Genital Warts Research Articles

The Risk Factors of High-Risk Human Papillomavirus Susceptibility and Clinical Features in HIV-Positive Patients with Anal Condyloma Acuminatum: A Retrospective Cohort Study

The Risk Factors of High-Risk Human Papillomavirus Susceptibility and Clinical Features in HIV-Positive Patients with Anal Condyloma Acuminatum: A Retrospective Cohort Study

Management of Charmakeela by Viddha Karma followed by Arka Ksheeradi Lepa externally and Vidanga Churna orally

Introduction: Charmakeela is one of the most common skin disorders affecting the children and teenage group by and large. It can be correlated to warts according to modern science owing to signs and symptoms. The incidence rate of EGW (extra genital warts) =10% Approx. Globally, 2-25% approx. India. The Incubation period of warts is around 90 days and the high recurrence rate in various modern treatment modalities. Aim: To evaluate the efficacy of Viddha Karma followed by Teekshna, Lekhana, Ropana, Krimighna properties of Arka Ksheera and Haridra Churna externally and Vidanga Churna Orally. Objectives: To arrive at a cost effective result oriented medication with least recurrence. Materials and Methods: A lean built Female patient, presenting with multiple warts on both the palms was selected from T.M.A.E’S AMC Hospital, Hospet. The patient was treated with Vidanga Churna (0-0-5mg) with hot water bed time and with aseptic precautions a 2ml syringe needle was taken and random pricks were made on the surface and surrounding the warts. This was followed by application of Arka Ksheera mixed with Haridra Lepa and was bandaged. The procedure was repeated once a week for 5 weeks. Results: A significant reduction in the size and other symptoms of warts was seen by 2 weeks and by the end of 5weeks the palms were completely clear and appeared normal. After a regular follow upto 8 weeks with oral medication alone no recurrence was noticed. Conclusion: The treatment was successful in warding off recurrence and effectively curing all warts with economical, noninvasive technique.

Pediatric genital warts successfully treated with photodynamic therapy

Genital warts (GWs) are the most common sexually transmitted infections worldwide, caused by the human papillomavirus (HPV). In adults, the primary mode of transmission is through sexual contact, whereas in children it can occur through skin-to-skin or skin-to-mucosa contact and be sexual or non-sexual. The increasing prevalence of GWs in children has renewed the interest in therapeutic management which still presents a unique challenge, being influenced by many variables including size, quantity, and location of warts, as well as the presence of comorbidities. Photodynamic therapy (PDT) has already shown encouraging results in treating viral warts in adult patients, but its use is still not standardized in the pediatric population. On this topic, we report the case of an otherwise healthy 5-year-old child affected by GWs, successfully treated with three sessions of PDT with 10% 5-aminolaevulinic acid (ALA), at one-month intervals. Our case is paradigmatic of the potentiality of PDT to treat difficult lesions in a pediatric setting.

The relationship between the recurrence rate of genital warts and administration of quadrivalent human papilloma virus vaccine in women

The relationship between the recurrence rate of genital warts and administration of quadrivalent human papilloma virus vaccine in women

Häufigkeit von sexuell übertragbaren Infektio-nen in deutschen Facharztpraxen

The aim of this study is to analyze the incidence of sexually transmitted infections (STI) in dermatological, urological, and gynecological practices in Germany. Data from the nationwide IQVIA Disease Analyzer database was used for this study. This cross-sectional study included 6,535 patients in 2014 and 6,491 patients in 2023 with an insured diagnosis of a sexually transmitted disease in 69 dermatology, 148 gynecology and 55 urology practices. The number of patients treated for sexually transmitted diseases in these practices changed only minimally between 2014 and 2023. On average, each dermatology practice treated 31 patients with STIs in 2023, each gynecology practice treated 21 patients and each urology practice treated 23 patients. Anogenital warts were the most commonly diagnosed STI in all specialties, with prevalence varying by specialty. Interestingly, the number of patients per practice with anogenital warts increased slightly in dermatology and urology practices between 2014 and 2023, while it decreased in gynecology practices. The average age of patients treated for STDs increased between 2014 and 2023 In summary, this study highlights that despite vaccination efforts and awareness campaigns in various medical specialties, STI patient numbers remain almost the same and thus STI continues to be a persistent and increasing challenge in the ageing patient population. The findings call for further initiatives in the public health sector and an adjustment of everyday practice to the special needs of these patient groups.

Genosensor based on polypyrrole and dendrimer-coated gold nanoparticles for human papillomavirus detection

Human Papillomavirus (HPV) is an often asymptomatic widespread sexually transmitted infection responsible for causing various health issues. Low-risk HPV primarily causes genital warts. High-risk HPV types are associated with several cancers, including cervical, anal, and oropharyngeal cancers, posing significant health risks. In this work, we developed an electrochemical biosensor for the detection and differentiation of HPV genotypes based on electropolymerized polypyrrole (PPy) and PAMAM dendrimer-coated gold nanoparticles (PAMAM-AuNPs) for the immobilization of a DNA probe for detecting different HPV genotypes. Electrochemical impedance spectroscopy (EIS), cyclic voltammetry (CV), and atomic force microscopy (AFM) were used to characterize the biosensor. AFM analysis revealed varied topographic surfaces associated with the increased peaks concerning the biosensor and against patient samples. Electrochemical responses indicated that the genosensor could detect HPV using plasmid (HPV 6, 16, 18, 31, and 33) and cDNA samples (HPV 6, 18, and 31) from infected patients. Different electrochemical profiles were obtained between high-risk and low-risk genotypes. The sensor presented an excellent analytical performance, presenting a lower LOD of 0.04 pg.µL−1 and 0.34 pg.µL−1 for plasmidial and cDNA samples, respectively. Electrochemical analysis pointed out the ability of the developed genosensor platform to differentiate the HPV genotypes. The proposed biosensor is a promising tool for detecting and monitoring HPV and related diseases such as cervical cancer.

Overview of the human papilloma virus: types and its treatment

The human papillomavirus (HPV) is the most prevalent sexually transmitted disease in the United States and one of the most common causes of sexually transmitted infections (STDs) globally. Warts are cutaneous and occasionally mucous lesions brought on by HPV, with 2-20% of elementary school students getting them. There are three types of warts: non-genital warts, flat warts, and plantar warts. Non-genital warts are hyperkeratotic, exophytic, dome-shaped papules or plaques commonly associated with HPV-1, 2, 4, 27, or 57. Flat warts appear as flesh-coloured, erythematous to brown, or hyperpigmented smooth papules with a flat top and a diameter of 2 to 5 mm. Plantar warts, also known as verrucae plantaris, are cutaneous lesions on the plantar aspect of the foot that result from a human papillomavirus infection of keratinocytes (HPV).Genital warts are transmitted through sexual contact, while autoinoculation and vertical transfer do occasionally happen. After engaging in sexual activity with an infected partner, about 70% of people experience anogenital warts. Treatment for HPV includes imiquimod cream formulations, photodynamic treatment (PDT), green tea, chemical cautery, fluorouracil cream, cryotherapy, and surgical treatment. Common warts are hyperkeratotic, exophytic, dome-shaped papules or plaques commonly found in fingers, dorsal surfaces of hands, knees, or elbows. Flat warts are flesh-coloured, erythematous to brown, or hyperpigmented smooth papules with a flat top and a diameter of 2 to 5 mm. Plantar warts are unique in their location and appearance, primarily affecting high-pressure locations on the palms and soles and are uniquely linked to HPV type 1.

Human PapillomaVirus Vaccine Uptake: Attitudes and Practices Among Moroccan Physicians.

In Morocco, cervical cancer is a serious public health problem with an estimated number of 2165 new cases and 1199 deaths in 2020. The human papillomavirus (HPV) vaccine has been available in Morocco since 2008. Few data are available on physicians' practices and attitudes toward HPV vaccine. Hence, this study aims to evaluate physicians' awareness and practice towards HPV vaccine and to highlight the main factors affecting physicians' recommendation of this vaccine in Morocco. We have carried out a structured interviewer-administered questionnaire with 500 physicians in different Moroccan regions between March 2019 and March 2020. This study showed an insufficient level of awareness of the two most common types of HPV associated with cervical cancer (36.6%). The rate of HPV vaccine recommendation did not exceed 16.6%. However, more than 63% of participants who were aware of HPV vaccine were willing to recommend it for their future eligible patients. Age (p value < 0.01), sector of activity (p value < 0.01), awareness of the two most common types of HPV associated with genital warts (p value = 0.02), of the vaccine schedules (p value = 0.03), and of the commercial name of this vaccine (p value < 0.01), were significant factors influencing physicians' recommendation of HPV vaccine. Our results showed that, older age (above 51years old) was associated with negative attitude towards the recommendation of this vaccine (OR: 0.17, 0.06-0.46 CI 95%). Practice in public sector was positively associated with recommendation of HPV vaccine (OR: 7.54, 3.38-16.80 CI 95%). Who were aware of the two most common types of HPV associated with genital warts were more likely to recommend HPV vaccine (OR: 3.36, 1.31-8.65 CI 95%). In the same line, participants, who were also more likely to recommend the vaccine, were those who were aware of HPV vaccine schedules (OR: 6.07, 3.51-10.50 IC 95%); participants who were aware of the commercial name of the HPV vaccine were more likely to recommend the vaccine (OR: 10.04, 5.02-20.09 IC 95%). Indeed, raising physicians' awareness is urgently needed to improve HPV vaccine coverage within Moroccan population.

Sexually transmitted infections in Belgian general practices: a nationwide continuing surveillance study, data from 2015 to 2020.

The current study aims at describing sexually transmitted infections (STI) surveillance data collected from 2015 to 2020 as well as investigating patients' characteristics and risk factors in the sample population. Reported STI cases are continuously increasing in Europe. In Belgium, 94.1% of citizens have a regular general practitioner (GP) or are affiliated to a general practice. By using GPs for surveillance, STIs can be monitored in the general population. Between January 2015 and December 2020, the Sentinel General Practitioners (SGP) network retrospectively reported five STIs: chlamydia, gonorrhoea, genital warts, herpes, and syphilis. In the SGP network database on STIs, participating GPs report on case-by-case basis through paper or online registration forms. We performed descriptive statistics, X2 test and logistic regression using SAS® 9.4. Multivariate multiple logistic regression was performed to investigate the relationship between STIs and patients' characteristics. During the study period, 1009 cases were reported, corresponding to an episode-based incidence estimated at 121 per 100,000 inhabitants. The majority of patients (59.8%) were men, and 83.6% were under age 30. Among female patients 92.7% had heterosexual contacts whereas 64.4% of male patients did. Women were more likely to be diagnosed with chlamydia (odds ratio [OR] 1.56; 95% confidence interval [CI] 1.12-2.17) and herpes (OR 1.72, 95% CI 1.04-2.86) than men.In this study, STI surveillance data were in agreement with literature. Continuous surveillance through the SGP network remains an important tool to obtain information about populations at risk and STI incidence in the general population.

Prevalence and Genotype Distribution of HPV in Gynecological Patients: A Cross-Sectional Study

Human papillomavirus (HPV) is a prevalent sexually transmitted virus that can lead to genital warts or cancer. Over 100 HPV strains have been discovered, some classified as high-risk and others as low-risk. This study aimed to analyze the prevalence of HPV genotypes in patients with gynecological problems and to compare the frequency of low-risk and high-risk HPV infections. A cross-sectional study was performed. Five hundred patients were recruited who attended a gynecological clinic due to various reasons such as genital warts, itching, bleeding, or even asymptomatic cases discovered during routine visits in the period extending from January 2nd, 2017 to December 31st, 2022. Genotyping was performed using the Hybrispot technique, targeting 27 different HPV genotypes. DNA flow technology, a rapid and sensitive method, was utilized for the analysis. Out of the 500 patients, 109 tested positive for HPV, indicating 21.8% incidence among those seeking gynecological care. Among the HPV-positive patients, 59% had low-risk HPV, and 41% had high-risk HPV. The most common low-risk genotypes were HPV6 and HPV11, while the most common high-risk genotypes were HPV53, HPV58, HPV18, and HPV16. Several infrequent HPV genotypes were missed by the multiplex real-time PCR method. The study revealed a higher frequency of low-risk HPV compared to high-risk HPV, with no significant difference between the two groups.

Machine Learning and Hyperspectral Imaging for Analysis of Human Papillomaviruses (HPV) Vaccine Self-Healing Particles.

Human papillomaviruses (HPV) are known to cause a variety of diseases, including cervical cancer and genital warts. HPV is a highly prevalent virus and is considered the most common sexually transmitted disease. Because of the risks associated with HPV, Gardasil, a quadrivalent recombinant vaccine, was developed by Merck & Co., Inc., Rahway, NJ, USA, and approved by the Food and Drug Administration (FDA) in 2006. The second generation of the vaccine, Gardasil9, was subsequently approved by the FDA in 2014, providing significant protection against HPV. The HPV vaccine may be given as 2 or 3 doses; however, vaccine administration as a single dose with a sustained release mechanism may potentially offer benefits to meet emerging health needs. To explore this, HPV vaccines were formulated within microporous self-healing particles (SHPs) to enable potential controlled release of HPV virus-like particle (VLP) antigen. Machine learning, in the form of multivariate curve resolution-alternating least-squares (MCR-ALS), with Raman hyperspectral imaging was used to determine the molecular identity and spatial distribution of all relevant species within this HPV vaccine formulation. The results indicate that machine learning with Raman hyperspectral imaging was able to spatially resolve HPV VLP antigens within SHP vaccines for the first time, providing crucial information necessary for vaccine development.

Sexual Function and Quality of Life in Iranian Women With Human Papillomavirus Infection.

Considering the prevalence of Human Papillomavirus (HPV) infection and the lack of HPV vaccination program in Iran among young women and the importance of quality of life and sexual performance in women, we decided to conduct a study to examine the relationship between HPV infection and sexual dysfunction and quality of life in Iranian women. In this cohort study, 250 married women who infected with HPV were recruited via convinence sampling from colposcopy clinic of Arash women hospital (Tehran, Iran) from April 2020 to May 2022.They were evaluated concerning their sexual function in the domains of desire, arousal, lubrication, orgasm, satisfaction and pain with the female sexual function index (FSFI) questionnaire (the total FSFI score is calculated by the sum of the nineteen items). Sexual quality of life-female (SQOL-F) items (Likert-type scale with a cut-off of 65 points) were organized into four sub-scales: psychosexual feelings, sexual and relationship satisfaction, self-worthlessness, and sexual repression. All patients filled out the female sexual function index (FSFI) and sexual quality of life (SQOL) questionnaires. Variables were analysed via correlation coefficient and linear regression tests. Mean age and mean marriage duration were 38.5±4.5 and 12.2±7.2, respectively. There was a weak correlation between FSFI and SQOL (r=0.15, p=0.001).Time of marriage and genital warts were the predictors on the FSFI and SQOL. The findings suggest that HPV infection can impair sexual function and quality of life. This research contributes valuable insights, especially considering the prevalence of HPV.

Usefulness of dermoscopy in anogenital warts: A descriptive study of 30 cases

Usefulness of dermoscopy in anogenital warts: A descriptive study of 30 cases

Seroprevalence of human papilloma virus 6, 11, 16 and 18 among pregnant women in Mwanza-Tanzania

IntroductionHigh-risk human-papilloma viruses 16 and 18 (HR-HPV 16 and HR-HPV-18) are well known to be associated with carcinoma of the cervix, head and neck, penis, and anus. Low-risk human papillomaviruses 6 and 11 (LR-HPV 6 and LR 11) infection has been associated with anogenital warts, oral papilloma, and laryngeal papillomatosis in children. HPV infection during pregnancy (HR-HPV and LR-HPV) increases the risk of vertical transmission from infected pregnant women to unborn children. The burden of HR-HPV type 16 and 18 and LR-HPV 6 and 11 is not well documented among pregnant women attending antenatal clinics (ANC). This study determined the seroprevalence and distributions of HR-HPV 16, 18, and LR –HPV 6, 11 antibodies among pregnant women attending ANC at Bugando Medical Centre (BMC) in Mwanza, Tanzania.MethodologyA cross-sectional study involving 255 pregnant women enrolled in obstetrics and gynecology outpatient clinics was conducted between November 2020 and March 2021 at Bugando Medical Centre (BMC) in Mwanza. A structured pre-tested questionnaire was used to obtain patients’ information. Sandwich Enzyme-Linked Immunosorbent Assay (ELISA) was used to detect HPV 6, 11, 16 and 18 specific immunoglobulin G (IgG) from sera. Stata version 15v1 was used for the descriptive data analysis.ResultsThe median age was 27(IQR: 22–31) years. The overall HPV seropositivity for any of the four serotypes was 63.9% (165/255), 95% CI: 58.0-69.7, whereby 37.6%(97/255), 32.2%( 83/255), 15.5% (40/255) and 27.1% (70) were positive for HPV 6, 11, 16 and 18 respectively. Eight participants (3.1%) were positive for all 4 genotypes.ConclusionAbout two-thirds of pregnant women had antibodies against HPV 6, 11 16, and 18 indicating previous HPV exposure. Vaccination programs should be emphasized to reduce the HPV-related manifestations in this population.

Conceptual Study on the Effect of Palasha Gudavarti in Post-operative Pain Management of Anorectal Surgeries

Post-operative pain management is a crucial component of recovery, particularly following anorectal surgeries, where pain can significantly hinder healing. The prevalence of postoperative pain after 24 hours of surgery is 55.3%, after 48 hours is 34.7 % and of moderate to severe post-operative pain is 13 % after 24 hours, and 11.7% after 48 hours1 .Ano rectal pathology amenable to ambulatory surgery includes anal fissures, warts, fistulas, hemorrhoids,abscess and small neoplasms. Quick recovery after ano rectal surgery can be successful only with effective post-operative pain control. Acharya Sushruta recommends the use of Yashtimadhu siddha ghritha application over the operated area2 . Additionally , he advocates the application of shoolahara dravyas and vatahara dravyas processed with ghritha to the surgical site for effective pain relief. Planning a cost effective, reliable, time tested and technically simple management is the need of this modem era. The present study explores the possible analgesic, anti-inflammatory, and wound-healing properties of Palasha Gudavarti, offering an alternative approach to conventional pain management techniques.

Menopause and Sexual Life Amongst Older Men: A Review Study

Objectives: To determine factors affecting the quality of men’s sexual life during menopause and identify the existing challenges. Design: A review study. Setting(s): Older people living in public institutions and living in their own homes. Participants: Older adults over 60 years of age. Outcome measures: All factors affecting the quality of sexual life of postmenopausal men in old age have been investigated in three physical, psycho-emotional, and social domains. Results: In the physical field, factors such as age, general health, disease, exercise, impotence, erectile dysfunction, genital warts, surgery of total hip arthroplasty, surgery of prostate, cancer radiotherapy, alopecia, and disorder in ejaculation, urinary disorders, and physical rehabilitation were known factors affecting the quality of men’s sexual life. The impacts of factors such as sleep problems, stressors, self-image, depression, alcohol addiction, premature ejaculation, emotional divorce, marital satisfaction, and fear of sexual activity were confirmed in the psycho-emotional field of studies. In the social field, factors such as education, duration of the marriage, marital status, income, life partners, number of sexual relations with spouse, the presence of multiple sexual partners, body mass of spouse (female), sex education and health literacy, sexual awareness, and quality of life related to health were recognized to be effective. Conclusions: Promoting sexual awareness through educational programs, providing opportunities for frequent sexual relationships, and addressing physical, psychological, emotional, cognitive, and social factors, and andropause could contribute to a more desirable sexual life quality in men during andropause.

Comprehensive Details on Human Papillomavirus (HPV) Infections and Associated Malignancies: Awareness about Prophylaxis &amp; Treatment Options Available for HPV Infections

Human Papilloma virus (HPV) role has now been widely accepted as a causative agent for cervical as well as head and neck squamous cell carcinomas. Screening and early detection of cervical cancer remains the key element to eradicate this deadly disease. Since it has a long natural history and disease progression, this gave an opportunity for early detection through screening of precancerous lesions which was adopted in high income countries (HIC) like UK which has led to the significant reduction of the cases. Unfortunately, Low- and middle-income countries are facing huge burden because of the lack of effective screening program. FDA approved Cervarix, Gardasil and Gardasil 9 are used as prophylaxis for cervical cancer &amp; genital warts but screening is still essential after vaccination because these vaccines are not effective against all types of HPV types. HPV 16 &amp; HPV 18 are highly oncogenic types and accounts for 70% of cervical cancers. The use of vaccine reduces the risk of getting HPV infection and decrease the rate of morbidity and mortality due to the cervical cancer. In addition to vaccines, many peptides or protein-based &amp; cell or DNA-based vaccines are still in clinical trials; these prevention and management available in vaccines are likely to come up with significant benefits of health in future. Although it’s usually cured by immune system but presence of certain cofactors such as smoking, HIV etc. reduces the probability of an individual to eradicate the infection effectively. The aim of this study is to review literature regarding HPV related infections and malignancies. Moreover, it will make individuals aware about prophylaxis &amp; treatment options available for HPV infection. This review article evaluates the HPV related diseases, there screening, evaluation and management currently available. Bangladesh Journal of Medical Science Vol. 23 No. 04 October’24 Page : 967-983

Emodin combined with 5-aminolevulinic acid photodynamic therapy inhibits condyloma acuminate angiogenesis by targeting SerRS.

Human papillomavirus (HPV) infection can cause condyloma acuminatum (CA), which is characterized by a high incidence and a propensity for recurrence after treatment. Angiogenesis plays an important role in the occurrence and development of CA. Seryl-tRNA synthetase (SerRS) is a newly identified, potent anti-angiogenic factor that directly binds to the vascular endothelial growth factor (VEGFA) promoter, thereby suppressing its transcription. Emodin is a natural anthraquinone derivative that can promote SerRS expression. This study aimed to investigate the effects of emodin on CA and explore combined treatment strategies. The HPV-infected cell line SiHa was treated with either DMSO, emodin, ALA-PDT or a combination of emodin and ALA-PDT. We observed the effects on cell proliferation, apoptosis and the SerRS-VEGFA pathway. Our findings demonstrated that emodin targets angiogenesis through the SerRS-VEGFA pathway, resulting in the inhibition of SiHa cell proliferation and promotion of apoptosis (p < 0.001). To verify the therapeutic effect of emodin combined with ALA-PDT on HPV-associated tumours invivo, we established an animal xenograft model by subcutaneously inoculating mice with SiHa cells (n = 4). The results showed that the combination of emodin and ALA-PDT significantly inhibited the expression of VEGFA to inhibit angiogenesis (p < 0.001), thus showing an inhibitory effect on tumour (p < 0.001). Furthermore, we determined that the mechanism underlying the decrease in VEGFA expression after emodin combined with ALA-PDT in CA may be attributed to the promotion of SerRS expression (p < 0.001). The combination of emodin and ALA-PDT holds promise as a novel therapeutic target for CA by targeting neovascularization in condyloma tissues.

Cost-Effectiveness of 9-Valent HPV Vaccination for Patients Treated for High-Grade Cervical Intraepithelial Neoplasia in the UK

Patients who have been treated for high-grade cervical intraepithelial neoplasia (CIN grade ≥2) are at a high risk for subsequent CIN and other cancers and diseases related to human papillomavirus (HPV). HPV vaccination can reduce the risk of subsequent disease in patients surgically treated for grade 2 or greater CIN; however, there is no formal recommendation for prophylactic HPV vaccination in this high-risk population, and the cost-effectiveness is unknown. To assess the incremental lifetime outcomes, costs, and cost-effectiveness of integrating peritreatment 9-valent HPV (9vHPV) vaccination in combination with posttreatment surveillance for the prevention of cervical cancer and other HPV-attributable diseases in patients surgically treated for grade 2 or greater CIN vs posttreatment surveillance alone from a UK payer perspective. This economic evaluation used 3 independent Markov model structures. Model inputs for vaccine efficacy, utilities, and costs were obtained from published sources, and cervical cancer screening data were obtained from the National Health Service Cervical Screening Program. Costs were adjusted to 2022 to 2023 reference years. Data were analyzed from October 2022 to September 2023. Peritreatment vaccination with 9vHPV in combination with posttreatment surveillance compared with posttreatment surveillance alone. Clinical outcomes included grade 1, 2, or 3 CIN; cervical cancer; vaginal cancer; vulvar cancer; anal cancer; head and neck cancer; genital warts; and recurrent respiratory papillomatosis. Incremental cost-effectiveness ratios (ICERs) using a willingness-to-pay threshold (WTP) of £20 000 (US $26 200) per quality-adjusted life-year (QALY) were estimated. Deterministic sensitivity analysis and probabilistic sensitivity analysis were performed. Vaccination with 9vHPV in conjunction with posttreatment surveillance was cost-effective, with a favorable ICER of £13 789.07 (US $18 064.68) per QALY gained (ie, below the WTP of £20 000 per QALY) vs posttreatment surveillance alone. The resulting ICER was £52 358.01 (US $68 588.99) per HPV-related cancer averted and £64 090 (US $83 958.18) per HPV-related cancer death averted. The ICER was most sensitive to discount rate, incidence of HPV infection, vaccine price, and age at initial treatment for grade 2 or greater CIN. Results of the probabilistic sensitivity analysis showed peritreatment 9vHPV vaccination was cost-effective at the WTP recommended by the UK's Joint Committee on Vaccination and Immunisation (90% of iterations <£30 000 [US $39 300] per QALY) in 100% of iterations. These findings suggest that peritreatment prophylactic 9vHPV vaccination is a cost-effective option for preventing subsequent HPV-attributable diseases in patients surgically treated for grade 2 or greater CIN.

Genotyping and phylogenetic analysis of human Papillomaviruses from women with genital warts

Background and objectives. The pathophysiology of Human Papillomavirus (HPV) infections is dependent on the genotype of virus, the host immune system and the local environmental conditions. HPV infections are linked to a variety of benign and malignant disorders. Anogenital warts is a Sexually Transmitted Infection (STI) primarily caused by Low-Risk HPV (LR-HPV) genotypes 6 and 11. The aims were to Investigation of the prevalence and genotypic distribution of HPV in women with genital warts in Mosul/Iraq, HPV-DNA sequencing and Phylogenetic analysis including minimum spanning trees of amplified HPV L1 gene comparison the present sequences with similar genotypes in GenBank – National Center Biotechnology Information (NCBI) using mega-7-software. Materials and methods. A total of 150 samples were collected from women with genital wart infections. Polymerase Chain Reaction (PCR) was performed using GP+5/GP+6 and MY09/MY11 consensus primers. Results. About 84.6% prevalence of HPV genotypes. The highest frequency (32% and 28.6%) were observed in the 19-28 and 29-38 age groups. Conclusion. Women in Mosul, Iraq, who have genital warts are more likely to have different genotypes of HPV. HPV 11 type was found to be the most common, followed HPV6 and HPV10 as LR HPV, while HPV 16 and HPV45 were the most common as HR HPV. The analysis of the phylogenetic tree revealed a genetic relationship between our isolates and global isolates ranging from (10-100%) bootstrap ratio this indicating phylogenetic relationships (divergent and convergent evolution) this was meant the diversity in origin of the various genotypes common in Mosul, Iraq.