncondylomatous warts. Women accounted for 67% of the population seen for condylomata, whereas a more equal number of women and men were seen for noncondylomatous warts. Per capita healthcare use for condylomata was equal between blacks and whites, and whites had almost five times more per capita healthcare use than blacks for noncondylomatous warts. Obstetrician/gynecologists were the most commonly consulted physicians for condylomata. Per capita condylomata visits per physician were highest for obstetrician/gynecologists, dermatologists, and urologists, and lower for all other physicians. CONCLUSIONS: The difference in age distribution between condylomata and noncondylomatous visits likely results from differing modes of transmission and age at first sexual contact. Females are more likely than males to use health care for condylomata, which may be attributable to increased prevalence, differences in treatment efficacy, differences in the gender frequency of genital health screenings, or psychosocial causes. Healthcare use for condylomata appears equal between blacks and whites. Patients with condylomata acuminata were most often seen by obstetrician/gynecologists, whereas patients with noncondylomatous warts most often consulted dermatologists. The fact that per capita condylomata visits per physician were highest for obstetrician/gynecologists, dermatologists, and urologists may imply that specialists in these fields have expertise in treating these patients.

Adolescent↗

PubMed2000

[Assay and L1 gene sequence analysis of human papillomavirus type 6 and 11 in condylomata acuminata].

OBJECTIVE: To determinate the prevalence of HPV type 6, 11 in condylomata acuminata, and analyze the sequence of L1 gene and its deduced L1 protein. METHODS: PCR was used to amplify DNA sequences between E6 and E7 of HPV type 6 and 11. The PCR products were identified by the fragment length cleaved with restriction enzyme RsaI. L1 genes were amplified with high fidelity Taq, and cloned DNA sequences were detected by the dideoxynucleotide method. RESULTS: In 34 examples of condylomata acuminata, HPV11 was found in 25 examples (73.5%), HPV6 in 15(44.1%), including HPV6 + HPV11 in 6(17.6%). In comparison with the prototypes there were 7-8 point mutations in HPV11 L1 gene and 3 in HPV6L1 gene. L1 encoded protein changes showed up only in 1-3 amino acids in the former cases. CONCLUSION: Most of patients tested with condylomata acuminata are mainly infected by HPV11, the rest of them by HPV6 or by co-infection of two mixex types. Sequence analysis of L1 genes indicated that mutations were found in both HPV6 and 11, whereas deduced amino acid mutations in L1 protein were limited in HPV11 only.

Adult↗

PubMed1989

[Adjuvant 5-fluorouracil lacquer administration for reducing the rate of recurrence of condylomata acuminata following laser surgery treatment].

In the recent past we have observed HPV-induced condylomata acuminata with increasing frequency. Providing 60-80% complete remission the laser coagulation is primary in the treatment of condylomata acuminata. However, the generalized mucosal infection with subclinical condylomata acuminata leads to a recurrence in 30-70% of cases. Therefore, we combined laser treatment with adjuvant 5-fluorouracil painting. In a prospective study, 137 patients with a total of 225 treatments were randomly allocated to three groups (laser/laser + 5-FU ointment 5%/Laser + 5-FU 2% painting). After laser treatment only, relapse occurred in 29% of cases, after laser treatment plus 5-fluorouracil 5% ointment in 32%, and after laser treatment and adjuvant 5-fluorouracil 2% painting in only 4%. A topical prophylactic treatment is beneficial because of the multifocal action of HPV. The adjuvant 5-FU painting after laser surgery has been shown to be superior to other treatment modalities with a recurrence rate of only 4%.

Adult↗

PubMed1990

[Adjuvant systemic interferon alpha-2B treatment in treatment refractory anogenital Condylomata acuminata].

Despite different treatment modalities, resistance to treatment is observed in 4-15% of patients with anogenital condylomata acuminata. A total of 16 patients with resistant condylomata acuminata or extended infection affecting an area of more than 6 cm2 were treated with a prospectively defined therapy entailing laser treatment and adjuvant systemic interferon-alpha 2B (3 x 1 MU/day for 7 days). Of the 16 patients, 13 (81%) were in complete remission after an 8-month period of follow up. The typical side-effects of interferon were attenuated in 80% of cases by simultaneous paracetamol (3 x 500 mg/day). The combination of laser treatment and adjuvant systemic interferon-alpha 2B seems to be highly effective in the treatment of resistant or extended condylomata acuminata. At present, these results are being tested for significance in a prospectively randomized study.

Adult↗

PubMed1989

[Cancer of the anus arising within condylomata acuminata. Apropos of 2 cases. Review of the literature].

Two cases of squamous carcinoma of the anus developing from condylomata acuminata are reported. The general characteristics of condylomata acuminata are reviewed: viral etiology due to HPV virus, histological appearance and role in the the genesis of certain cancers. The association of condylomata acuminata and cancer of the anus is more particularly studied in a review of the literature: etiology, anatomoclinical aspects, treatment and current state of knowledge concerning the oncogenic role of HPV virus at this site.

Adult↗

PubMed1982

Laser versus electrical cautery in the treatment of condylomata acuminata of the anus.

Thirty-eight patients with condylomata acuminata of the anus, requiring surgical therapy, had the left half of the anus treated with conventional electrical cautery, while the right half of the anus was treated with the carbon dioxide laser at the same time. Patients were questioned about the amount of pain on both sides and were studied for evidence of recurrence. The laser was associated with either more pain or the same amount of pain when compared with that of electrical cautery. Recurrences were first seen more often on the laser side. The cost of the laser treatment to the patient was higher by $50. it is concluded that the laser offers no advantage and may, indeed, be less effective than the conventional electrical cautery in the treatment of condylomata acuminata of the anus.

Anus Neoplasms↗

PubMed1998

Risk factors for incident and recurrent condylomata acuminata among women. A population-based study.

BACKGROUND: Condylomata acuminata is one of the most common sexually transmitted diseases (STDs) diagnosed in the United States, yet relatively little research has been conducted on the determinants of this disease in well-defined populations. GOAL: To determine the exposures that predispose a woman to the development of condylomata acuminata or genital warts. STUDY DESIGN: A population-based case-control study was conducted among enrollees of Group Health Cooperative of Puget Sound. Patients (94 women with incident and 55 women with recurrent condyloma) were diagnosed between April 1, 1987 and September 30, 1991. Control subjects were 133 women without a history of genital warts. An in-person interview was conducted to collect information on subject characteristics, exposures, and on all episodes of genital warts. RESULTS: Women with five or more partners within the 5 years before reference date were over seven times more likely to have incident condyloma (relative risk [RR], 7.5; 95% confidence interval [CI], 3.1-18.1) and over 12 times more likely to have recurrent condyloma (RR, 12.8; 95% CI, 4.2-38.9) compared with women with only one sexual partner during this time period. An increased risk of incident condyloma was also associated with a history of any STD (RR, 2.6; 95% CI, 1.1-5.8), a history of oral herpes (RR, 2.2; 95% CI, 1.1-4.4), and a history of allergies (RR, 2.0 95% CI, 1.0-3.8). Our data did not support a strong association between risk of condyloma and smoking or recent use of oral contraceptives. CONCLUSION: Our results suggest that risk of condyloma is primarily related to sexual behavior. We did not observe a strong association between risk of condyloma and many of the exposures considered to be potential cofactors for anogenital cancers associated with other types of human papillomaviruses.

Adolescent↗

PubMed1994

Detection of multiple human papillomavirus types in condylomata acuminata from immunosuppressed patients.

Using the hybrid capture method, condylomata acuminata from healthy patients (controls) and patients with altered cell-mediated immunity were analyzed for multiple human papillomavirus (HPV) DNA: 82.9% and 38.0% of lesions from 41 controls and 21 patients, respectively, were HPV DNA-positive only with probes for low-risk HPV types (P = .00035). Using probes for both low- and high-risk HPV types, 16.3% and 52.3% of lesions from 43 controls and 21 patients, respectively, were positive for both probes (P = .0038). Evidence of multiple HPV types was also found by Southern blot and in situ hybridization studies. The mean HPV copy number detected by either probe did not differ significantly among patient groups. Using sensitive techniques, such as hybrid capture, multiple HPV types, including those associated with genital malignancy, can be detected in condylomata acuminata. Serial biopsies demonstrate the dynamic nature of genital HPV infection and that changes in the predominant HPV types may be reflected in tissue pathology.

Biopsy↗

PubMed1988

Human papillomavirus DNA in condylomata acuminata from Japanese males.

We examined condylomata acuminata from Japanese males for the presence of human papillomavirus (HPV) genomes by Southern blot hybridization. HPV 6/11-related DNA was found in 91% (32/35) of the condylomata. HPV 6a DNA was found in 40% (14/35), HPV 6c DNA in 6% (2/35), and HPV 11a DNA in 37% (13/35). HPV 6-related DNA, which had an unusual PstI-cleavage pattern, was detected in one sample. Types and subtypes of HPV DNA in the samples studied (HPV 6a, 6c, and HPV 11a DNA) were not correlated with the patients' ages nor outcomes of the disease. HPV 16 DNA was not detected in any condyloma acuminatum.

Adult↗

PubMed1986

[Alpha interferon in condylomata acuminata and juvenile diabetes mellitus].

Persistent condylomata acuminata in a 21-year-old patient with diabetes mellitus were treated with highly purified interferon-alpha (IFN-alpha) obtained by recombinant DNA technology. Daily dose was 1.5 X 10(6) IU, given subcutaneously. Already during treatment the condylomata regressed. Two weeks after the end of therapy, i.e. after a total dose of 10.5 X 10(6) IU IFN-alpha, all condylomata had completely receded. Blood glucose levels remained constant with concomitant insulin therapy. Toxic side-effects or antibodies to IFN-alpha were not observed.

Adult↗