Treatment Of Condylomata Research Articles

Argon Plasma Coagulation as Treatment for Anal Condylomas: A Narrative Review

Objectives Anal condylomas are a manifestation of anal human papillomavirus infection and can be associated with precancerous lesions and squamous cell carcinomas. Several methods have been described for treatment, including argon plasma coagulation. A narrative review of the evidence published on this topic was conducted. Methods A search was conducted using PubMed, Scopus, and Web of Science databases. Results Five studies reported on anal/perianal condyloma treatment with argon plasma coagulation. In 3 of these studies, there was a comparison with other treatment methods (addition of imiquimod, electrofulguration, and electrocautery, respectively). Argon plasma coagulation settings varied between studies. This type of treatment was effective for ablation. Recurrence rates and follow-up times varied largely between studies. No major complications, such as pain, scarring, sexual dysfunction, or severe bleeding were described. Conclusion Studies indicate that argon plasma coagulation is an effective and safe therapy for anal and perianal condylomas.

Acral vasculitis and Chilblain-like lesions: is it COVID-19 infection?

The cutaneous manifestations associated with COVID-19 are increasingly reported, their exact incidence remains to be estimated, their pathophysiological mechanisms are largely unknown and the role, direct or indirect, of SARS-CoV-2 in their pathogenesis is still debated. We present a case of COVID-19 that manifested with a purpuric vasculitis pattern on the lower extremities and chilblain-like lesion in toe in a patient presented COVID-19 lungs involvement with polymerase chain reaction and serology are negatives. The reported presenting dermatological symptoms: associated chilblain-like lesions and vasculitis pattern of patient with negative COVID-19 RT-PCR and serology. The polymorphism of cutaneous lesions associated with the COVID-19 infection can mimic or appear similar to other well-known conditions. Even though, RT- PCR and serology are negatives, an infection of SARS-CoV-2 should be considerate.

Assessment of sinecatechins 10% ointment used as proactive sequential therapy in recurrence rate of genital warts lesions after cryotherapy. The PACT-II Trial (postablation immunomodulator treatment of condylomata with sinecatechins): a prospective assessor-blinded, multicenter, pilot trial.

Cryotherapy is commonly used as ablative treatment of external genital warts (EGW). However, after cryotherapy recurrence of lesions affects on average 45% (42-70%) of subjects in the 6 months after the treatment. Sinecatechins 10% are an effective topical treatment of EGW. A low recurrence rate (<6%) was observed in pivotal phase 3 trials conducted with this product. Topical sinecatechins have demonstrated to significantly reduce the recurrence rate of EGW in subjects treated with laser therapy (The PACT-I trial). So far, no prospective data are available regarding the efficacy of sinecathechins as immunomodulator sequential therapy after cryotherapy in EGW subjects. The purpose of this study was to assess the rate of recurrence lesions after the use of topical sinecatechins 10%, as sequential proactive immunomodulation treatment after cryotherapy in subjects with EGW (The PACT-II Trial: the postablation immunomodulator treatment of condylomata with sinecatechins trial) (Trial Registration number: ISRCTN44037479). In a prospective, assessor-blinded, multicenter trial a total of 55 subjects with a diagnosis of multiple EGW (36 men and 19 women, mean age 47±10 years) and a mean lesion number of 9±7, after their informed consent, were enrolled in the study. All subjects were treated with cryotherapy (an average of 2 sessions). After the ablative treatment, all subjects were instructed to apply sinecatechin 10% ointment 3 times daily for 4 consecutive months. The primary study endpoint was the evaluation (assessor-blinded) of recurrent lesions after 6 months (2 month of follow-up after the conclusion of topical treatment). The secondary study endpoints were the appearance of new EGW lesions (lesions affecting area not treated by cryotherapy) and the local tolerability. At baseline, the mean number of EGW lesions were 9±7. After cryotherapy, the mean lesions number were reduced to 1.6±1.8. At month 4, EGW mean lesion number were 0.2±0.4 (P=0.0001 vs. after cryotherapy). At month 6, recurrence of lesions was detected in 10 subjects (18%; 95% CI: 9-30%) with an average of 1.4 lesions. Of these recurrent lesions, 6 occurred in completely healed lesions site after cryotherapy and 8 in partially healed ones. New lesions (outside the cryotherapy treated area) were observed in 10 subjects. The product was very well tolerated. No serious side effects were reported. Three subjects reported moderate skin irritation on the application site. The PACT-II Trial has shown that the recurrence rate of EGW lesions after successful cryotherapy using sinecatechins as immunomodulator sequential therapy is lower in comparison with the percentage documented in the literature without sequential therapy (20 vs. 45%). These results are in line with already published data evaluating the role of sinecatechins after laser therapy (PACT-I trial). Future comparative, double-blind controlled trials assessing the efficacy of different proactive strategies are warranted.

Opioid Prescribing Patterns After Anorectal Surgery

BackgroundAnorectal procedures are frequently performed and have the potential to be particularly painful. There are no evidence-based guidelines regarding opioid prescribing after anorectal surgery and limited data on how surgeons determine opioid prescriptions after anorectal procedures. We hypothesize significant variations in prescribing practices. The aim of this study is to determine current opioid prescribing patterns after anorectal surgery. MethodsA survey was sent to members of the American Society of Colon and Rectal Surgeons. It included demographics, opioid prescribing habits after anorectal procedures, and factors influencing prescribing. Median morphine equivalents were calculated. Respondents prescribing higher than the median for >4 procedures were considered high prescribers. Results519 surveys were completed (3160 sent). 38.6% of respondents were high prescribers, and 61.4% were low prescribers. There were significant differences by years in practice (P = 0.049), hospital type (P = 0.037), region (P < 0.001), and procedures performed per month (P < 0.001). 73% prescribed a standard quantity of opioids for each procedure. The mean milligrams of ME prescribed overall was 129 (SD 82); by procedure the quantities were as follows: hemorrhoidectomy 188 (111), condyloma treatment 149 (105), fistulotomy 146 (98), advancement flap 144 (97), LIFT 140 (93), abscess drainage 107 (91), sphincterotomy 105 (85), chemodenervation 64 (34). Nearly, all (98%) surgeons used local anesthesia. 91% typically prescribed adjunctive medications. In multivariable analysis, performing <10 anorectal procedures per month or practicing in the Northeast or outside the US was associated with low prescribers. High prescribers were more likely to be in practice for >10 y, report >25% of patients request refills, or significantly consider patient satisfaction or phone calls when prescribing. ConclusionsOpioid prescribing patterns are highly variable after anorectal procedures. Creating opioid prescribing guidelines for anorectal surgery is important to improve patient safety and quality of care.

Consensos em HPV Masculino da Sociedade Portuguesa de Andrologia, Medicina Sexual e Reprodução: Tratamento

The treatment of condyloma is generally a challenge in clinical practice. Although the spontaneous resolution rate is high, a significant proportion of patients seek treatment, not because of symptomatology, but mainly for aesthetic issues and concerns related to the transmission or worsening of existing lesions. The available treatments should be applied only for clinically evident macroscopic lesions. Ideally, available therapies should have rapid action onset and clearance, resolve symptoms, reduce recurrence rate and viral load, be effective in treating small lesions, and be well tolerated. However, none of the currently available treatments is clearly more effective than the others and there is no ideal treatment for all patients or for all condyloma. Therefore, the therapeutic decision should be based on the clinician's experience, available resources, lesion morphology, size, number and location, primary or recurrent lesions, disease severity, patient preference and expectations, patient's immune competence, convenience, tolerance, cost of treatment and results of previous therapies. The available treatments are divided into three groups: applied by the patient himself (imiquimod 3.75 or 5%, podophyllotoxin .5%, synecatekines 10% or 15%), applied by the health care provider (bi‐ and tricloacetic acids 80%‐90%, intralesional interferon alpha, cryotherapy, surgical removal, electrofulguration, laser ablation) and experimental or alternative therapies (topical cidofovir, intralesional bleomycin, photodynamic therapy). Treatment methodologies can be further divided into their action ‐ ablative or destructive treatment (cryotherapy, electrofulguration, laser ablation, surgical excision), cytotoxic or proapoptotic treatments (podophyllotoxin .5%, 5‐fluoruracil, bleomycin) and immunomodulatory treatments (imiquimod 3.75% or 5%, synecatekines 10% or 15%, intralesional interferon alpha). The overall success rate of the various treatments available ranges from 23% to 94%. Only treatments that include cryotherapy or surgical excision are suitable in condyloma with any anatomical location and that have the highest success rate in monotherapy. Recurrences are common regardless of the treatment received. In contrast, immunomodulatory therapies despite having lower initial clearance rates appear to have higher probabilities of cure in the medium term, with low recurrence rates. Some treatments may be combined with each other and the effectiveness of combined therapies appears to be superior to monotherapy (proactive sequential treatment). The consensuses for the treatment of HPV also consider special situations: immunocompromised patients, meatus and intraurethral lesions and treatment of the partner.

Topical condyloma treatment: comparative evidence for a common problem.

Topical condyloma treatment: comparative evidence for a common problem.

Efficacy of sinecatechins 10% as proactive sequential therapy of external genital warts after laser CO2 ablative therapy: The PACT study (post-ablation immunomodulator treatment of condylomata with sinecatechins): a randomized, masked outcome assessment, multicenter trial.

External genital warts (EGW) are the most common viral sexually transmitted infection. Ablative treatments like cryotherapy, curettage, and CO2 laser therapies offer rapid onset of effect, fast clearance, and reduction of virus load. However, these procedures are associated with high recurrence rates (RRs) ranging from 20% to 77% in the short and medium terms and do not provide sustained clearance. After laser therapy removal of EGW, an RR up to 77% has been reported. Topical sinecatechins (TS) 10% is a patient-applied regimen for the treatment of EGW with a low RR (<6.5%) at three months after completion of the therapy in the pivotal trials conducted so far. Sinecatechins can be considered a suitable proactive sequential therapy (PST) after ablative strategies to obtain a low RR. So far, no prospective data are available regarding the efficacy of sinecatechins 10% as PST. We evaluated the efficacy and tolerability of TS 10% ointment applied twice daily in subjects with "difficult to treat" EGW after CO2 laser ablative treatment in a prospective controlled trial. A total of 87 subjects (76 men and 11 women; mean age 42 years) were enrolled in this three-month masked outcome assessment parallel group trial with imbalanced randomization allocation (2:1). One week after a successful CO2 laser treatment, 60 subjects were randomized to TS 10% treatment and 27 subjects to no treatment (control group: ConTRol (CTR); no sequential therapy). All patients had a history of an average of 4.5 previous ablative treatments in the last 12 months due to recurrent EGW. Mean (standard deviation) baseline number of treated lesions was 6.5 (2.7). One subject in the TS arm dropped out due to burning sensation after the application of the product. Therefore, 86 subjects completed the study. After three months, in the TS group, three subjects presented new EGW lesions (RR: 5%) on treated sites. In the CTR group, eight subjects presented new EGW lesions (RR: 29%) on treated sites (p = 0.0024; odds ratio: 0.16; 95% confidence interval: 0.04-0.68). In the TS group, 34 subjects (56%) reported mild to moderate erythema or burning sensation at the application site. In this prospective multicenter trial, the use of TS 10% as PST after ablative treatment with CO2 laser was associated with a lower recurrence rate of new EGW lesions in the short term in comparison with the control group. Comparative larger trials are warranted to evaluate the role of this approach as PST (Trial Registration Number: ISRCTN44037479).

BCG In the treatment of recurrent. Genital condyloma accuminatum

Introduction: The Human Papilloma Virus (HPV) is the most prevalent sexually transmissible disease. The treatment of Condyloma Accuminatum is a great challenge because of the high recurrence rate and of the lack of any drug efficient in its elimination. Objective: To assess the efficacy of the treatment with Imuno BCG (Bacillus Calmette-Guérin) for bearers of condylomas recurrent for more than 2 years. Patients and Methods: Patients with age between 18 and 60 years, having a history of more than 2 years of genital warts, were included, attended as from 01-08-2011; bearers of serious diseases, immunodeficiency or users of immune-suppressors, being excluded. The procedure adopted began with a biopsy of the wart(s) with local anesthetic, followed by the electro-coagulation of all the warts and bases of the biopsies, a solution with 80 mg of Imuno BCG dissolved in 2 ml of saline solution 0.9% was applied to all the genital area, including the cauterized areas. The area was covered with plastic for 2 hours and afterwards washed with water. The local application of Imuno BCG was repeated for 8 consecutive weeks. At the end of the second month the cases were re-assessed. When there was clinical recurrence a new procedure with the same drug was undertaken, but with 3 weekly applications made by the patient himself for 8 weeks. Result: Sixteen patients completed 2-year follow-up. The cure rate was of 62.5%. Of the 10 patients cured, 6 (37.5%) used one series of Imuno BCG, 1 (6.25%) used 2 series, and 3 (18.75%) used 3 series. Of the 6 patients who were not cured, there was a reduction in the number of cauterizations from 5.5 times (over an average period of the disease of 51.6 months) to 2.4 cauterizations (over an average follow-up period of 52.3 months) after the use Imuno BCG. The collateral effects of the use of Imuno BCG were insignificant. Conclusion: Topical BCG is a good option for the treatment of recurrent condylomas, with minimal collateral effect. It may be used even on PPD-negative patients. However, this result must be confirmed with larger sample populations and control-group studies.

Application of a Thulium Laser for Treatment of Cervical Neoplasias and Condylomas: A Feasibility Study.

Evaluation of safety, feasibility, and possibilities of the thulium laser, Vela(®), with a wavelength of 1.9 μm for laser treatment of the portio, vagina, and/or vulva. Laser techniques have been used for many years in the gynecological setting for the treatment of cervical, vaginal, and vulval intraepithelial neoplasias (CIN, VAIN, VIN) and also for the treatment of condylomas. To date, the most commonly used laser for this treatment is the CO2 laser. After indication was made for laser treatment, the patients were treated using the thulium laser, Vela. Follow-up examination usually took place after 1-2 weeks, 3 months, and 6 months, when colposcopy and, where necessary, a cytological smear were performed. During the period from January 2012 to January 2014, 18 patients were treated using the thulium laser. Three patients had a CIN I, 12 had condylomas, two had CIN I and condylomas, and one had CIN II and condylomas. During the follow-up, 40% (n = 6) of patients had a relapse of condylomas. No relapse occurred in cases of CIN. Itching, burning, pain, bleeding, discharge, and skin irritation were listed as side effects of the procedure. This feasibility study shows that the use of the thulium laser for the treatment of cervical neoplasias and condylomas offers a good alternative to the standard treatment using a CO2 laser.

Induction of apoptosis in HPV16 E7 transfected human keratinocyte by ALA-mediated photodynamic therapy

Background and objective5-Aminolevulinic acid (ALA)-mediated photodynamic therapy (ALA-PDT) is effective for the treatment of condyloma and intraepithelial neoplasia associated with human papillomaviruses (HPV). However, the mechanism of PDT on HPV-infected host cells is not fully understood. The aim of this in vitro study was to examine ALA-PDT induced apoptosis in a high-risk HPV E7 gene transfected cell line. Materials and methodsHPV16 E7 gene obtained from HPV16 positive human cervical carcinoma was transfected into a human keratinocyte cell line. PpIX generation and ALA-PDT-induced apoptosis and mitochondrial damage were investigated in vitro. ResultsFluorescence examination showed that HPV16E7 transfected cells could produce PpIX fairly quickly in the presence of 1mM ALA. Apoptosis occurred after ALA-PDT at dose levels of 4, 8, and 12J/cm2. Mitochondrial potential collapse occurred as early as 2h post PDT. ALA-PDT induced a relatively weak and shorter caspase-9 activation but a strong and long lasting caspase-3 activation. However, mRNA levels of caspase-9 and -3 genes in cells treated with ALA-PDT were unchanged. ConclusionThis in vitro study demonstrated that HPV16 E7 transfected keratinocytes could generate PpIX in the presence of ALA. Under light irradiation, ALA-PDT could induce mitochondrial-dependent apoptosis in HPV16 E7 transfected cells.

Anal condyloma treatment and recurrence in HIV-negative men who have sex with men.

Men who have sex with men have increased prevalence of both human papillomavirus and anogenital condyloma. Risk factors for multiple treatment and recurrence of anal condyloma were examined. This is a retrospective study of HIV-negative men who have sex with men who were treated for anal condyloma. This study was conducted in a private surgical practice. The patients were HIV-negative men who have sex with men, aged 18 years or older. Ablation with electrocautery or CO2 laser was performed, as well as excision and topical imiquimod condyloma treatment adjuvant. Primary clearance, defined as 4 months of condyloma-free survival posttreatment, and recurrence, defined as any anal condyloma diagnosis after primary clearance. Of 231 participants, 207 achieved primary clearance (median age, 32.0 years) and were followed (median, 18.2 months) after primary treatment. Most had intra-anal and perianal condyloma (56%), were treated with electrocautery ablation (79.2%), and required 1 treatment (range, 1-6) for clearance. There were 57 recurrences (median, 12 months). One-third each had minimal, moderate, or extensive disease. Forty-six percent of patients received imiquimod posttreatment adjuvant. High-grade dysplasia was found in 31% at presentation and 43% during follow-up. Factors associated with requiring multiple treatments for clearance were participants having moderate disease (adjusted odds ratio, 6.0 (1.7-21.4)) and receiving imiquimod adjuvant (adjusted odds ratio, 4.7 (2.0-10.6)). No single factor predicted recurrence, but those with moderate disease experienced recurrences significantly sooner (median, 25 months of follow-up). This was a retrospective chart review, it was limited to a single practice, and it excluded those who did not achieve primary clearance. Most men who have sex with men have intra-anal and perianal condyloma and concomitant high-grade dysplasia is common. Most achieved clearance with 1 treatment. Having both intra-anal and perianal condyloma, increased severity of disease, and imiquimod adjuvant were significant predictors of requiring multiple treatments for clearance. No identified risk factors proved a significant predictor of recurrence.

Photodiagnosis and treatment of condyloma acuminatum using 5-aminolevulinic acid and homemade devices

The objective of this study was to improve the feasibility of applying topic 5-aminolevulinic acid (ALA) in photodiagnosis (PD) and treatment of condyloma caused by human papillomavirus (HPV) using two homemade handheld devices and to discuss the photodynamic therapy (PDT) as a suitable alternative for each of the cases studied. Both, protoporphyrin IX production and photodegradation were analyzed, and the pain experienced during the illumination was correlated with the light intensities. A total of 40 women with different grades of lesions caused by HPV were chosen from patients of the School of Medicine of Ribeirão Preto (University of Sao Paulo) and of the Unit of Public Health of Araraquara, Sao Paulo. We did not encounter any unexpected difficulties using our devices during the treatment. The existence of an easily observable reddish fluorescence with large intensity concentrated on the lesions is the clinical indication of the penetration and the selective concentration of protoporphyrin IX in the clinical and subclinical lesions rather than in the healthy tissue. The aesthetic results were much better than those obtained by conventional techniques as surgery or cryogenics, with no recurrence reported after two years of treatment. Our results are proof for the various advantages using ALA cream for the PD and PDT in many different cases of condyloma by HPV. This study will be continued to investigate the PpIX photobleaching and the irradiance and fluence rate to optimize conducting the clinical trials, to improve the devices and therefore increase the treatment response.

Protoporphyrin IX production and photobleaching during treatment of condyloma by HPV with methyl aminolevulinate

Protoporphyrin IX production and photobleaching during treatment of condyloma by HPV with methyl aminolevulinate

V1558 TREATMENT OF URETHRAL MULTIPLE CONDYLOMATOSIS WITH GREENLIGHT LASER

You have accessJournal of UrologyInfertility, Infection, Erectile Dysfunction & Trauma1 Apr 2011V1558 TREATMENT OF URETHRAL MULTIPLE CONDYLOMATOSIS WITH GREENLIGHT LASER Ricardo Garcia Navas, Luis Cordoba, Eldiberto Fernandez, and Francisco Javier Burgos Ricardo Garcia NavasRicardo Garcia Navas Madrid, Spain More articles by this author , Luis CordobaLuis Cordoba Madrid, Spain More articles by this author , Eldiberto FernandezEldiberto Fernandez Madrid, Spain More articles by this author , and Francisco Javier BurgosFrancisco Javier Burgos Madrid, Spain More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1581AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Human Papilloma Virus (HPV) is a sexually transmitted infection that has been classically related with genital warts. Most frequently, genital warts present as condylomas. Treatment of urethral condylomas include laser vaporisation. CO2 or Neodinium-YAG laser can be used to vaporise small, single/few condylomas with good results but when multiple urethral condylomas are present it is often necessary to repeat the treatment. We present two cases in whom Greenlight laser (AMS, HPS Laser) was used to treat urethral condylomatosis. METHODS Case 1. 28 year-old male. No previous medical conditions. He presented with condyloma in the navicularis fosae. We performed an urethrocystoscopy to search for urethral condyloma. These were present from the bulbo-membranous urethra to the mid-penile urethra. We performed photovaporisation with HPS at 30 W intensity. A total of 72,800 joules were applied. A urethral catether was left for five days and removed afterwards; the patient left our centre after 24 hours hospitalization with no immediate post-operative complications. Case 2 32 year-old male with haematological disease (myeloid aplasia). He presented with a condyloma in the glans and mictional “spray.” We performed simple excision of the condyloma and an urethrocystoscopy to search for urethral condyloma. These were present in all the urethral circumference from the veru montanum proximally to the navicularis fosae distally. We performed photovaporisation with HPS laser (Greenlight laser) at 30 W intensity. A total of 84,500 joules were applied with treatment of all condylomas. An urethral catether was left for five days and removed; the patient left our centre after 24 hours hospitalization with no immediate post-operative complications. RESULTS Case 1 Control urethrocystoscopy was performed 1 month after treatment with no condylomas left and a healthy urethral mucosa observed. Urinary flow was performed after and before surgery (peak flow: 21.7 ml/s vs 20.9ml/s). 3 months after, the patient is asymptomatic with no genital external warts and a normal control urethrocystoscopy. Case 2 Control urethrocystoscopy was performed 1 month after treatment with no condylomas left and a healthy urethral mucosa observed. Urinary flow was performed after and before surgery (peak flow: 17.3 ml/s vs 14.3 ml/s). 6 months after, the patient is asymptomatic with no genital external warts and a normal control urethrocystoscopy performed 6 months after surgery. CONCLUSIONS In our limited experience Greenlight laser is a good alternative in the treatment of complicated cases of multiple urethral condylomas. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e625-e626 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ricardo Garcia Navas Madrid, Spain More articles by this author Luis Cordoba Madrid, Spain More articles by this author Eldiberto Fernandez Madrid, Spain More articles by this author Francisco Javier Burgos Madrid, Spain More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Prise en charge des lésions exophytiques condylomateuses pendant la grossesse par vaporisation laser au CO 2

Objective . – To evaluate therapeutic effectiveness of the carbon dioxide laser on genital condyloma in pregnancy. Patients and methods. – From 1998 to 2002, 18 pregnant women with genital condyloma were treated with laser vaporization. Treatment was given without regard to the gestational period. All the women were treated at least once. Condyloma localisation, treatment gestational age and complication rate were analysed. Results. – Patients were treated at a gestational age of 15–38 weeks. During pregnancy follow-up, 2 patients had recurrences that required repeated treatment before delivery. In each case, no condylomas were found during delivery. There were no abortions, no premature birth and no complications (bleeding, infections) in our study. Conclusion . – Laser vaporisation is a safe and effective treatment for condyloma during pregnancy.

The efficacy of chemoradiation therapy in HIV seropositive patients with squamous cell carcinoma of the anus.

The aim was to assess the efficacy of chemoradiation therapy for squamous cell carcinoma of the anal canal in HIV seropositive patients. A retrospective review of all patients with squamous cell carcinoma of the anus treated primarily with combined chemotherapy (5-fluorouracil and mitomycin) and radiotherapy or local excision was undertaken comparing HIV seropositive to HIV seronegative patients. Thirteen HIV seronegative patients were compared with 6 HIV seropositive patients. The HIV positive group included a higher proportion of males and a significantly greater history of prior treatment for condyloma. There was no difference in the median radiation dose (5020 cGy vs 4500 cGy, P=0.10). There was a trend towards higher local tumour recurrence in the HIV seropositive patients although this was not statistically significant (30% vs 66%). The CD4 count of HIV positive patients did not correlate either with their ability to complete the prescribed treatment regimen or with subsequent recurrence. Combined chemoradiation is feasible in HIV positive patients, however, local recurrence rates in HIV positive patients may be higher. Tolerance of this therapy in HIV seropositive patients or recurrence after therapy are not related to the patient's CD4 cell count.

Oral cimetidine for the management of genital and perigenital warts in children.

It is believed that most warts are self-limiting and generally require little or no treatment. When numerous or almost complete infestation of the perineum, genital area and groin is encountered it can be distressing and a difficult problem to treat in children. Multiple treatments with caustic agents are sometimes necessary, and treatment of perigenital warts may require use of anesthesia for multiple procedures. Cimetidine is a histamine receptor antagonist that has been used mainly to treat peptic ulcer disease. Recently it has been reported to be useful for the treatment of mucocutaneous candidiasis, herpes simplex, herpes zoster and verruca because of its immunomodulatory effects. Several studies have been published indicating its effectiveness in the treatment of warts. We treated 4 children with extensive condylomata acuminata of the genital and perigenital areas with high doses of cimetidine in an attempt to eradicate the condyloma and avoid recurrence in 2 and as primary treatment in 2. All patients were treated with 30 to 40 mg./kg. cimetidine daily in 3 divided doses during a 3-month period. All patients are free of condyloma at 24 months following treatment. Our results show that cimetidine is useful for primary and adjunctive treatment of condyloma in young children. It also appears to be effective as first line therapy.

Laser vaporization of genital condylomata in pregnancy.

Sixteen pregnant women with genital condylomata acuminata were treated with laser vaporization to assess effectiveness, complication rate, and impact on recurrence. Patients were treated at a gestational age of 13-35 weeks. No recurrences occurred before delivery. Five patients experienced uterine contractions before 37 weeks. Only one delivery before 37 weeks may have been attributed to the laser therapy. Four recurrences were detected during postpartum follow-up. Laser vaporization is a safe and effective treatment for condyloma during pregnancy. It is effective in maintaining a lesion-free state during pregnancy, but postpartum recurrences are not rare.

Urological Applications of Human Papillomavirus Typing Using Deoxyribonucleic Acid Probes for the Diagnosis and Treatment of Genital Condyloma

The use of deoxyribonucleic acid probes to examine the type of the human papillomavirus genome found in penile lesions is described at a technical level and in a clinical application. At least 40 different types of human papillomavirus have been identified and these types vary not only in their deoxyribonucleic acid base sequences but also in their clinical manifestations. Although deoxyribonucleic acid probes currently have a role only in a research setting, this study delineates the possible role of this technology in a clinical setting to detect subclinical intraurethral human papillomavirus. The results have widespread implications regarding the treatment of condyloma and the associated cervical dysplasia. In this series 25 grossly visible lesions were typed and 85 per cent contained human papillomavirus types 6 and 11. In contrast, microscopic lesions identified in the male partners of women with cervical dysplasia were shown to contain human papillomavirus types 16, 18 or 31 in 60 per cent of the cases. In addition, urethral brushings were obtained and were positive for human papillomavirus in 50 per cent of the cases despite normal urethroscopy. Human papillomavirus types 16, 18 or 31 accounted for 70 per cent of the positive urethral brushings.

Infrared coagulation in the treatment of condyloma acuminata in the female genital tract.

An infrared contact coagulator was used for the treatment of genital condyloma acuminata in 89 women. After direct application to the condyloma, the device produces a precisely adjustable tissue necrosis without tissue adhesion. Of the 89 women, 74 returned for scheduled follow-up visits after one, three, and six months. Treatment failure, i.e., recurrence of warts in a treated area, was seen in 13 (10.8%) of 120 treated areas, or in 13 (17.6%) of 74 patients. No complications were observed. The physical working principle of infrared coagulation as well as the results in treatment of condyloma are the same as those of the CO2 laser, but the equipment is cheaper, safer, and more easily handled. It can be used in out-patient departments of clinical and general practices.