Effectiveness of HPV vaccines against genital warts in women from Valencia, Spain.

OBJECTIVES: To assess the effectiveness of the HPV vaccines in preventing genital warts in young women. DESIGN: Population-based study using health databases. SETTING: Valencian Community (Spain). PARTICIPANTS: All girls and women aged 14-19years who were registered in the Valencian Community between January 2009 and December 2014 (n=279,787). MAIN OUTCOME MEASURES: Incident cases of genital warts were defined as the first activation of diagnosis code ICD-9-CM 078.11 (Condyloma acuminatum) in primary care and outpatient clinics during the study period. RESULTS: There were 612 cases of genital warts. The overall incidence rate was 75.8/100,000 person-years (95% CrI 69.7-81.8). There was a decrease in genital warts when female candidates to be vaccinated with quadrivalent HPV vaccine reached the age of 18 (in 2012), compared to previous years. Incidence of genital warts in unvaccinated women and those who received the bivalent vaccine was higher than in girls and women who received the quadrivalent HPV vaccine. The effectiveness of a three-dose regimen of the quadrivalent HPV vaccine was 77% (95 CrI: 66-85%), whereas that of a single dose was 61% (95 CrI: 20-87%). No effectiveness was seen with a full vaccination course with the bivalent HPV vaccine. CONCLUSIONS: Three doses of the quadrivalent HPV vaccine were effective against genital warts in our population. Moreover, with low vaccine coverage the incidence of genital warts decreased only in the vaccinated.

Validation and clinical use of the CECA, a disease-specific quality of life questionnaire for patients with anogenital condylomata acuminata.

The aim of this validation study was to assess the measurement properties of the CECA (Spanish acronym for the Specific Questionnaire for Condylomata Acuminata) in patients with anogenital condylomas. A total of 247 patients aged > 18 years completed the questionnaire on 2 occasions as well as the Dermatology Life Quality Index (DLQI). The CECA questionnaire showed good internal consistency (Cronbach's alpha values of 0.86 and 0.91 in the emotional and sexual activity dimensions) and good testretest reliability (intraclass correlation coefficient 0.76 emotional dimension, 0.82 sexual activity dimension). Patients with de novo lesions and those with more extensive lesions and larger number of warts showed poorer health-related quality of life. CECA and DLQI scores correlated moderately. Patients whose lesions cleared at follow-up or with a reduction of >or= 50% showed a better improvement of health-related quality of life. The CECA questionnaire is a valid, reliable and sensitive tool for the assessment of health-related quality of life in patients with anogenital warts.

[Behçet disease: study of 74 patients]. / Enfermedad de Behçet: estudio de 74 pacientes.

BACKGROUND AND OBJECTIVE: Behçet disease (BD) has a low prevalence in the Spanish population. Only a few reports have been published on the clinical features of BD in our country. The aim of this study is to determine the type and frequency of these features of BD in a population of patients in the Community of Valencia. PATIENTS AND METHOD: We retrospectively studied clinical data from patients with BD diagnosed between 1990 and 2005 in La Fe, General and Doctor Peset Universitary Hospitals. All Patients fulfilled the International Study Group Criteria for the diagnosis of BD. Statistical analysis was carried out using the chi2 test. RESULTS: Seventy four patients (40 male and 34 female) were studied. The most frequent manifestations were oral (98.5%) and genital aphthae (82.4%), followed by cutaneous lesions (64.2%), ocular lesions (42.5%), fever (39.4%) and vascular manifestations (28.4%). Venous manifestations were more frequent than arterial events. Gastrointestinal lesions occurred more frequently in females compared with males (p = 0.002). Vascular and ocular manifestations were more severe in males than in females. With respect to cardiovascular risk factors, 32.4% of patients were smokers, 20.3% were hyperlipidemic, 19% hypertensive, 13.5% obese and 9.5%diabetic. Cardiovascular risk factors were not related to thrombotic events or posterior uveitis in these patients (p > 0.05). CONCLUSIONS: BD in patients in the community of Valencia is characterized by a variety of clinical manifestations similar to other geographical areas. Gastrointestinal manifestations occur more frequently in female patients, and venous thrombotic manifestations were more frequent than arterial events. Cardiovascular risk factors do not seem to play a role in the development of thrombotic events and posterior uveitis in these patients.

Effectiveness of an educational leaflet on the prevention of external genital warts recurrences.

The study aims to assess the effectiveness of an educational leaflet in the prevention of external genital warts recurrences after achieving clearance with topical immune response modifiers treatment. A six-month follow-up, prospective, open, multi-centre randomized by centres study was conducted, which included a total of 216 patients. A total of 103 (47.7%) patients were given an educational leaflet. In all, 201 subjects (93.1%) came to the second follow-up visit, of which 62.7% achieved condyloma acuminatum (CA) clearance. During follow-up, 15% (confidence intervals [CI] 95%, 7.1-26.6%) of the patients who were given the educational leaflet, and 33.3% (CI 95%, 20.4-48.4%) of those who were not given the educational leaflet showed CA recurrences; the global rate of CA recurrence at the end of the six-month follow-up was 23.1% (CI 95%, 15.6-32.2%). The educational leaflet has therefore proved to be effective at reducing the recurrence rate after successful treatment with immune response modifiers.

Combination of qualitative and quantitative methods for developing a new Health Related Quality of Life measure for patients with anogenital warts.

BACKGROUND: Anogenital warts are the most easily recognized sign of genital Human Papilloma Virus infection. The objective was to develop a short, valid and reliable questionnaire to measure Health Related Quality of Life (HRQL) in patients with anogenital warts. METHODS: First a literature review was performed to identify relevant papers describing the impact of anogenital warts in HRQL; second the main domains were identified by some experts in a focus group, and third in-depth-semi-structured interviews were conducted in patients with anogenital warts to identify the initial set of items. A qualitative reduction of the initial set of items was performed based on the mean scoring of the experts for the three scales: clarity, frequency and importance. The initial questionnaire was pilot tested in 135 patients. Rasch analysis was performed with the results of the questionnaire in order to refine the instrument. Spearman's correlation was calculated between the initial questionnaire and the reduced version. Additionally the measurement properties (validity and reliability) of the resulting final questionnaire were tested and compared using standard procedures (Cronbach's Alpha and item-total correlation). RESULTS: the main domains identified as affected in patient's life were: sexual, colleagues and partner relationships. After a proper qualitative reduction the initial set of 134 items was reduced to 22. The questionnaire was pilot tested in 135 patients and two dimensions were identified after the multifactorial analysis: emotional dimension and sexual activity dimension. As a result of the Rasch analysis the questionnaire was reduced to 10 items. High correlation was found between the initial and the reduced version for the two dimensions. Cronbach's alpha values were acceptable (0.86). CONCLUSION: The initial 22 items questionnaire was reduced by Rasch analysis to a version of 10 items, with two dimensions: emotional and sexual. The results suggest the adequacy of the 10 items to evaluate HRQL of patients with anogenital warts in a valid and reliable way.

Effectiveness, satisfaction and compliance with imiquimod in the treatment of external anogenital warts.

This study aims to evaluate the effectiveness of imiquimod treatment of external anogenital warts and analyse its possible relationship with patient treatment satisfaction and compliance under conditions of routine clinical practice. An observational, prospective and multi-centre study was conducted in a cohort of 559 patients with external anogenital warts. Imiquimod 5% cream was administered three times a week until the end of treatment (complete wart clearance or up to a maximum of 16 weeks). Effectiveness and compliance were evaluated at four weeks and again at the end of treatment, when satisfaction was also assessed. Complete wart clearance was experienced by 66.6% of patients at the end of treatment and a 50% or greater reduction in total wart area occurred in 79.5%. Imiquimod was more effective in patients who were more satisfied and compliant with treatment. Under conditions of routine clinical practice, imiquimod is an effective treatment for external anogenital warts.