Treatment Of Human Papillomavirus Research Articles

Glycyrrhizinic Acid as an Antiviral and Anticancer Agent in the Treatment of Human Papillomavirus.

Human papillomavirus (HPV), like any other virus, needs to penetrate the host cell and make use of its machinery to replicate. From there, HPV infection can be asymptomatic or lead to benign and premalignant lesions or even different types of cancer. HPV oncogenesis is due to the ability of the viral oncoproteins E6 and E7 to alter the control mechanisms for the growth and proliferation of host cell. Therefore, the use of agents with the ability to control these processes is essential in the search for effective treatments against HPV infections. Glycyrrhizinic acid (Gly), the active ingredient in liquorice, has been shown in numerous preclinical studies to have an antiviral and anticancer activity, reducing the expression of E6 and E7 and inducing apoptosis in cervical cancer cells. In addition, it also has antioxidant, anti-inflammatory, immunomodulatory or re-epithelializing properties that can be useful in HPV infections. This review includes the different antiviral and anticancer mechanisms described for Gly, as well as the clinical studies carried out that position it as a potential therapeutic strategy against HPV both through its topical application and by oral administration.

Prevention and treatment of human papillomavirus in men benefits both men and women.

Men should not be overlooked in research on human papillomavirus (HPV) and its associated genital diseases. This is because men infected with HPV are not only at higher risk of genital cancers, but also increase their partners' risk of HPV infection and reinfection through sexual contact. Herein, we summarized the state of knowledge regarding the prevention and treatment of HPV infection in men as well as the possible effects of the prevention and treatment of HPV in men on their female partners. Condom use, smoking cessation, male circumcision, and HPV vaccination for men each play an important role in preventing HPV infection within heterosexual couples. Additionally, men could choose to test for certain types of HPV, such as the oncogenic HPV16 or HPV18 strains, as part of a routine screening program when their partner is positive for HPV. Although there is no recognized treatment for HPV infection as of yet, immunotherapy drugs, such as toll-like receptor agonists, therapeutic HPV vaccines, and immune checkpoint inhibitors, have shown promising results in clinical trials and in actual clinical practice. HPV infection in men also increases the risk of cervical cancer in their female partners. Because of the high partner concordance for HPV demonstrated in prior research, the prevention and treatment of HPV in men should be explored more comprehensively in future research.

Immunothrombotic Mechanisms Induced by Ingenol Mebutate Lead to Rapid Necrosis and Clearance of Anogenital Warts.

Ingenol mebutate (IM) is highly effective in the treatment of human papillomavirus (HPV)-induced anogenital warts (AGW) leading to fast ablation within hours. However, the exact mode of action is still largely unknown. We performed dermoscopy, in vivo confocal microscopy (CLM), histology, immunohistochemistry, and immunofluorescence to gain insights in mechanisms of IM treatment in AGW. In addition, we used in vitro assays (ELISA, HPV-transfection models) to further investigate in vivo findings. IM treatment leads to a strong recruitment of neutrophils with thrombosis of small skin vessels within 8 h, in a sense of immunothrombosis. In vivo and in vitro analyses showed that IM supports a prothrombotic environment by endothelial cell activation and von Willebrand factor (VWF) secretion, in addition to induction of neutrophil extracellular traps (NETosis). IM superinduces CXCL8/IL-8 expression in HPV-E6/E7 transfected HaCaT cells when compared to non-infected keratinocytes. Rapid ablation of warts after IM treatment can be well explained by the observed immunothrombosis. This new mechanism has so far only been observed in HPV-induced lesions and is completely different from the mechanisms we see in the treatment of transformed keratinocytes in actinic keratosis. Our initial findings indicate an HPV-specific effect, which could be also of interest for the treatment of other HPV-induced lesions. Larger studies are now needed to further investigate the potential of IM in different HPV tumors.

Quantification of Tumor-Associated Cell-Free HPV DNA in Surgical Drain Fluid Equates to Molecular Residual Disease and Correlates with High-Risk Pathology

<h3>Purpose/Objective(s)</h3> Multi-institutional efforts aimed at safely de-escalating treatment in human papillomavirus (HPV) associated oropharyngeal squamous cell carcinoma (OPC) patients rely on subjective pathology for risk stratification. While plasma HPV assays are emerging for post-treatment disease surveillance, they have poor sensitivity to detect postoperative molecular residual disease (MRD). Here we present a liquid biopsy assay of the serosanguinous fluid removed from surgical drains, proximal to the surgical site, to sensitively measure postoperative MRD. We hypothesize that HPV quantified in surgical drain fluid (SDF), 1) represents post-operative regional MRD, and 2) could improve patient risk-stratification to guide precision radiotherapy. <h3>Materials/Methods</h3> We collected SDF at 24-48 hours post-surgery for cell-free (cf) DNA extraction. Our 87-patient head and neck cancer cohort included 74 HPV(+) and 8 HPV(-) OPCs, and 5 benign tumors. Paired plasma and tumor samples were collected from approximately half of all patients. We used the HPV16 E6T2aE7 plasmid to compare our Taqman quantitative PCR (qPCR) to digital droplet PCR (ddPCR). We validated HPV(+) OPC PCR results using next-generation HPV sequencing (NGS) in 9 patients. Then we correlated SDF HPV copies to extranodal extension (ENE), AJCC 8^th edition pathological stage, smoking pack-years, recurrence-free survival (RFS), and composite risk scores derived from OPC de-escalation clinical trials. Statistical methods included Fisher's Exact test, Mann-Whitney (MW) test, Kruskal-Wallis (KW) test, and Kaplan-Meier (KM) analysis. <h3>Results</h3> Our HPV qPCR assay's limit of detection was 9.7 copies, similar to what we saw with ddPCR. HPV genotyping was concordant between NGS and PCR, and all SDF cfDNA samples with nondetectable (ND) HPV via PCR were ND via NGS. HPV was detected in 63 of 74 (85%) SDF samples compared to only 7 of 48 (15%) paired plasma samples. Median HPV copies in ENE+ patients' SDF was 15-fold higher than SDF from ENE- patients (P = 0.002). HPV copies also increased with increasing nodal (P = 0.01) but not primary tumor stage (P = 0.4), suggesting post-operative SDF HPV load reflects invasive nodal disease and is a proxy for regional MRD. When we stratified our cohort according to high-risk and low-risk scores drawn from four clinical trials (RTOG 9501, EORTC 22931, ECOG 3311, MC1273), SDF HPV load was consistently higher in patients with trial-defined high-risk pathology (mean AUC = 0.73). Lastly, KM RFS analysis of HPV-high and HPV-low patients, defined by an RTOG 9501-derived SDF classifier, showed HPV-high patients trended toward worse RFS (HR = 3.1; P = 0.1). <h3>Conclusion</h3> Liquid biopsy assessment of SDF, the biofluid most proximal to the nodal environment, enables postoperative regional MRD detection in HPV(+) OPC, and correlates with high-risk nodal pathology and worse RFS. If confirmed, SDF cfDNA analysis could aid traditional pathology and imaging to personalize adjuvant radiotherapy for surgically treated HPV(+) OPC.

Comparison of different treatments for HPV+ oropharyngeal carcinoma: a network meta-analysis.

Treatment of human papillomavirus (HPV)-related head and neck squamous cell carcinoma (HNSCC) is rapidly evolving. Despite either surgery or radiotherapy (RT), with or without chemotherapy (CT), being acceptable in intermediate and locally advanced diseases, there is uncertainty regarding the best treatment option for these patients. Therefore, we performed a network meta-analysis (NMA) to compare the relative efficacy of different treatments for HPV+ oropharyngeal carcinoma. Randomized clinical trials that enrolled adults with non-metastatic HPV+ oropharynx cancer and provided data about overall survival (OS) and/or progression-free survival (PFS) and/or locoregional control and distant metastases (LRC and DM) were included. Fixed- or random-effects models were fit using a Bayesian approach to NMA. Between-group comparisons were estimated using hazard ratios (HRs) with 95% credible intervals (CrIs). The primary outcome was OS. A total of 844 citations were screened; 11 randomized clinical trials were included (HPV+ stage III-IV cancer, mainly oropharynx carcinomas). Nine treatment arms were compared. Radiotherapy (altered or standard fractionation) + triweekly cisplatin (HR 3.8; 95% CrIs 0.29-65 and 0.3; 95% CrIs 0.03-2.51) was superior to RT in term of OS (P score = 0.42 and 0.16). Radiotherapy with low and high cisplatin doses appeared similar (HR 1.57; 95% CrIs 0.19-12.72). Altered fractionation or standard RT + 3-weekly cisplatin are the 2 highest-ranked options in terms of PFS (P score = 0.35 and 0.34). This meta-analysis confirms the role of cisplatin added to RT as the best option for HPV+ oropharyngeal carcinoma. RT+ 3-weekly cisplatin is likely to be the best radical treatment in terms of OS and PFS.

Trends in Adjuvant Therapy After Surgery for Oropharyngeal Squamous Cell Carcinoma.

We aim to 1) evaluate trends in adjuvant treatment of human papilloma virus (HPV)-related oropharyngeal cancer; 2) assess change in complications and functional outcomes over time; and 3) assess change in overall and disease-free survival (DFS) over time. Retrospective analysis. Charts of patients who underwent transoral robotic surgery for HPV-related oropharyngeal cancer between 2011 and 2019 were reviewed. Trend analysis was used to compare rate of adjuvant treatment over time. The Kaplan-Meier method was conducted to analyze overall survival (OS) and DFS. Three hundred and forty-two patients met inclusion criteria. One hundred and sixty-three (47.7%) patients underwent adjuvant radiation, and 90 (26.3%) patients underwent adjuvant chemoradiation. Rate of extranodular extension decreased significantly from 38.9% to 24.0% (P =.004). Rate of adjuvant therapy decreased significantly from 90.9% to 62.5% between 2011 and 2019 (P=.001). In patients who received adjuvant treatment, rate of adjuvant chemoradiation therapy decreased significantly from 40.0% to 20.0% (P < .0005). There was a decrease in rate of 1-year gastrostomy tube dependence in patients treated in 2015 to 2019 versus 2011 to 2014 (2.2% vs. 7.1%, P=.025). In 2011 to 2014, 2-year OS and DFS were 96% and 89%, respectively; in 2015 to 2019, 2-year OS and DFS were 96% and 94%, respectively. There was no difference in OS or DFS between the two time periods. The rate of adjuvant therapy, particularly chemotherapy, has decreased over time. One-year gastrostomy tube dependence rate has decreased significantly from 2011 to 2014 to 2015 to 2019. There was no change in OS and DFS over this time period. 3 Laryngoscope, 132:806-812, 2022.

Knowledge of prevention and treatment of human papillomavirus (HPV) infections among young men

Background: Today, human papillomavirus (HPV) infection has become the most common sexually transmitted disease worldwide. Major consequences of contracting the virus include both mild skin lesions and a range of cancers, the most frequent of which are cervical cancer, penile cancer, oral cavity cancer, throat cancer, and anal cancer, undoubtedly demonstrating its high oncogenic potential. Aim of the study: The objective of this study is to determine the level of knowledge among men aged 18–26 years with regard to HPV prevention and treatment. Materials and methods: An online survey was conducted using a questionnaire developed by the authors. The questionnaire was comprised of 16 closed-ended questions and 5 questions pertaining to demographics. Chi-squared tests or Spearman’s rank correlation coefficients were used for the statistical analysis. Results: Only 27.5% of the respondents correctly answered a question regarding the number of types of the virus, and 33% correctly determined the percentage of the cases where an active infection turns into a chronic state. However, a high level of awareness of the routes of infection was demonstrated, with more than half of the respondents (63%) answering this question correctly. Additionally, more than two-thirds (67.9%) of the men indicated correctly that one of the factors facilitating infection is a young age at the time of the first contact with the virus. Nearly all respondents (90%) indicated that using condoms is an effective form of prevention. Conclusions: The results expressly indicate an insufficient level of knowledge regarding HPV among young men. Due to the high level of sexual activity in this age group, increased education with regard to the prevention of sexually transmitted diseases is needed.

Cryosurgery with liquid nitrogen versus trichloroacetic acid in the treatment of human papillomavirus (HPV) penile wart: a randomized controlled trial

BACKGROUND: Anogenital warts are the most prevalent sexually transmitted infection (0.5%) among dermatological consultations. Cryotherapy with liquid nitrogen (LN) and therapy with trichloroacetic acid (TCA) are remarkable among the treatment strategies. OBJECTIVE: To evaluate the effectiveness of LN versus TCA in to treat penile warts in patients from a Brazilian public institution. METHODS: Open, parallel, randomized clinical trial. Following randomization, the warts were counted and submitted to cryotherapy (10s) or case therapy (TCA 80%) in each visit. The primary dependent variable was the lesion count before and after four weeks of treatment. We assessed the following variables: complete clearance, age, immunosuppression, smoking, topography, and education. RESULTS: 142 treatments were evaluated in 52 participants. There was a predominance of young adults, and the main topography affected was the penis shaft. The mean reduction rate per session was 48% for LN and 26% for TCA (p=0.11). 42 (81%) participants achieved complete clearance, with 39 (75%; 95% CI: 64-85%) reaching clearance in up to three sessions. Age was associated with a worse therapeutic response rate (ß =-0.09; p<0.01). CONCLUSIONS: LN and TCA proved to be effective to treat penile warts, without difference between treatments. Age was associated with a worse therapeutic response.

Synergistic Therapeutic Effects of Probiotic Lactobacillus casei TD-2 Consumption on GM-CSF-Induced Immune Responses in a Murine Model of Cervical Cancer

We perceive the potential of combined immunotherapy for the synergistic treatment of human papillomavirus (HPV)-associated tumors. So, the tumor inhibiting effects of combination of L. casei TD2a and GM-CSF on the TC-1 growth were evaluated In Vivo using lymphocyte proliferation, lymphocyte cytotoxicity, splenocyte, and tumor cytokine assays. The results showed that tumor inhibition in transplanted mice in the GM-CSF combined with probiotic L. casei group was significantly higher than that observed in the other groups excluding GM-CSF group whose tumor inhibition effect was considerable. The findings also indicated that the combined group could generate tumor-specific cytolytic and splenocyte proliferative responses. The levels of IFN–γ, IL-4, and IL-12 after treating with GM-CSF combined with probiotic L. casei were significantly higher than those of other groups. The intratumoral Tumor Necrosis Factor Related Apoptosis-Inducing Ligand (TRAIL) was also significantly increased in the combined group. Tumor analysis further showed that the combined group decreased the accumulation of IL-10 in the tumor microenvironment of treated mice. Furthermore, tumor volume analysis demonstrated that combination group and even GM-CSF suppress tumor growth. Our findings showed that the combination of GM-CSF and probiotic results in improved tumor suppression against HPV-associated tumors and stimulates enhancement of specific antitumor immune responses.

Acupuncture and herbal treatment for human papillomavirus (HPV) and uterine myoma

Human papillomavirus (HPV) is the most common sexually transmitted infection globally. Almost all cervical cancers are due to HPV with two types, HPV16 and HPV18, which account for 70% of cases. Myomas are benign growths in different parts and places of the uterus. In this research is presented a case of 32 year old woman diagnosed with uterine myoma and HPV type 16. The myoma was found in September, 2018 and the HPV infection in January, 2020, two years later after the myoma was treated. The myoma was treated with 10 acupuncture treatments, Cordiceps synensis tea capsules 1.5 grams per day and Yunnan Baiyao tea capsules 1 gram per day in a period of 4 months. The HPV treatment included 10 acupuncture treatments and 1.5 gram Cordiceps synensis tea capsules per day in a period of 3 months. The findings after the treatments for the myoma were normal, with no presence of any abnormalities. The two tests for HPV after the treatment were negative too. Acupuncture and herbal treatment as part of the TCM give very good and satisfying results in gynecological disorders and can help in resolving of conditions like HPV and myoma.

Cervical Cancer Screening: Past, Present, and Future

Cervical cancer is the leading cause of cancer deaths in women in the developing world. New technologies have been developed to allow for more rapid, cost-effective, and sensitive cervical cancer screening and treatment. The aim of this study was to describe methods for detection and treatment of human papillomavirus (HPV), cervical dysplasia (CD), and cervical cancer. New technologies and updated screening strategies will be emphasized. A literature search was conducted using PubMed to identify publications relevant to the subject. Sensitivity and cost-effectiveness of new cervical cancer screening methods were the main outcome measures. HPV and cervical cancer have a significant global impact. Research and innovations related to detection and treatment are key in reducing their burden worldwide. Screening a woman for HPV and CD can dramatically decrease her risk of dying from cervical cancer. New, rapid, low-cost, HPV testing can allow for high-volume screening for the approximately 1.5 billion women who have never been screened. HPV screening can then be combined with high resolution digital colposcopy to detect CD. In the near future, these colposcopic images will be interpreted by artificial intelligence software. Detected lesions can then be treated easily and effectively with thermocoagulation. This see-and-treat model is a sensitive, efficient, and low-cost vision for the future. Bedell SL, Goldstein LS, Goldstein AR, etal. Cervical Cancer Screening: Past, Present, and Future. Sex Med Rev 2020;8:28-37.

A Phase II Trial of Alternative Volumes of Oropharyngeal Irradiation for Deintensification (AVOID): Omission of the Resected Primary Tumor Bed for Squamous Cell Carcinoma of the Oropharynx

Treatment of human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC) with initial surgical resection followed by adjuvant radiotherapy yields high cure rates, but can cause long-term toxicity. This phase II trial evaluated whether omitting high dose radiation to the resected primary tumor bed while targeting only the regional neck nodes, could maintain high local control rates while reducing late sequelae. Eligible patients were those appropriate for adjuvant RT after surgical resection for p16-positive, pathologic stage III-IVa (7th edition) p16-positive OPSCC. Pathologic inclusion criteria included: T1-T2 disease, any N1-2, negative resection margins, and no perineural or lymphovascular invasion. Patients received 60-66 Gy RT over 30-33 fractions to the regional nodes of the bilateral neck, with active omission of high-dose RT to the resected primary tumor bed. Concurrent chemotherapy was given for patients with extranodal extension. The primary end point was 2-year locoregional control. Sixty patients were enrolled. Thirty-two (53%) received intensity-modulated radiation therapy (IMRT), 27 (45%) received proton therapy, and 1 (2%) received a 50:50 hybrid IMRT:proton plan. Average follow-up was 2 years, with local control of 98%, regional control of 100%, distant control of 97%, and overall survival of 100%. Median dose delivered to the avoided primary site was 37 Gy (40 Gy for IMRT, 34 Gy for proton RT, p = 0.03). There was only 1 local recurrence, occurring 9 months after completion of RT, which was successfully salvaged via surgical resection. Two (3%) patients experienced post-RT primary site tissue necrosis, both of whom experienced complete resolution with conservative management. Percutaneous endoscopic gastrostomy (PEG) tube dependence rates were: 0 patients (0%) during RT, and 1 patient (2%) at time of last follow-up. Avoidance of radiation to the resected primary tumor bed appears safe in well-selected patients with HPV-associated OPSCC. This approach resulted in a low rate of treatment-associated complications, and is worthy of further study as a strategy for deintensification.

A Qualitative Exploration of Women's Experiences with a Community Health Volunteer-Led Cervical Cancer Educational Module in Migori County, Kenya.

Detection and treatment of human papillomavirus (HPV) and cervical precancer through screening programs is an effective way to reduce cervical cancer deaths. However, high cervical cancer mortality persists in low- and middle-income countries. As screening programs become more widely available, it is essential to understand how knowledge about cervical cancer and perceived disease risk impacts screening uptake and acceptability. We evaluated women's experiences with a cervical cancer education strategy led by community health volunteers (CHVs) in Migori County, Kenya, as part of a cluster randomized controlled trial of cervical cancer screening implementation strategies. The educational modules employed simple language and images and sought to increase understanding of the relationship between HPV and cervical cancer, the mechanisms of self-collected HPV testing, and the importance of cervical cancer screening. Modules took place in three different contexts throughout the study: (1) during community mobilization; (2) prior to screening in either community health campaigns or health facilities; and (3) prior to treatment. Between January and September 2016, we conducted in-depth interviews with 525 participants to assess their experience with various aspects of the screening program. After the context-specific educational modules, women reported increased awareness of cervical cancer screening and willingness to screen, described HPV- and cervical cancer-related stigma and emphasized the use of educational modules to reduce stigma. Some misconceptions about cervical cancer were evident. With effective and context-specific training, lay health workers, such as CHVs, can help bridge the gap between cervical cancer screening uptake and acceptability.

Editorial: What's new this month?

Microwaves are tested as a new treatment for human papilloma virus (HPV)-related cutaneous warts in a pilot phase I open label uncontrolled study. Microwaves have been applied to thermally ablate inoperable liver tumours, but have not previously been used on the skin [1]. In this issue of the European Journal of Dermatology, Bristow et al. present a study of 32 adult volunteers who were recruited with 54 refractory plantar warts, present for more than a year, with at least two failed treatments. [...]

Revisión bibliográfica sobre la eficacia terapéutica de la crioterapia y el laser en el tratamiento de la verruga plantar provocada por el virus del papiloma humano.

La crioterapia y el láser son dos de las técnicas físicas más usadas actualmente para el tratamiento no quirúrgico del virus del papiloma humano causante de las verrugas plantares (verruca pedis).El objetivo del presente estudio fue comparar estas dos técnicas para evaluar cuál es la que mejor tasa de curación posee en el tratamiento de la verruga plantar.Se realizó una búsqueda bibliográfica en el portal científico PubMed, con los términos “plantar wart”, “verruca plantar” y “plantar papilloma” en combinación con los descriptores “cryotherapy”, y “laser”, que engloban tanto los tratamientos únicos mediante estas dos técnicas como los combinados con otros, tales como el ácido salicílico y la fotodinámica, acotando los años de búsqueda al periodo que comprende desde el 1 de enero de 2005 a octubre de 2015.De los resultados obtenidos, los 19 artículos que recogen tasas de curación muestran la superioridad terapéutica del láser frente a la crioterapia en el tratamiento de la verruga plantar, siendo las tasas de curación más elevadas en el láser YAG de Erbio combinado con fotodinámica y en el láser de dióxido de carbono.Por tanto, con el presente estudio queda demostrada la mayor tasa de curación del láser frente a la crioterapia para el tratamiento de las verrugas plantares.

Potential Anti-HPV and Related Cancer Agents from Marine Resources: An Overview

Recently, the studies on the prevention and treatment of human papillomavirus (HPV) which is closely related to the cervical cancer and other genital diseases are attracting more and more attention all over the world. Marine-derived polysaccharides and other bioactive compounds have been shown to possess a variety of anti-HPV and related cancer activities. This paper will review the recent progress in research on the potential anti-HPV and related cancer agents from marine resources. In particular, it will provide an update on the anti-HPV actions of heparinoid polysaccharides and bioactive compounds present in marine organisms, as well as the therapeutic vaccines relating to marine organisms. In addition, the possible mechanisms of anti-HPV actions of marine bioactive compounds and their potential for therapeutic application will also be summarized in detail.

Reduced tumorigenicity and pathogenicity of cervical carcinoma SiHa cells selected for resistance to cidofovir

BackgroundInsights into the mechanisms associated with chemotherapy-resistance are important for implementation of therapeutic strategies and for unraveling the mode of action of chemotherapeutics. Although cidofovir (CDV) has proven efficacious in the treatment of human papillomavirus (HPV)-induced proliferation, no studies concerning the development of resistance to CDV in HPV-positive tumor cells have been performed yet.MethodsFrom the cervical carcinoma SiHa cells (SiHaparental), which are HPV-16 positive, cidofovir-resistant cells (SiHaCDV) were selected, and differential gene expression profiles were analyzed by means of microarrays. We examined in vitro phenotyping of resistant cells compared to parental cells as well as tumorigenicity and pathogenicity in a mouse-xenograft model.ResultsSiHaCDV had a resistant phenotype and a reduced growth both in vitro and in vivo. A markedly diminished inflammatory response (as measured by production of host- and tumor-derived cytokines and number of neutrophils and macrophages in spleen) was induced by SiHaCDV than by SiHaparental in the xenograft model. Gene expression profiling identified several genes with differential expression upon acquisition of CDV-resistance and pointed to a diminished induction of inflammatory response in SiHaCDV compared to SiHaparental.ConclusionsOur results indicate that acquisition of resistance to cidofovir in SiHa cells is linked to reduced pathogenicity. The present study contributes to our understanding on the antiproliferative effects of CDV and on the mechanisms involved, the inflammatory response playing a central role.

PM.93 A Complicated Case of Giant Vulval Condylomata in Pregnancy

Anogenital warts are one of the most common sexually transmitted diseases in the UK caused by HPV infection.1 2 The condition is not purely benign with significant symptoms present in...

Clinical Use of the Antiseptic Polihexanide for Genital Tract Infections

Background: In clinical practice, treatment of genital tract infections is based on administration of either antibiotics or antiseptics. While antibiotics may be applied systemically or topically, antiseptics may be applied only topically. In case of bacterial vaginosis (BV), antibiotic therapy may often be limited and side effects due to systemic administration may develop. Polihexanide (PHMB) is a promising option for the topical treatment of genital tract infections, in particular BV and vaginitis. Method: A systematic search for publications on the use of PHMB for the treatment of genital infections in two electronic databases was performed. Titles, abstracts and citations were imported into a reference database. Duplicates were removed and two reviewers assessed each identified publication separately. Results: Among a total of 204 references, 3 prospective randomized trials were identified. Two trials treated BV infections with PHMB in comparison to clindamycin as antibiotic standard therapy with no significant differences either in safety or in efficacy. The third controlled trial investigated the clinical efficacy of PHMB compared to placebo in the treatment of human papilloma virus. Patients treated with PHMB daily for up to 16-weeks showed significantly higher (52%) clearance of genital warts as compared to patients treated with placebo (4%). Conclusion: PHMB may be a clinically effective alternative for the treatment of BV and human papilloma virus. Although PHMB-based antiseptics are available since the late 90s, controlled trials to investigate its clinical potential for antiseptic treatment are scant. Clinical use of antiseptics for the treatment of infectious diseases should be explored and supported further.

Public health: Prevention comes of age

Sub-Saharan countries lag behind in screening and treatment for human papillomavirus. But national efforts and the introduction of low-tech methods could change that.