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PubMed1981

[Condylomata acuminata].

Condylomata acuminata are benign epitheliomas which are caused by the human papilloma virus. 8 subgroups (variants) of the virus are known up to now. Condylomata acuminata are infectious, the virus being transferred by direct contact with a lesion. Condylomata acuminata are found more often in males than in females and never occur in children prior to the age of two years. The peak incidence is between 19 and 22 years of age. Greatly proliferating condylomata acuminata (type Buschke-Löwenstein) may lead to malignant degeneration. There exists a broad spectrum of topical therapeutic modalities: cytotoxic substances such as podophyllin (10 to 25%), colchicine (8%), 5-fluorouracil (1 to 5%), cryotherapy (solid carbon dioxyde or liquid nitrogen), surgical treatment (excochleation, electrocautery or laser beam. Vaccination therapy may prove successful in certain cases in the future.

Adult↗
PubMed2006

Cancer risk among patients with condylomata acuminata.

Condylomata acuminata have been shown to increase the risk of anogenital cancers. However, previous studies have been of limited sample size and/or short follow-up duration, which prevent precise estimates of long-term excess risk, especially for specific cancer sites. We estimated the risk of specific cancers in a large cohort of hospitalized patients with condylomata acuminata, as recorded in the Swedish Inpatient Register between 1965 and 1999. Altogether, 10,971 patients (1,685 men and 9,286 women) were followed through 1999 for a median of 13 years. The standardized incidence ratio (SIR)--the ratio of the observed number of cancers to the number expected on the basis of the incidence in the Swedish population at large--was used as a measure of relative risk. After excluding the first-year of follow-up, we observed 43 cases of anogenital cancer in women, and 7 cases in men. Risks were elevated for cancers of the vulva (N = 13, SIR = 10.2, 95% confidence interval (CI) = 5.4-17.4), vagina (N = 4, SIR = 12.0, 95% CI = 3.3-30.7) and penis (N = 5, SIR = 21.9, 95% CI = 7.1-51.2). There was a moderate excess risk of cervical cancer in situ (N = 259, SIR = 1.9, 95% CI = 1.7-2.1), but not invasive cervical cancer. Excess risks of esophageal, buccal cavity, nonmelanoma skin, lung and bladder cancers, and Hodgkin and non-Hodgkin lymphoma, were also observed in both men and women. In conclusion, condylomata acuminata are strongly associated with increased risk of cancers of the vulva, vagina, penis and anus, as well as some nonanogenital malignancies, but not invasive cervical cancer.

Adult↗
PubMed1994

[Laser applications in condylomata acuminata].

Condylomata acuminata are benign epidermal proliferations caused by human papillomavirus (HPV). Recent epidemiological data have shown that HPV infection is the most common sexually transmitted disease. Some HPV types are considered to be potentially oncogenic. Therefore, effective examinations and treatment of both sexual partners are important in all cases. The CO2 laser and the Nd:-YAG laser have gained widespread acceptance in the treatment of HPV efflorescences. CO2 lasers are characterized by surface absorption; the Nd:-YAG laser effect depends on volume absorption; depth of coagulation can be controlled by laser power, spot size and exposure time. Both of these fundamentally different laser effects lead to excellent cosmetic results and high cure rates. Our follow-up examinations revealed recurrences in 22%.

Condylomata Acuminata↗
PubMed1991

A comparison of interferon alfa-2a and podophyllin in the treatment of primary condylomata acuminata. The Condylomata International Collaborative Study Group.

OBJECTIVES: to compare the response to treatment and recurrence rate of condylomata accuminata using subcutaneous injection of interferon alfa 2a 1.5 million units three times weekly for four weeks, or podophyllin resin 25% applied to lesions twice weekly for up to six weeks. DESIGN: Randomised open study. SETTING: Multicentre European study in genitourinary medicine, dermatovenereology, and gynaecology departments. PATIENTS: 87 males and 67 females with condylomata acuminata for less than six months and no history of previous treatment. MAIN OUTCOME MEASURES: Complete clearance of lesions and evidence of recurrence at three months and nine months after treatment commenced. RESULTS: A complete response was achieved at three months in 15 of 64 (23%) in the interferon treated group, and 31 of 69 (45%) in the podophyllin treated group (p = 0.003). At nine months 10 of 13 patients in the interferon group and 22 of 30 patients in the podophyllin group remained completely clear of lesions.

Administration, Topical↗
PubMed1994

Treatment of urethral condylomata acuminata or flat condylomata with interferon-alpha 2a.

The effectiveness of intraurethral 5-fluorouracil and systemic administration of interferon-alpha 2a in the therapy of condylomata acuminata or flat condylomata of the urethra is assessed. From March 1986 to September 1991, 1,372 male sexual partners of women with condylomata acuminata, flat condylomata or cervical intraepithelial neoplasia underwent urethroscopy and brush cytological examination of the urethra. Of these men 305 (22.23%) had intraepithelial human papillomavirus (confirmed cytologically) and 284 were treated. The best treatment modalities, regardless of the type of lesion, were the combinations of 5-fluorouracil plus high (95.34%) and low (70.58%) dose interferon-alpha 2a. Interferon-alpha 2a can be used as first line treatment with 5-fluorouracil cream in patients with intraurethral condylomata acuminata or flat condylomata.

Condylomata Acuminata↗
PubMed1980

Carbon dioxide laser treatment for condylomata acuminata venereal infections.

Condylomata acuminata virus accounts for a significant number of venereal infections in the western world and constitutes a major public health problem. Unfortunately, conventional therapeutic measures have given inconsistent and largely unsuccessful results for the elimination of genital warts. A 3.5-year experience with 110 women using the carbon dioxide (CO2) laser for evaporation of viral warts is presented. Six patients (5.5%) developed recurrent lesions and were retreated. Several patients were staged for 2 or 3 treatments because of extensive condylomata; this occurred especially during pregnancy and other altered states of immunity. The principal advantages of CO2 laser therapy are precision, which results in sparing of normal tissue; probable elimination of the infective agent; and rapid healing without scar formation. Sixty-three patients had atypical cytology associated with condylomata acuminata; this finding suggests an association with lower genital tract neoplasia.

Adolescent↗
PubMed1994

Perianal condylomata acuminata.

Perianal condylomata, a result of clinical infection with human papillomavirus, are an increasing problem. The warts lead to bleeding, itching, and discomfort in the anal region and also may be associated with anal canal neoplasia. Treatment options are numerous and include chemical caustic agents, surgical ablative methods, and immunotherapy. A high rate of recurrence is encountered despite the best of efforts.

Anus Diseases↗
PubMedDate not supplied

[Incidence and management of condylomata acuminata by French general physicians].

OBJECTIVES: Condylomata acuminata (or genital warts) are sexually transmitted diseases caused by human papillomavirus. Until now, there has been no available epidemiologic data about this disease in France. We conducted a prospective study among French general practitioners (GPs) to estimate the incidence of consultations for external condylomata acuminata in general practice. We also assessed the management of patients with external condylomata acuminata by French GP's. DESIGN: A panel of French general practitioners, members of the Sentinel network, had to fill-in prospectively a questionnaire for each patient with condylomata acuminata diagnosed between July and November 2000. RESULTS: The annual number of consultations for external condylomata acuminata with French GP's was estimated at 23,000 (CI (95 p. 100) 21,000-25,000) including 15,000 new cases (CI (95 p. 100) 13,000-17,000). Taking into account the estimations we made at the same time in office-based private dermatologists, we estimated the annual incidence of external condylomata acuminata in France at 107/100 000 inhabitants. The management of patients with external condylomata acuminata by French GP's was in accordance with the European guidelines in 54 to 78 p. 100 of cases. French GP's mostly prescribed chemical treatment. DISCUSSION: A proportion of cases of condylomata acuminata may have not been diagnosed. Similarly, some lesions may have been wrongly diagnosed as condylomata acuminata, but these proportions of false positive and false negative remain unknown. The incidence of external condylomata acuminata in France is similar to those estimated in others developed countries.

Adjuvants, Immunologic↗
PubMed1992

Initial experience with combined interferon-alpha 2B and carbon dioxide laser for the treatment of condylomata acuminata.

The incidence of condylomata acuminata, a common sexually transmitted disease caused by certain types of human papillomaviruses, is increasing rapidly and treatment regimens presently are not consistently effective. One of the more popular and effective modes of treatment has been laser therapy. Because of the relatively high recurrence rate of condylomata acuminata with laser treatment alone and because laser treatment in some patients with confluent acetowhite lesions would render cosmetically unacceptable results in the entire area were treated, we believed that it was reasonable to use intralesional pretreatment. We present our preliminary data on 14 consecutive patients with the clinical diagnosis of condylomata acuminata who were treated with the combination of carbon dioxide laser and intralesional interferon-alpha 2B. We found the treatment regimen to be effective in decreasing the recurrence rate compared to laser treatment alone and it was well tolerated with only transient side effects in a minority of patients. We are encouraged by our result and have recently begun a randomized double-blind prospective study to provide more conclusive information regarding this treatment combination.

Adolescent↗
PubMed1989

Condylomata acuminata (venereal warts)

Condylomata acuminata (venereal warts) is a sexually transmitted disease which has increased markedly in both adults and children during the past 15 years. The human papilloma virus is notoriously difficult to treat and often requires multiple office visits utilizing a variety of treatment modalities. Enhancing patient compliance through an increased understanding of the infection, its transmission, pathogenesis, comfort measures and evaluation of the patient's reaction to the diagnosis is essential. Despite the fact that the majority of cases can be managed within an office setting, the nurse practitioner needs to be aware of situations requiring specialist referral. The patient will need tremendous support during treatment and in regard to future health care needs.

Condylomata Acuminata↗
PubMed1999

Detection of multiple human papillomavirus types in Condylomata acuminata lesions from otherwise healthy and immunosuppressed patients.

Condylomata acuminata, or genital warts, are proliferative lesions of genital epithelium caused by human papillomavirus (HPV) infection. HPV types 6 and 11 are most often detected in these lesions. Genital lesions consistent with exophytic condylomata acuminata were removed by excision biopsy from 65 patients, 41 of whom were otherwise healthy individuals (control group) and 24 of whom had conditions known to cause immunosuppression. Histologically, the majority of the lesions were typical condylomata acuminata. Three lesions removed from immunosuppressed individuals also contained foci of moderate to severe dysplasia (intraepithelial neoplasia grade II/III). A recently developed PCR and reverse blot strip assay was used to determine the specific HPV types present in the genital lesions. With a set of oligonucleotide primers based on the same primer binding regions used for the MY09 and MY11 primer pair, this PCR assay detects the presence of 27 HPV types known to infect the genital tract. All but two condylomata acuminata contained either HPV type 6 or 11. The predominant type in the lesions from control patients was HPV 6, while lesions from immunosuppressed types most often contained HPV 11. Condylomata acuminata from immunosuppressed patients contained significantly more overall HPV types than lesions from the control group. HPV types associated with an increased risk of dysplasia (high-risk types) were detected in 42 (64.6%) of the total of 65 specimens; 18 (43.9%) specimens were detected in the 41 otherwise healthy individuals, and 24 (100%) specimens were detected in the 24 immunosuppressed patients. HPV 16 was the most common high-risk type detected, found in 21 of 65 (32.3%) specimens. After HPV types 6 and 11, HPV types 53 and 54 were the most frequently detected low-risk HPV types. This study demonstrates that a high percentage of condylomata acuminata lesions contain multiple HPV types, including types associated with a high risk of dysplastic abnormalities. Further studies are needed to determine the influence these additional HPV types have on the epidemiology of genital tract HPV infections and the natural history of condylomata acuminata, especially in immunosuppressed patients.

Adolescent↗
PubMed2001

Primary treatment of condylomata acuminata with viable bacillus Calmette-Guerin.

PURPOSE: Condylomata acuminata or genital warts are caused by human papillomavirus. Prevalence data show that infection rates are increasing. To our knowledge we report the first successful primary treatment of genital warts with topical bacillus Calmette-Guerin (BCG) and provide long-term followup in a group of adjuvant treated patients with recurrent condylomata acuminata. MATERIALS AND METHODS: In 10 consecutive men viable BCG was directly applied to the condylomata acuminata lesions once weekly for 6 weeks. In nonresponding patients another course of 9 applications was administered for 3 weeks. RESULTS: A complete response was achieved in 6 of the 10 men after 1 or 2 treatment cycles. All responding patients are disease-free at a median followup of 9.2 months (range 4 to 12). One patient achieved partial regression of the lesions and in 3 the condylomata did not disappear. Side effects were rare and mild. Long-term followup in 6 adjuvant treated patients with rapidly recurrent condylomata acuminata showed no further recurrence after topical BCG in 5 at a median of 30.8 months (range 29 to 50). CONCLUSIONS: Topical application of viable BCG has therapeutic activity as adjuvant and primary treatment for penile condylomata acuminata with negligible side effects. Long-term followup implies the prevention of recurrent disease.

Adjuvants, Immunologic↗
PubMed2004

Topical 5-aminolaevulinic acid-photodynamic therapy for the treatment of urethral condylomata acuminata.

BACKGROUND: Electrocoagulation and laser evaporation for urethral condylomata acuminata have high recurrence rates and can be associated with urethral malformations. OBJECTIVES: To investigate the effect of photodynamic therapy (PDT) with topical 5-aminolaevulinic acid (ALA) on urethral condylomata acuminata and to examine the histological changes in lesions of condylomata acuminata after ALA-PDT. METHODS: Patients with urethral condylomata (n = 164) were given topical ALA followed by intraurethral PDT through a cylindrical fibre. Patients included 11 individuals with 16 penile or vulval condylomatous lesions which were biopsied before or after treatment; the histological changes were then evaluated by light microscopy and electron microscopy. RESULTS: The complete response rate was 95% and the recurrence rate was 5% after 6-24 months of follow-up. Light microscopy revealed keratinocytes in the middle and upper layers of the epidermis showing marked vacuolation and some necrocytosis 1 and 3 h after PDT. Necrosis in all layers of the epidermis was noted 5 h after PDT. Electron microscopy of keratinocytes revealed distinct ultrastructural abnormalities of mitochondria and the endoplasmic reticulum, and membrane damage. Apoptotic bodies were detected 3 h after PDT and a large number of keratinocytes exhibited necrosis 5 h after PDT. CONCLUSIONS: Results suggest that, compared with conventional therapies, topical ALA-PDT is a simple, effective, safe and well-tolerated treatment for urethral condylomata acuminata that is associated with a low recurrence rate. The mechanism might be the triggering of both apoptosis and necrosis by ALA-PDT in human papillomavirus-infected keratinocytes.

Adult↗
PubMed2001

Direct medical costs for surgical and medical treatment of condylomata acuminata.

OBJECTIVE: To determine which treatment modalities for condylomata acuminata are associated with the lowest direct medical costs. DESIGN: Cost-effectiveness analysis. SETTING: Ambulatory private practice, primary or specialty care. PATIENTS OR OTHER PARTICIPANTS: Adults with no presenting complaints other than condylomata acuminata. INTERVENTIONS: Construction of a cost-effectiveness model. From a literature review, extraction of commonly accepted guidelines regarding duration and frequency as well as reports of efficacies of typical treatment regimens; from Medicare physician fee schedules, costs of physician visits and physician-administered treatments; from published data, average wholesale prices of medications. MAIN OUTCOME MEASURE: Estimated direct medical costs per complete clearance associated with different treatment options for condylomata acuminata. RESULTS: Mean direct medical costs per complete clearance are lowest for surgical excision ($285). Other low-cost modalities are loop electrosurgical excision procedure ($316), electrodesiccation ($347), carbon dioxide laser ($416), podofilox ($424), and pulsed-dye laser ($479). Higher-cost modalities are cryotherapy ($951), trichloroacetic acid ($986), imiquimod ($1255), podophyllum resin ($1632), and interferon alfa-2b ($6665). CONCLUSION: Surgical modalities, including excision, electrodesiccation, loop electrosurgical excision procedure, and laser, as well as podofilox are low-cost options for the treatment of condylomata acuminata.

Condylomata Acuminata↗