Anogenital Skin Research Articles

Changes in HPV infection in patients with anogenital warts and their partners.

OBJECTIVES--To investigate the relationship between clinical findings and the detection of human papillomavirus (HPV) DNA in a range of anatomical sites in patients with and without anogenital warts. SUBJECTS--Men and women with a clinical diagnosis of anogenital warts, or a current partner with anogenital warts. SETTING--A department of genitourinary medicine in central London. METHODS--The anogenital areas of the patients were thoroughly examined using a colposcope before and after application of acetic acid. Different types of specimens were taken from a variety of anatomical sites. Superficial skin sampling was performed by the application of slides covered with "Superglue" (SG) to clinically normal and abnormal areas of anogenital skin. The presence of human cells in the SG samples was confirmed by detection of the beta-globin gene using the polymerase chain reaction (PCR). HPV DNA was extracted from the specimens and amplified by using consensus primers with the PCR. HPV types 6, 11, 16, 18, 31 and 33 were identified by Southern blotting followed by hybridisation. RESULTS--In women, HPV DNA was detected in 83% of wart biopsies, 29% of cervical biopsies, 36% of cervical scrapes, 25% of urethral loop specimens, 37% of vaginal washes and 33% of rectal swab specimens. In men, HPV DNA was detected in 67% of wart biopsies, 37% of urethral loop specimens and 12% of rectal swab specimens. Of the SG samples containing the beta-globin gene, 49% from women and 50% from men contained HPV DNA. HPV DNA was not detected in buccal scrapes and serum samples from women or men. Of all specimens with detectable HPV DNA, there was evidence of a single HPV type in 41%, multiple types in 48% and undetermined types in 11%. Samples taken from different sites of a patient tended to have HPV types in common. Sexual partners, however, did not consistently have HPV types in common. CONCLUSIONS--HPV DNA was distributed widely in the anogenital area, in warts, acetowhite areas and clinically normal skin. The SG technique was well tolerated by patients and produced results consistent with other findings. Sampling from a single site of the genitalia on one occasion may significantly underestimate the infection rate with HPV. Multifocal infection of the anogenital area with HPV should be taken into consideration when interpreting epidemiological studies and management strategies.

Demonstration of Changes in Cytokeratin Expression in Condylomata Accuminata in Relation to the Presence of Human Papilloma Virus as Shown by a Combination of Immunohistochemistry and In Situ Hybridization

Human papillomavirus (HPV) can be detected in, and is probably involved in the etiology of, the majority of anogenital neoplasias. Infection with the virus induces a number of events in the infected epithelial cells that may lead to the development of benign or malignant tumors. One change that can be detected in the infected cells is in squamous differentiation, which is reflected by the pattern of cytokeratin polypeptide expression. By studying this pattern in relation to the presence of the virus, an indication may be obtained of the influence of the virus on the cellular differentiation in individual cells. By using a combination of DNA in situ hybridization and immunohistochemistry, for HPV and cytokeratin polypeptides, respectively, we studied the presence of HPV6 or HPV11 in condylomata accuminata derived from anogenital skin in relation to the cytokeratin polypeptides K1, 4, 8, 10, 14, and 18. We found that in many samples the presence of the skin-type cytokeratins K1 and K10 was decreased, whereas K13, and to a lesser degree K4, appeared. The cellular localization of these aberrations in cytokeratin expression could be related to the presence of HPV6 or 11 DNA in the tissue.

Successful Treatment of Condylomata Acuminata and Bowenoid Papulosis With Subcutaneous Injections of Low-Dose Recombinant Interferon-a

<h3>To the Editor.—</h3> Treatment of genitoanal papillomavirus-associated lesions has been shown to be rather difficult. Condylomata acuminata of the urethral and anorectal mucosae especially remain a therapeutic problem. Surgical methods that include electrosurgery, cryosurgery, or even laser surgery are seldom devoid of side effects, such as associated pains or formation of scars at the treated site. Relapses are seen in up to 39% of the cases treated with conventional surgical methods.¹Bowenoid papulosis (BP), a peculiar disease that could have been contributed only very recently to the list of human papillomavirus (HPV)-associated lesions,²thus far was regarded as untreatable by noninvasive means. Bowenoid papulosis lesions that are situated on the anogenital skin and mucosae consist of flat, slightly pigmented papules or even leukoplakialike efflorescences.²These lesions, though clinically exhibiting very unsuspicious maculae, papulae, or plaques, histologically represent carcinomata in situ that harbor HPV-16 regularly.^2,3DNA sequences

Healing of anorectal wounds with reference to rectal medication.

Under the impact of modern chemotherapy it became abundantly clear that potent therapeutic agents, such as the steroid hormones, when applied to the anogenital area in a vanishing type base (cream) exert a profound local pharmacologic effect, e. g., in pruritus. In numerous instances, when these same drugs are applied in an oleagenous ointment or grease base they are ineffective, and vice versa. These observations as well as subsequent studies led to our almost complete discontinuance of the topical application to the anogenital skin of drugs in oleagenous ointment, a vehicle which one of us had employed in the past.* In line with the foregoing and other observations, we instituted an investigation of the effects of various therapeutic agents in ointments and creams on the healing process of the anorectal wounds; to some of these agents healing-promoting qualities had been attributed by authors or in the promotion of marketed preparations.