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Evaluation of non-radioactive temperature gradient SSCP analysis and of temperature gradient gel electrophoresis for the detection of HPV 6-variants in condylomata acuminata and Buschke-Loewenstein tumours.

A modified non-radioactive single strand conformation polymorphism analysis incorporating a temperature gradient (TG-SSCP) and temperature gradient gel electrophoresis (TGGE) were evaluated for the detection of human papillomavirus type 6 (HPV 6)-variants in 41 condylomata acuminata and 5 Buschke-Loewenstein tumours. TG-SSCP and TGGE analysed part of the transforming ORF E6 of HPV 6 spanning nucleotides 10 to 495. TG-SSCP distinguished between 8 HPV 6-variants whereas TGGE demonstrated 6 different DNA-species. HPV 6-strains found in Buschke-Loewenstein tumours did not vary in the analysed portion of the E6 ORF as compared to ordinary condylomata acuminata. TG-SSCP and TGGE further showed absence of double infection with different HPV 6-strains in the analysed samples. Our results demonstrated that both methods may be successfully used for the detection of different strains of microbiological agents, although TG-SSCP seemed to provide easier execution and to confer a higher degree of flexibility than TGGE.

Condylomata Acuminata↗

Invasive giant condylomata acuminata: a case report.

We report on a patient with invasive giant condylomata acuminata (Buschke-Loewenstein tumor). This tumor is an exophytic human papilloma viral lesion with downward growth without histological malignancy. The aggressive progression of this lesion requires early surgical excision with clear margins. Delay in recognition of this tumor can otherwise lead to a fatal clinical course.

Adult↗

Condylomata acuminata of the bladder.

A case of invasion of the bladder by condylomata acuminata in a kidney-transplanted patient under immunosuppressive treatment is presented. Conservative treatment with application of podophyllin and transurethral resection was carried out. There were numerous recurrences, but so far it has been possible to control the disease, in contrast to the four cases found in the literature, which have all resulted in total cystectomy.

Adolescent↗

Histopathologic changes in condylomata acuminata after application of podophyllum.

The histologic changes of podophyllin-treated condylomata acuminata were studied at 24-hour, 48-hour, and 7-day intervals. The 24-hour specimens had scattered individual atypical cells, whereas 48-hour specimens demonstrated small focal areas of atypia. Seven-day specimens exhibited very mild atypia of cells. All treated specimens had inflammation-necrosis ranging from scattered inflammatory cells to degeneration of the squamous epithelium.

Administration, Topical↗

Changes in serum lipids in patients with condylomata acuminata treated with interferon alfa-n1 (Wellferon).

Nine men with refractory condylomata acuminata were treated with intramuscular interferon alfa-n1 and the effect on their serum lipid levels was noted. Comparison of lipid panels before and after interferon revealed that all nine patients had an increase (median 62 mg/dl, p = 0.004) in their triglyceride level and a decrease (median 21 mg/dl, p = 0.004) in high-density lipoprotein cholesterol levels. Total cholesterol levels tended to decrease but the change was not statistically significant. This effect on serum lipids should be considered when interferon alfa-n1 is used in the treatment of genital warts.

Cholesterol↗

Management of vulvar condylomata acuminata with argon laser.

One hundred and one female patients with vulvar condylomata acuminata were treated with the argon laser. Most were managed under regional or general anesthesia because of the large size and extent of the warts. Ten patients were lost to follow-up after the first session. Of 91 other patients, 78 (86%) were free of lesions on follow-up examinations after one or two treatments. The 13 other patients had recurrent lesions: seven patients underwent three laser sessions; four required four sessions, and 2 others required five and six sessions, respectively. These results were comparable with those achieved with the carbon dioxide laser.

Adolescent↗

[Therapeutic possibilities in condylomata acuminata].

This article deals with surgical as well as with conservative treatment of condylomata acuminata, e.g. 10% podophyllin in liquid paraffin. Both methods are equally successful and may be combined in special cases.

Combined Modality Therapy↗

The treatment of perianal and anal condylomata acuminata: a new operative technique.

Seventy-five patients have been treated for condylomata acuminata by means of a new operative approach which results in the preservation of the maximum amount of normal tissue. The technique has proved to be simple to perform, it has minimal complications and causes the patient little in the way of discomfort. Three out of 4 patients treated have no significant recurrent wart formation.

Adult↗

Laser treatment of condylomata acuminata in pregnancy.

A young patient in the third trimester of pregnancy had massive condylomata acuminata, successfully treated with the carbon dioxide laser. Lack of postoperative pain and of vulvar edema, minimal blood loss and easy vaginal delivery at term were significant factors in this case.

Adolescent↗

Laser therapy of genital condylomata acuminata.

The effectiveness of the carbon dioxide laser was evaluated in the treatment of penile, anorectal, and urethral condylomata acuminata in 40 men. All but six cases of urethral condylomata were prior conventional treatment failures. Postlaser follow-up ranged between one and two years, with an average of 16 months. No patients were lost to follow-up. Postlaser recurrence rates were 7.5%. No postoperative complications occurred in this series. Carbon dioxide laser is highly successful for treating persistent and/or extensive urogenital and anal condylomata in the male patient.

Adult↗

Treatment of advanced condylomata acuminata with semi-purified and purified human leukocyte interferon.

Twelve patients with advanced condylomata acuminata were treated by systemic human leukocyte interferon (IFN) therapy. Semi-purified and purified preparations were both able to affect condylomatous growth. Treatment of the patients at various periods of their disease resulted in one complete remission, 6 partial remissions, 4 minimal responses while one case showed progressive disease. Side-effects were unexpectedly common in these advanced patients and 4 of them had to stop IFN treatment.

Adult↗

An open, comparative, study of the efficacy of 0.5% podophyllotoxin lotion and 25% podophyllotoxin solution in the treatment of condylomata acuminata in males and females.

The efficacy and safety of topical treatment for external condylomata acuminata with either self-applied 0.5% podophyllotoxin (PT) or hospital-applied 25% podophyllin (PODO) solution was compared in 138 males and 67 females in an open multicentre study. After one week of treatment, wart clearance was observed in 53% of males and 37% of females in the PT group as compared with 19% of males and 19% of females in the PODO group (P < 0.001 in males; P = 0.13 in females). At 5 weeks after commencing treatment, clearance of warts had been achieved in 86% males and 72% females in the PT group as compared with 78% of males and 62% females in the PODO group (P = 0.08 in males; P = 0.14 in females). Treatment had cleared 81% of 180 treated sites in all PT recipients as compared with 61% of 95 treated sites in all PODO recipients (P < 0.001). The increased speed of action of PT was associated with an increased incidence of symptoms and signs of inflammation at treatment sites in both males and females (P < 0.001). These were generally mild, did not interfere with continuing treatment, and were more frequent in those patients whose warts were eradicated most rapidly. Home-based treatment with 0.5% podophyllotoxin lotion in appropriately instructed patients of either sex is superior in efficacy to outpatient applied 25% podophyllin and has the potential to reduce the number of hospital attendances required in genital wart eradication.

Administration, Topical↗

[Condylomata acuminata in children].

During the period 1.1.1967 to 31.12.1986, a total of 34 children with condylomata acuminata were treated in the County Hospitals in Copenhagen. Nineteen of these were treated during the last five years of the period. A retrospective study revealed that 12 of the children were under the age of two years when the condylomata appeared. In eight of these, one or both of the parents had condylomata at the time of the child's birth suggesting that infection of the child may have occurred during delivery. Among the remaining 22 children, a possible source of infection was revealed in only one case. In the children, condylomata were much more frequently localized perianally or anally than in adults. There was no evidence of sexual abuse in any of the children but systematic investigation with this in mind was not undertaken. The finding of condylomata in children raises the suspicion of sexual abuse but does not prove this. Investigation and treatment should, as a rule, be undertaken by a multidisciplinary team preferably in a paediatric department.

Adolescent↗

Topical cidofovir (HPMPC) is an effective adjuvant to surgical treatment of anogenital condylomata acuminata.

PURPOSE: Human papilloma virus infections of the anogenital region are very common and cause condylomata acuminata; cervical, penile, vulvar, or perianal intraepithelial neoplasia; and more rarely, invasive cancer. The currently available therapies often result in painful, extensive, slow-healing ulcerations and frequent early relapses. This study was aimed at determining the efficacy of topical application of the antiviral agent cidofovir at 1 percent. METHODS: Twenty patients treated with coagulations were compared with 27 patients treated with cidofovir. Lesions refractory to cidofovir were cleared up with additional coagulations. The number of patients previously treated for condylomata did not differ between the two groups. Significantly more patients treated with cidofovir, however, had an impaired immune status (37 percent) compared with the patients treated with coagulations (5 percent). RESULTS: Cidofovir alone cured the lesions in 32 percent of the patients and induced partial regression in 60 percent. However, in smokers, complete resolution of the condylomata occurred only in 16.6 percent compared with 66 percent of nonsmokers (P = 0.03). The number of coagulation sessions was much lower (P < 0.0005) in the cidofovir treated group (1 +/- 0.8 vs. 2.9 +/- 2). Furthermore, the relapse rate was significantly lower in the cidofovir group (3.7 vs. 55). All recurrences in the electrocoagulation group occurred within four months of confirmed lesion clearance. Topical applications of cidofovir 1 percent were well tolerated. Thirty-three percent of the patients reported only mild pain caused by erosive dermatitis. In contrast, coagulations caused painful ulcerations that necessitated the use of analgesics in all patients treated this way. CONCLUSIONS: Topical applications of cidofovir, an antiviral compound with activity against human papilloma virus, is effective in the majority of patients with perianal condylomata and is a valuable adjuvant to surgical treatment of these lesions.

Administration, Topical↗