Humans with inherited T cell CD28 deficiency are susceptible to skin papillomaviruses but are otherwise healthy.

We study a patient with the human papilloma virus (HPV)-2-driven "tree-man" phenotype and two relatives with unusually severe HPV4-driven warts. The giant horns form an HPV-2-driven multifocal benign epithelial tumor overexpressing viral oncogenes in the epidermis basal layer. The patients are unexpectedly homozygous for a private CD28 variant. They have no detectable CD28 on their T cells, with the exception of a small contingent of revertant memory CD4+ T cells. T cell development is barely affected, and T cells respond to CD3 and CD2, but not CD28, costimulation. Although the patients do not display HPV-2- and HPV-4-reactive CD4+ T cells in vitro, they make antibodies specific for both viruses in vivo. CD28-deficient mice are susceptible to cutaneous infections with the mouse papillomavirus MmuPV1. The control of HPV-2 and HPV-4 in keratinocytes is dependent on the T cell CD28 co-activation pathway. Surprisingly, human CD28-dependent T cell responses are largely redundant for protective immunity.

Monogenic etiologies of persistent human papillomavirus infections: A comprehensive systematic review.

PURPOSE: Persistent human papillomavirus infection (PHPVI) causes cutaneous, anogenital, and mucosal warts. Cutaneous warts include common warts, Treeman syndrome, and epidermodysplasia verruciformis, among others. Although more reports of monogenic predisposition to PHPVI have been published with the development of genomic technologies, genetic testing is rarely incorporated into clinical assessments. To encourage broader molecular testing, we compiled a list of the various monogenic etiologies of PHPVI. METHODS: We conducted a systematic literature review to determine the genetic, immunological, and clinical characteristics of patients with PHPVI. RESULTS: The inclusion criteria were met by 261 of 40,687 articles. In 842 patients, 83 PHPVI-associated genes were identified, including 42, 6, and 35 genes with strong, moderate, and weak evidence for causality, respectively. Autosomal recessive inheritance predominated (69%). PHPVI onset age was 10.8 ± 8.6 years, with an interquartile range of 5 to 14 years. GATA2,IL2RG,DOCK8, CXCR4, TMC6, TMC8, and CIB1 are the most frequently reported PHPVI-associated genes with strong causality. Most genes (74 out of 83) belong to a catalog of 485 inborn errors of immunity-related genes, and 40 genes (54%) are represented in the nonsyndromic and syndromic combined immunodeficiency categories. CONCLUSION: PHPVI has at least 83 monogenic etiologies and a genetic diagnosis is essential for effective management.

Human papillomavirus prevalence and genotype distribution in Liaocheng men between 2016 and 2022.

Human papillomavirus (HPV) infection can lead to HPV-related cancer in men, including the anus, penile, and oropharyngeal cancers and precancerous lesions. This study retrospectively investigated HPV prevalence and genotype distribution in Liaocheng men between 2016 and 2022. The total HPV positive rate was 64.87% (2388/3681, 95% confidence interval [CI]: 63.32%-66.40%), where high risk (HR)-HPV and low risk (LR)-HPV accounted for 42.49% (1564/3681, 95% CI: 40.90%-44.09%) and 69.71% (2566/3681, 95% CI: 68.20%-71.17%), respectively. The mixed HPV infection rate of two and more genotypes was 35.72%. The infection rate of HR-HPV increased with the number of positive cases annually from 2016 (16.91%) to 2022 (46.59%). The most common HR-HPV genotypes were HPV16 (11.60%), HPV52 (6.95%), and HPV59 (6.28%), whereas the least common HR-HPV was HPV26. The most common LR-HPV genotypes were HPV6 (56.99%), HPV11 (23.79%), and HPV43 (6.37%). The 9 v HPV vaccine preventable for LR-HPV and HR-HPV accounted for 80.78% and 30.40%, respectively, in this study. Most HPV-positive patients aged 1-86 were in the 30-39 age group. This study confirmed that HPV prevalence in Liaocheng men was common and diverse. HPV16, HPV52, and HPV59 are widely distributed in Liaocheng men, and the male HR-HPV infection rate remained high in this region. Regarding public health and cancer prevention, it is recommended and effective to include the HPV vaccination in the national vaccination program for men.

Imaging features for the evaluation of skin and nail infections.

Clinical manifestations of dermatological and musculoskeletal conditions can sometimes overlap, leading to confusion in diagnosis. Patients with nail and skin infections may undergo imaging examinations with suspicions of muscle, tendon, or joint injuries. Dermatological infections often involve soft tissues and musculoskeletal structures, and their etiology can range from fungi, bacteria, viruses, to protozoa. Relying solely on physical examination may not be sufficient for accurate diagnosis and treatment planning, necessitating the use of complementary imaging exams. The objective of this paper is to present and discuss imaging findings of the main infectious conditions affecting the nail apparatus and skin. The paper also highlights the importance of imaging in clarifying diagnostic uncertainties and guiding appropriate treatment for dermatological conditions.

Efficacy of Intralesional Candida Antigen Versus Measles, Mumps, and Rubella Vaccine Versus Topical Podophyllin in Treatment of Resistant Genital Warts.

BACKGROUND: No single treatment is ideal for genital warts with high rate of resistance using conventional modalities as topical podophyllin; however, several intralesional immunotherapies are being tested nowadays, with variable results. In this study, we compared the safety and efficacy of treating resistant and recurrent genital warts by 2 intralesional immunotherapies [Candida antigen and measles, mumps, and rubella (MMR) vaccine] and compared them with topical podophyllin. PATIENTS/METHODS: A total of 45 patients with resistant or recurrent genital warts were enrolled in this study. Size and number of warts were detected in each patient, patients were divided into 3 groups. Group A injected with intralesional Candida antigen. Group B with intralesional MMR vaccine. Group C were treated with topical 25% podophyllin. Patients received a session every 2 weeks for 3 treatment sessions. RESULTS: With regard to the reduction in size and number of all warts, the best response was obtained in Candida antigen group where 46.7% showed complete clearance and 40% showed partial response followed by MMR group and the last was the podophyllin group, with no significant difference between them. Complete clearance of mother warts was noticed in 86.7% of Candida group, 53.3% in MMR group, and last 40% in podophyllin group, with a significantly better response in the Candida group (P = .027). CONCLUSION: Both intralesional Candida antigen and MMR vaccine are simple, safe, and effective treatment options with comparable results and better response than topical podophyllin.

Intralesional Measles, Mumps, Rubella Vaccine versus Tuberculin Purified Protein Derivative Injections in the Treatment of Palmoplantar and Periungual Warts: A Double-Blind Randomized Controlled Trial.

BACKGROUND: Palmoplantar and periungual warts tend to be recalcitrant. Intralesional immunotherapy can provide high efficacy with additional benefit to distant warts. However, evidence on comparative effects between intralesional immunotherapy with measles, mumps, rubella vaccine (MMR) and tuberculin purified protein derivative (PPD) and roles of dermoscopy in predicting treatment outcomes in palmoplantar/periungual warts is limited. OBJECTIVES: The study aimed to compare efficacy and safety of intralesional MMR and PPD injections in treatment of palmoplantar/periungual warts and explore associations between dermoscopic findings and treatment outcomes. METHODS: We conducted a double-blind randomized controlled trial involving 40 patients with palmoplantar/periungual warts who were equally assigned to receive MMR or PPD. Intralesional injection was done every 2 weeks until clearance or maximum of 5 treatments. RESULTS: Complete resolution was higher in MMR than PPD group (90.0% vs. 80.0% in index lesion and 81.3% vs. 54.6% in distant lesions, respectively), although the differences were statistically nonsignificant. Dermoscopic findings were not significantly associated with complete resolution. Local swelling, i.e., the most common adverse event, occurred more frequently in PPD (40.0%) than MMR group (10.0%). CONCLUSION: This study suggests that intralesional immunotherapy with either MMR or PPD is efficacious in palmoplantar/periungual warts, with MMR showing a trend toward higher clearance and lower adverse events.

Evaluation of the optimal sampling approach for HPV genotyping in circumcised heterosexual men with genital warts.

BACKGROUND: Human papillomavirus (HPV) causes a serious socioeconomic burden globally. However, there is currently no consensus on the optimal sampling method for HPVDNA genotyping in circumcised heterosexual men. This study aimed to determine the diagnostic efficacy of 6 different anatomic sampling sites in HPV DNA polymerase chain reaction (PCR) testing of circumcised heterosexual men with genital warts. METHODS: The study included circumcised heterosexual men who presented to our clinic with complaints of genital warts. Swab samples were obtained from the penile shaft (PS), scrotum, coronal sulcus (CS), and external urethral meatus (EUM). First-void urine (FVU) and genital wart biopsy (GWB) were also tested for HPV DNA by PCR. RESULTS: A total of 32 patients (mean age: 36.9 ± 6.9 years) were included. None of the six samples studied was sufficient on its own to reveal all HPV types detected in a patient. When the samples were analyzed individually, GWB detected an average of 49.5% of total HPV types in a patient. This rate was 50.5% for PS, 40.4% for CS, 31.6% for scrotum, 26.3% for EUM, and 15.8% for FVU samples. The detection rate increased to 75.8% with combined testing of GWB and PS samples, 83.2% with GWB/PS/CS, 90.5% with GWB/PS/CS/scrotum, and 98.9% with GWB/PS/CS/scrotum/EUM samples. CONCLUSION: No single anatomic region or sample type can detect all HPV types present in circumcised heterosexual men by PCR assay. The detection rate approaches 99% when wart biopsy is combined with swab sampling of the penile shaft, coronal sulcus, scrotum, and external urethral meatus.

The efficacy of intralesional vitamin D3 injection in the treatment of cutaneous warts: A clinical therapeutic trial study.

BACKGROUND: The human papillomavirus that causes warts is usually harmless, and it can infect any part of the skin or mucous membranes. Despite the availability of several treatments, warts often return, and scarring, pigmentation changes, and recurrence are all possible side effects. AIM: Intralesional vitamin D3 was employed as an immunotherapy for cutaneous warts in the current investigation. MATERIALS AND METHODS: In Al-Sadr Medical City in the city of Al-Najaf Al-Ashraf, a skin clinic conducted a therapeutic clinical experiment. A total of 204 cutaneous warts were examined in 40 patients (14 men and 26 females). Vitamin D3 solution of the dose (600 000 IU) was injected into the lesions' bases, with 0.2 mL per patient. Each session could only inject up to five warts. The injections were given every 2 weeks for a total of four times. Instructing patients to forego the use of any topical or oral medication was also a part of the protocol. Each patient was evaluated for recurrence risk before each therapy and then again 6 months later. RESULT AND DISCUSSION: There was a wide range of patient ages in this study, from 20 months to 52 years. About 65% of the cases included females. When looking at the many kinds of warts, the most prevalent was the common wart (71.6%). After four treatments, a positive response was considered to have occurred when all lesions had disappeared, a partial response when more than half of the lesions had disappeared, and no reaction when less than half of the lesions had disappeared. The final tally was 81.9% for those who responded in whole, 11.3% for those who responded partially, and 6.9% for those who did not respond at all. Next-session complete response rates were 12.7%, 29.9%, 54.9%, and 81.9%, respectively. Thirteen people experienced adverse symptoms, most noticeably minor swelling and itching. Within 6 months of follow-up, warts had completely disappeared for all patients with a partial or modest response except one who had no reaction. CONCLUSION: Vitamin D3 administered intralesional is an effective and low-cost treatment for cutaneous warts.

Dual-wavelength long-pulsed 755-nm alexandrite/1,064-nm Nd:YAG laser versus Nd:YAG alone for treatment of palmoplantar verruca.

We compared the effectiveness and safety of the long-pulsed neodymium-doped yttrium-aluminum-garnet (Nd:YAG) laser alone and combined with a 755-nm alexandrite laser for treating palmoplantar warts. We divided patients into two groups to receive up to four monthly treatments with Nd:YAG alone (single-wavelength) or combined with the alexandrite laser (dual-wavelength). We assessed treatment responses (according to clearance rate), vascular/hyperkeratosis grades, and patient satisfaction and pain ratings. The differences in treatment response (p = .348), patient satisfaction (p = .560), and pain ratings (p = .728) between the groups were not significant. The single- and dual-wavelength treatment options were equally effective in treating recalcitrant palmoplantar warts.

Efficacy of Cryotherapy Combined With Intralesional Purified Protein Derivative (PPD) Versus Intralesional PPD Monotherapy in the Treatment of Multiple Common Warts.

INTRODUCTION: Intralesional antigen immunotherapy represents a promising therapeutic approach for the treatment of different types of warts, particularly if multiple and/or recalcitrant. AIM: to investigate the efficacy and safety of combined cryotherapy with intralesional purified protein derivative (PPD) immunotherapy in the treatment of multiple common warts. METHODS: Fifty patients were randomly divided into two groups (25 patients each): Group A: receiving intralesional PPD immunotherapy for the largest wart, while group B: receiving cryotherapy for all warts plus intralesional PPD for the largest wart. Treatments were performed every 2 weeks for a maximum of four sessions. Photographs were taken at baseline and at each visit and clinical response was evaluated by the reduction in number and size of warts. Adverse effects were recorded. RESULTS: There was a significant reduction in size and number of warts in both groups (P < .001), with no significant difference between the two groups. Complete clearance of the lesions was observed in 48% of patients in group A and 44% in group B (P = .39). Higher rates of near complete/complete response were achieved after fewer sessions (2, 3 sessions) in group B (P = .002). Blistering was common after cryotherapy. Higher rate of hypopigmentation was noticed after combined treatment than after PPD monotherapy (56%, 8% respectively; P < .001), which resolved gradually. CONCLUSION: Both intralesional PPD alone and combined cryotherapy with PPD are safe and effective in clearing of common warts. Cryotherapy may be a successful adjunct to intralesional PPD immunotherapy that helps in reducing the number of treatment sessions.The study protocol was registered at ClinicalTrials.gov with ID: NCT04288817.

A Clinico-Pathological Study of Vulvo-Vaginal Disease at a Nigerian Tertiary Health Facility.

INTRODUCTION: The vulva and vagina are of great significance to womanhood owing to the myriads of specialized functions they perform. The diseases of this organ have physical, social, mental, and psychological ramifications. The aim of this work is to study the pathological pattern and clinical presentation of diseases of the vulva and vagina at the Department of Anatomical Pathology and Forensic Medicine of the Jos University Teaching Hospital between 1st January 2011 and December 31st, 2020. METHODOLOGY: This study is descriptive of all cases of histologically diagnosed vulval and vaginal lesions seen at the Center. Histological diagnosis, biodata, and clinical information of patients were retrieved from the medical records. Data realized were analyzed and presented in tables as simple frequencies, percentages, ranges, and measures of central tendencies. RESULTS: Two hundred and fifteen vulval and vaginal biopsies were included in the study. Squamous cell carcinoma was the commonest histologically diagnosed lesion accounting for 70(32.6%) cases of all lesions and 77.8% of all malignancies. The second commonest lesion and the most frequent benign pathology is the Condyloma acuminatum (viral warts) which accounted for 41(19.1%) cases. The age bracket 20 to 59 years constituted 79.5% of cases (171 cases). The age range, mean, median, and mode in years were 5.0-85.0, 39.5+15.9, 38.0, and 50.0 respectively. CONCLUSION: Squamous cell carcinoma and veneral warts are the commonest lesions of the vulva and vagina in our environment. Robust vaccination programs against the etiological agent, the human papilloma virus is highly recommended.

INTRODUCTION: La vulve et le vagin ont une importance considérable pour la féminité en raison des myriades de fonctions spécialisées qu'ils remplissent. Les maladies de cet organe ont des ramifications physiques, sociales, mentales et psychologiques. L'objectif de ce travail est d'étudier le modèle pathologique et la présentation clinique des maladies de la vulve et du vagin au département de pathologie anatomique et de médecine légale de l'hôpital universitaire de Jos entre le 1er janvier 2011 et le 31 décembre 2020. METHODOLOGIE: Cette étude est descriptive de tous les cas de lésions vulvaires et vaginales diagnostiquées histologiquement au Centre. Le diagnostic histologique, les données biologiques et les informations cliniques des patientes ont été extraits des dossiers médicaux. Les données obtenues ont été analysées et présentées dans des tableaux sous forme de fréquences simples, de pourcentages, d'intervalles et de mesures de tendances centrales. RÉSULTATS: Deux cent quinze biopsies vulvaires et vaginales ont été incluses dans l'étude. Le carcinome épidermoïde était la lésion histologiquement diagnostiquée la plus fréquente, représentant 70 (32,6 %) cas de toutes les lésions et 77,8 % de toutes les tumeurs malignes. La deuxième lésion la plus fréquente et la pathologie bénigne la plus fréquente est le condylome acuminé (verrues virales), qui représente 41 (19,1 %) cas. La tranche d'âge de 20 à 59 ans représentait 79,5 % des cas (171 cas). La fourchette d'âge, la moyenne, la médiane et le mode en années étaient respectivement de 5,0-85,0, 39,5+15,9, 38,0 et 50,0. CONCLUSION: le carcinome épidermoïde et les verrues générales sont les lésions les plus fréquentes de la vulve et du vagin dans notre environnement. Des programmes de vaccination robustes contre l'agent étiologique de cette pathologie, le virus du papillome humain, sont fortement recommandés. Mots clés: Vulve, Vagin, Cancer, Verrue.

Human papillomavirus prevalence and genotype distribution in Vietnamese male patients between 2016 and 2020.

Human papillomavirus (HPV) infection in men is a serious issue because it is associated with genital warts, anogenital cancers, and HPV transmission to their sex partners. This study aimed to investigate the prevalence and genotypes of HPVs in Vietnamese male patients hospitalized with sexually transmitted infection (STI) symptoms between 2016 and 2020 by using polymerase chain reaction and reverse dot blot hybridization analysis. HPV DNA was detected in 191/941 (20.3%) penile cell samples. The HPV patient's mean age was 30.3 in the range of 16- and 69-year-old. The highest HPV prevalence (84.7%) was found in patients between 20- and 39-year-old. A total of 313 HPV genotypes were identified. The multiple-infection rate was 42.9%. The most common high-risk (HR)-HPV genotypes were HPV-16 (8.0%), HPV-51 (7.7%), HPV-52 (4.8%), HPV-56 (4.2%), and HPV-18 (3.8%). Furthermore, HPV-11 and HPV-6 genotypes were the two most common low-risk (LR)-HPV genotypes with the rate of 36.7% and 21.4%, respectively. Notably, HPV-52 was found circulating in Vietnam for the first time. In conclusion, this study results showed that HPV prevalence in Vietnamese male patients was common and diverse. In addition, regarding public health and cancer prevention, the inclusion of the HPV vaccination into the national vaccination program for both men and women is recommended.

Investigation of frequency and typing of human papillomavirus among genital warts using a reverse dot blot hybridization approach.

BACKGROUND: Human papillomavirus (HPV) is the most common sexually transmitted infection worldwide, affecting about 80% of women up to the age of 50. The persistent infection of high risk-HPV types (HR-HPV) is the leading cause of cervical cancer, the fourth most common cancer of women. Therefore, we aimed to evaluate the frequency and typing of HPV in the genital lesions in the Iranian population. METHODS: This descriptive-analytic study was conducted on a population in the South-Khorasan province of Iran. All of the participants were sexually active and were checked for evident cervical warts. Biopsy samples were collected from various lesions, and all samples were tested for detection and genotyping of HPV using a reverse dot blot hybridization method (HPV direct flow CHIP). RESULTS: In overall, 370 samples were evaluated; 10 cases (2.7%) were male and the rest were female. The mean age of patients was 33.3 ± 8.5 years, of which 48.1% were in the age range from 25 to 36 years. Among the samples, 345 (93.2%) were positive for HPV-DNA; the low risk HPV types (LR-HPV) and HR-HPV were identified among 80.9% and 15.5% of tissue samples, respectively. Among the LR-HPV, HPV-6, 11, 42 and 54 were the most common genotypes, and HPV-16 and 39 were prevalent HR-HPV types detected. The number of pregnancies, marriage age, and partner infection were not significantly related to the HPV types. Types 42 had a declining pattern toward aging, and HPV-11 was increasing toward aging. CONCLUSION: The number of samples with HR-HPV was rather high. Due to the greater frequency of infection in the age range of 25-35 years, it is advised that all individuals referred to gynecological clinics at gestational age be tested for HPV types.

Intralesional injection of purified protein derivative versus Candida antigen in treatment of genital warts.

The Genital warts are common sexually transmitted diseases caused by definite types of human papillomavirus. There are many strategies for the treatment of genital wart and intralesional immunotherapy is considered to be a safe and effective treatment modality. However, there are lack of studies that comparing the clinical effectiveness of intralesional purified protein derivative (PPD) and Candida antigen (CA) in genital wart treatment. To investigate the effectiveness and safety of PPD and CA in the treatment of genital warts. Eighty patients were enrolled in this study and were randomly divided into 2 groups with 40 patients in each. Each antigen was injected intralesionally at a dose of 0.1 ml into the largest wart every 2 weeks until complete improvement or for a maximum of four sessions. Complete clinical response was demonstrated in 65%, 62.5% in PPD and CA groups, respectively. There was no statistically difference between both groups. After the 3-month follow-up period, 72.5%, 85% of patients showed complete clearance in PPD and CA groups respectively. Side effects were mild and insignificant in both groups. Recurrence was observed in only one patient in each group. Immunotherapy by intralesional PPD and CA injection is considered to be effective and well-tolerated modalities in treatment of genital wart with minimal side effects and recurrence rate compared to other modalities.

Home treatment of single cutaneous warts combining face-to-face and teledermatology consultation: A new perspective.

During the COVID-19 pandemic, teledermatology services were set up and enhanced to take care of those benign conditions like cutaneous warts (CWs) which, if undiagnosed or treated with delay, could have worsened, enlarged, and potentially spread to the community. The aim of this hybrid exploratory trial was to combine face-to-face clinical and dermoscopic evaluation with teledermatology follow-up in the management of CWs with a cryogenic pen based on nitrous oxide for home treatment. Twelve adult patients affected by CWs were enrolled. During the first face-to-face visit, single CWs were selected for the study by clinical and dermoscopic evaluation. The home schedule consisted of one application to be repeated after 2 weeks, when signs of CWs were still evident. Patients were also asked to send a clinical photo of the treated lesion at weekly intervals. A final face-to-face evaluation was scheduled to verify the response to home treatment by clinical and dermoscopy evaluation. A total of 20 CWs located on the trunk and the extremities were treated: a complete clinical and dermoscopic resolution was observed in 16 out of 20 lesions (80%), and a partial response in two cases. The adverse events observed during treatment were comparable to those normally observed with cryotherapy of CWs. In conclusion, home treatment of CWs with the cryogenic pen, that should be always preceded by dermatologist diagnosis and prescription, is safe and effective, especially if combined with face-to-face and teledermatology consultations, pointing out its important role during pandemic times or in any other environmental limitations that may impair the access to medical care services. The combination of face-to-face consultations for initial and final visits and teledermatology during the treatment phase could represent a model for other dermatologic conditions as well (e.g., acne, rosacea, psoriasis, atopic eczema etc.).

A multi center real world observation to evaluate the efficacy of cryotherapy versus local hyperthermia for the treatment of plane warts.

Most plane warts are recalcitrant to treatment. Both cryotherapy and local hyperthermia have been applied to treat plane warts. However, no direct comparative study on their respective efficacy and safety has ever been performed. To assess the efficacy and safety of local hyperthermia at 43 ± 1°C versus liquid nitrogen cryotherapy for plane warts. Sequential patients with plane warts entered the study, either receiving cryotherapy or local hyperthermia therapy at the discretion of the patients and the recommendations of consultants. Cryotherapy with liquid nitrogen was delivered in two sessions 2 weeks apart, while local hyperthermia was delivered on three consecutive days, plus two similar treatments 10 ± 3 days later. The temperature over the treated skin surface was set at 43 ± 1°C for 30 min in each session. The primary outcome was the clearance rates of the lesions 6 months after treatment. Among the 194 participants enrolled, 183 were included in the analysis at 6 months. Local hyperthermia and cryotherapy achieved clearance rates of 35.56% (48/135) and 31.25% (15/48), respectively (p = 0.724); recurrence rates of 16.67% (8/48) and 53.33% (8/15) (p = 0.01); and adverse events rates of 20.74% (28/135) and 83.33% (40/48), respectively (p < 0.001). Cryotherapy had a higher pain score (p < 0.001) and a longer healing time (p < 0.001). Local hyperthermia at 43°C and cryotherapy had similar efficacy for plane warts. Local hyperthermia had a safer profile than cryotherapy but it required more treatment visits during a treatment course. More patients preferred local hyperthermia due to its treatment friendly nature.

A rare case of self-healing giant condyloma acuminatum.

Giant condyloma acuminatum (GCA) which is also called Buschke-Lowenstein tumor. It is a rare tumor of the anorectal area and external genitalia associated with low-risk HPV types 6 or 11. GCA has a high-rate of recurrence (66%) and malignant transformation (56%). The clinical features of GCA are progression of exophytic, ulcerative, and cauliflower-shaped tumors, it has significant dimensions and may undergo malignant transformation such as squamous cell carcinoma or cervical cancer. It is difficult to treat GCA, and it may be impossible for GCA to self-healing, but we herein report a rare case of a 19-year-old female with self-healing GCA.

Sexual dysfunction in women with genital warts: a systematic review.

PURPOSE: To provide an understanding of the changes in sexual function in women with genital warts. METHODS: In this review study, databases searched included: PubMed, Science Direct, Scopus, Web of Science, Cochrane Library of Systematic Reviews, Google Scholar, ProQuest, Wiley, and Highwire Press. No study design limitations were applied to the initial search, and qualitative and quantitative studies published between 2005 and 2021 were included. RESULTS: 19 articles were selected and analyzed narratively. The quality of the studies was almost good. The findings were classified into three groups: The prevalence of sexual dysfunction in women with genital warts (GWs) and Human Papillomavirus (HPV); Types of sexual dysfunction in women with genital warts, and associated factors; Psychosexual effects of genital warts. CONCLUSION: This study provides up-to-date evidence of the changes in sexual function in women with genital warts. Although the results of most studies showed that women with genital warts experienced sexual dysfunction in almost all dimensions, differences in study design and study population made it difficult to determine the specific type of disorder such as libido, or arousal disorders in these women. Based on the findings of this review, more research in this field is recommended for the future. SYSTEMATIC REVIEW REGISTRATION: (PROSPERO: CRD42020188584, https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=188584 ).

Asian guidelines for condyloma acuminatum.

The present guidelines aim to provide comprehensive information on genital condyloma acuminata, including the epidemiology, clinical features, diagnosis and management. The guidelines provide evidence-based recommendations on the diagnosis, prevention and treatment of genital condyloma acuminata in adults in Asia, including patients with HIV co-infection. METHODOLOGY: A PubMed search was performed, using the keywords "condyloma acuminata", "anal wart", "anogenital wart", "genital wart" and "genital HPV". A total of 3031 results were found in publications during last six years. A careful review of the titles and abstracts was done to find all the studies pertaining to epidemiology, clinical features, diagnosis, treatment and prevention of condyloma acuminata. DIAGNOSIS: Various diagnostic procedures described are: 1. PCR (LE: 2b). 2. Serology (LE: 2b). 3. In-situ hybridization (LE: 3). PREVENTION: 1. Vaccination (LE: 1a): Quadrivalent vaccine reduced the frequency of anogenital warts in both vaccinated and unvaccinated contacts. According to the update Advisory Committee on Immunization Practices (ACIP) recommendations, the following protocol is recommended: (a). HPV vaccination at age 11 or 12 years for both males and females. (b). Catch-up vaccination for all persons through age 26 years. (c). Shared clinical decision-making regarding potential HPV vaccination for persons aged 27-45 years, who are at risk of new HPV infection. 2. Male circumcision (LE: 2a): conflicting evidence. HIV AND CONDYLOMA ACUMINATA: In HIV-affected individuals, the course of HPV is more aggressive, with a greater risk of treatment resistance, increased chances of intraepithelial neoplasia as well as cancers. TREATMENT: Physician administered. 1. Photodynamic therapy (LE: 1a). 2. Laser (LE: 2b). 3. Surgery (LE: 1a). 4. Electrosurgery (LE: 2c). 5. Cryotherapy (LE: 1b). 6. Immunotherapy (LE: 1b). 7. Podophyllin (LE: 1b). Provider administered. 1. Imiquimod 5%(LE: 1a). 2. Podophyllotoxin (LE: 1b). 3. Sinecatechins (LE: 1a). 4. Cidofovir (LE: 3). 5. 5- Fluorouracil (LE: 1a). 6. Interferon (LE: 1a).

Airborne particulate concentration during non-thermal nano-pulse stimulation wart clearance is negligible compared to thermal modalities.

OBJECTIVES: As clinicians continue to implement safety protocols amid the global pandemic, considerations to mitigate potential viral transmission of airborne particulates (plume) generated from certain dermatologic procedures are of growing interest. This study intended to measure the change in airborne particulate matter using a non-thermal energy modality called nano-pulse stimulation (NPS) and compare levels of concentration to common thermal modalities (CO2 laser and electrocautery). NPS is a new non-thermal modality that applies nanosecond pulses of electrical energy to induce regulated cell death in cellular structures while sparing the surrounding acellular structure of the dermis. MATERIALS AND METHODS: The study used a Condensation Particle Counter during four types of dermatologic procedures: (1) using non-thermal NPS for the clearance of cutaneous, nongenital warts; (2) an electrocautery treatment of warts; (3) a CO2 laser for facial resurfacing; and (4) an electrocautery procedure for a facelift. Four subjects and a total of 11 warts were treated with NPS while a particle counter was used to detect the average particles per cubic centimeter once per second. The same particle counter was used, for comparison, during a wart removal procedure using electrocautery for comparison, and for control, during a skin resurfacing procedure with a CO2 laser and a facelift in which electrocautery was used. RESULTS: Only one of the 11 NPS wart procedures generated any detectable change in the particulate concentration and that change was negligible in comparison to the increase in particulate concentration measured during the CO2 laser resurfacing and the electrocautery use during a facelift procedure. CONCLUSIONS: Procedures using non-thermal NPS technology do not generate significant plume when applied to eliminate warts, suggesting it is unlikely that this new energy modality would release viral DNA into the air.