Anogenital Human Papillomavirus Prevalence is Unaffected by Therapeutic Tumour Necrosis Factor-alpha Inhibition.

Patients receiving tumour necrosis factor alpha (TNF-α) inhibitors are at increased risk of exacerbation of (myco-)bacterial and some viral infections. However, information on anogenital human papillomavirus (HPV) infection in these patients is sparse or conflicting. In this study 222 patients with psoriasis or inflammatory bowel disease (IBD), who received either anti-TNF-α inhibitors or alternatives (purine-, folic acid analogues, phototherapy, fumaric ester, mesalazine) continuously for at least 6 months, were evaluated for the presence of anogenital HPV-induced lesions, mucosal HPV DNA, and serological status of mucosal low-risk HPV6 and high-risk HPV16/HPV18. Hallmarks of anogenital HPV infection were more frequently detected in patients with psoriasis than in those with IBD. HPV-induced lesions, viral DNA, and seroprevalence were not elevated in participants with psoriasis or IBD, who received TNF-α inhibitors for a mean duration of 31.4 months (range 6-96 months) compared with recipients of alternative or no treatment. TNF-α blockade for a mean period of 31.4 months does not increase detectable anogenital HPV infection or disease.

Update on the treatment of genital warts.

This review summarizes new treatments from the last seven years employed for the treatment of genital warts caused by human papillomavirus (HPV). Imquimod 3.75% is a new agent with fewer side effects and perhaps a better dosing schedule than imquimod 5%, but is not more effective. Sinecatechins/Polyphenon E 15%, a novel extract from green tea can be effective against genital warts but requires three times a day dosing and is not more effective than existing treatments; the treatment course is 12-16 weeks. Photodynamic therapy combined with other destructive modalities might increase the cure rate for genital warts. The quadrivalent vaccine against HPV 6, 11, 16, 18 is decreasing the incidence of warts in the western world but the evidence does not support vaccination as a treatment for those already infected by HPV. Hyperthermia and immunomodulators might be positive additions to the armamentarium of clinicians. In sum, there are new tools that physicians can use but none is really a great advance over what was available a decade ago.

Incidence of genital warts in adolescents and young adults in an integrated health care delivery system in the United States before human papillomavirus vaccine recommendations.

BACKGROUND: Information on genital wart incidence in adolescents and young adults before human papillomavirus (HPV) vaccination is important for understanding the impact of the vaccine on the epidemiology of this early outcome of HPV infection. METHODS: The study population included 11- to 29-year-old enrollees of Northern California Kaiser Permanente between July 1, 2000, and July 1, 2005, before the availability of the HPV vaccine. We identified genital warts with an algorithm combining genital wart-specific International Classification of Diseases, Ninth Revision, Clinical Modification codes (078.10, 078.11, and 078.19) with physician-recorded anatomic locations. We calculated sex- and age-specific incidence rates of genital warts and described the specific anatomic location of presentation, as well as recurrences of genital warts. RESULTS: We identified 1,682 cases of genital warts among 181,264 individuals. The incidence rate was highest among women (6.3/1000 person-years) and men (2.9/1000 person-years) aged 20 to 24 years old. Among women (n = 96,792), 63.4% of the 1240 incident genital wart cases occurred on the vulva and 21.1% on the cervix. Among men (n = 84,472), 91.6% of the 442 incident genital wart cases did not have a specific anatomic location recorded. Most people with an incident genital wart diagnosis (87.2%) did not have a recurrence during the observation period. CONCLUSIONS: Our study found that the incidence of genital warts was highest among persons aged 20 to 24 years using a unique method to identify the location of the wart. Information on incidence of genital warts before vaccine use provides baseline data that can be used to measure HPV vaccine impact.

Eficacia terapéutica comparativa entre la podofilina y el allium sativum en el condiloma acuminado / Comparative therapeutic eficiency between podophylline and allium savitum in verruga acuminata

Se realizó un estudio abierto, controlado, para comparar la eficacia de podofilina 25 por ciento y Allium sativum en el tratamiento del Condiloma Acuminado. Se incluyeron al azar 30 pacientes: 15, en el grupo A y 15, en el grupo B, en la consulta dermatológica del Hospital Universitario Celia Sánchez Manduley (2006-2007); aplicando al grupo A podofilina 25 por ciento, 2 veces a la semana, y el grupo B Allium sativum, 2 veces por semana. Ambos productos tópicamente por 6 semanas. La eficacia terapéutica fue evaluada una semana después de culminar el tratamiento comparando el estado inicial y final de las lesiones. A los pacientes curados, se les realizó seguimiento trimestral durante un año para detectar posibles recidivas. La eficacia terapéutica fue mejor en el grupo B (73,3 por ciento) con menos recidivas (9,1 por ciento), aunque estadísticamente la diferencia fue poco significativa. El resultado empezó a verse generalmente entre la 3-4 semana del tratamiento. Se demostró la eficacia del Allium sativum en esta dermatosisAU)

An opened and controlled study was carried-out, to compare the efficiency of Podophylline 25 percent and Allium sativum in the treatement of verruca acuminata. 30 patients were taken at random: 15 in group A and 15 in group B in the Dermatology consultation of Celia Sánchez M. Universitary Hospital in the year 2006-2007; applaying to group A, Podophylline 25 percent twice per week and Allium savitum to group B twice per week. Both products per six weeks. The therapeutic efficiency was evaluated a week after finishing the treatment comparing the initial state and final lesion. To the cured patients a tracking every three months was carried out during the whole year to detect possible relapses. The therapeutic efficiency was better in group B (73,3 percent) with less relapses (9,1 percent), although statistically the difference was less significant. The results started to be seen between the three-four weeks of treatment. The eficiency of Allium sativum was proved in this dermatoid lesions(AU)

La quimiopuntura, nueva estrategia de tratamiento del paciente con condiloma acuminado recidivante / Chemopuncture, new strategy to treat patients with recidivant acuminated condyloma

El tratamiento de afecciones médicas basado en la inyección en ciertos puntos acupunturales con productos químicos, mediante la cual la absorción del producto es mucho mayor, se conoce con el nombre de Quimiopuntura o Farmacopuntura. Teniendo en cuenta la alta incidencia de pacientes con condilomas acuminados recidivantes en nuestra consulta y la ausencia de tratamientos que controlen las tasas de recidivas, decidimos evaluar la eficacia de la Quimiopuntura con el empleo de la vitamina B 12 subcutáneo en puntos inmunoestimulantes en Clínica MININT provincial, ya que se conoce la relación de las recidivas de esta afección con el estado inmune de los pacientes afectados. Usando el método de aleatorización simple sin reemplazo, distribuimos a nuestros pacientes con diagnóstico clínico de condilomas acuminados recidivantes en dos grupos (n= 30 para cada grupo). El Grupo A (control) se trató con crioterapia (inmunomodulador tópico) y el Grupo B (experimental) con quimiopuntura. Los pacientes fueron evaluados quincenalmente durante los tratamientos y mensualmente post-tratamiento durante 6 meses. Con esta investigación se demuestra que la quimiopuntura con vitamina B12 es eficaz en el control de la recidiva de los condilomas acuminados(AU)

The treatment of medical affections based on the injections in certain acupunctural points with chemical products, through which the absorption of the products is higher, is known by the name of chemopuncture or pharmacopuncture. Taking into account the high incidence of patients with recidivant acuminated condylomas in our consultation and the lack of treatments controlling the recidivant rate, we decided to evaluate the efficacy of chemopuncture using subcutaneous B 12 vitamin in immunostimulant points at the provincial INTMIN clinic, because it is known the relationship of this affection recidivants with the immune status of the affected patients. Using the simple randomized method without replacement, we divided our patients with a clinic diagnosis of recidivant acuminated condylomas in two groups (n= 30 for each group). The Group A (control) patients were treated with cryotherapy (topic immunomodulator) and the Group B (experimental) patients with chemopuncture. Patients were evaluated fortnightly during the treatment and monthly during six months after the treatment. This investigation showed that chemopuncture with B 12 vitamin is efficacious in controlling the recidivism of the acuminated condylomas(AU)

La quimiopuntura, nueva estrategia de tratamiento del paciente con condiloma acuminado recidivante / Chemopuncture, new strategy to treat patients with recidivant acuminated condyloma

El tratamiento de afecciones médicas basado en la inyección en ciertos puntos acupunturales con productos químicos, mediante la cual la absorción del producto es mucho mayor, se conoce con el nombre de Quimiopuntura o Farmacopuntura. Teniendo en cuenta la alta incidencia de pacientes con condilomas acuminados recidivantes en nuestra consulta y la ausencia de tratamientos que controlen las tasas de recidivas, decidimos evaluar la eficacia de la Quimiopuntura con el empleo de la vitamina B 12 subcutáneo en puntos inmunoestimulantes en Clínica MININT provincial, ya que se conoce la relación de las recidivas de esta afección con el estado inmune de los pacientes afectados. Usando el método de aleatorización simple sin reemplazo, distribuimos a nuestros pacientes con diagnóstico clínico de condilomas acuminados recidivantes en dos grupos (n= 30 para cada grupo). El Grupo A (control) se trató con crioterapia (inmunomodulador tópico) y el Grupo B (experimental) con quimiopuntura. Los pacientes fueron evaluados quincenalmente durante los tratamientos y mensualmente post-tratamiento durante 6 meses. Con esta investigación se demuestra que la quimiopuntura con vitamina B12 es eficaz en el control de la recidiva de los condilomas acuminados.

The treatment of medical affections based on the injections in certain acupunctural points with chemical products, through which the absorption of the products is higher, is known by the name of chemopuncture or pharmacopuncture. Taking into account the high incidence of patients with recidivant acuminated condylomas in our consultation and the lack of treatments controlling the recidivant rate, we decided to evaluate the efficacy of chemopuncture using subcutaneous B 12 vitamin in immunostimulant points at the provincial INTMIN clinic, because it is known the relationship of this affection recidivants with the immune status of the affected patients. Using the simple randomized method without replacement, we divided our patients with a clinic diagnosis of recidivant acuminated condylomas in two groups (n= 30 for each group). The Group A (control) patients were treated with cryotherapy (topic immunomodulator) and the Group B (experimental) patients with chemopuncture. Patients were evaluated fortnightly during the treatment and monthly during six months after the treatment. This investigation showed that chemopuncture with B 12 vitamin is efficacious in controlling the recidivism of the acuminated condylomas.

[Contribution of palaeopathology to defining the pathocoenosis of infectious diseases (Part two)]. / Apporti della paleopatologia alla definizione della patocenosi delle malattieinfettive (II parte).

In the second part of their review the authors focus on palaeopathological studies, performed in mummified tissues, with reference to infectious diseases. The analysis of samples obtained from both natural and artificial mummies may provide, in some favourable events, a more complete knowledge of these findings in comparison to information obtained from only comprehensive examination of the skeleton. The acquired data enable us to understand not only the diseases which afflicted mankind, but also dietary and hygiene conditions of ancient populations. We report knowledge acquired regarding some palaeopathological conditions, including schistosomiasis, smallpox, cisticercosis, trichinosis, ascaridiasis, echinococcosis, filariasis, hepatitis E virus, condylomatosis, pulmonary tubercolosis, pediculosis, visceral leishmaniasis as well as Diphyllobotrium sp., Dicrocoelium dendriticum and Fasciola hepatica infestations. In addition some interesting findings concerning the relationship between dietary and food intake colonized by streptomyces are described. This review reports the discovery of human remains from different geographic areas: while most of these studies describe findings in two Mediterranean countries (Italy and Egypt), some refer to Britain and German-speaking countries (Austria and Germany) as well as the area in Africa known as Nubia, along the Nile. Both histological and biomolecular diagnosis are useful not only to identify a specific disease in a subject from the remote past, but also to achieve information concerning its frequency and evolution. Such knowledge may thus allow us to understand the intensity of cultural exchanges and links among different populations and the role of these relationships in transmitting and spreading infectious diseases in a certain geographic area.

[Polyphenon E. A new topical therapy for condylomata acuminata]. / Polyphenon E. Eine neue topische Therapie für Condylomata acuminata.

Treatment of genital warts (condylomata acuminata) is still not completely satisfactory, despite the introduction of imiquimod 5% cream. With the development of Polyphenon E 15% ointment, progress has been made towards optimized, patient-friendly treatment of genital warts. Polyphenon E is a mixture of different polyphenols/catechins from green tea extracts (Camilla sinensis), which are known to have antioxidative, antiinflammatory, anti-proliferative and anticancer activities. In 3 placebo-controlled clinical studies safety and efficacy of Polyphenol E 15% ointment was studied in a total of 1400 patients with genital warts from Europe, North- and South America as well as South Africa. Complete responses with total healing of genital warts were seen in 54.9% of the patients in contrast to 35.4% of patients receiving placebo (p >0.001) (Combined study data). The recurrence rate was 6.2%. Polyphenon E offers special advantages with regard to its very good safety profile. Systemic adverse reactions are unlikely. Mild to moderate local reactions are of short duration. "Drug-holidays" are not necessary and the ointment does not have to be washed off. There is no contraindication for uncircumcised men with genital warts.

Nursing care and treatment of the patient with human papillomavirus.

Human papillomavirus is a common and highly contagious virus that causes genital warts, which are not only unsightly, but the treatment may also be complex and the results of such treatment variable. For the patient this may result in physical and psychological trauma. Over 100 genotypes of the virus have been identified and a number of these can result in benign tumours of the skin and mucosa. Others however, are associated with intraepithelial neoplaisa of the vulva, cervix, penis and anus and squamous cell carcinoma. The nurse can provide the patient with the physical and psychological support the patient needs only if he/she has insight and understanding regarding the infection, its natural history, the diagnosis and subsequent management. Care should be provided in a non-judgmental manner, with respect and empathy.

[Incidence and management of condylomata acuminata by French general physicians]. / Incidence et prise en charge des condylomes acuminés externes en médecine générale.

OBJECTIVES: Condylomata acuminata (or genital warts) are sexually transmitted diseases caused by human papillomavirus. Until now, there has been no available epidemiologic data about this disease in France. We conducted a prospective study among French general practitioners (GPs) to estimate the incidence of consultations for external condylomata acuminata in general practice. We also assessed the management of patients with external condylomata acuminata by French GP's. DESIGN: A panel of French general practitioners, members of the Sentinel network, had to fill-in prospectively a questionnaire for each patient with condylomata acuminata diagnosed between July and November 2000. RESULTS: The annual number of consultations for external condylomata acuminata with French GP's was estimated at 23,000 (CI (95 p. 100) 21,000-25,000) including 15,000 new cases (CI (95 p. 100) 13,000-17,000). Taking into account the estimations we made at the same time in office-based private dermatologists, we estimated the annual incidence of external condylomata acuminata in France at 107/100 000 inhabitants. The management of patients with external condylomata acuminata by French GP's was in accordance with the European guidelines in 54 to 78 p. 100 of cases. French GP's mostly prescribed chemical treatment. DISCUSSION: A proportion of cases of condylomata acuminata may have not been diagnosed. Similarly, some lesions may have been wrongly diagnosed as condylomata acuminata, but these proportions of false positive and false negative remain unknown. The incidence of external condylomata acuminata in France is similar to those estimated in others developed countries.

The epidemiology and treatment of anogenital warts in Singapore: a retrospective evaluation.

INTRODUCTION: A retrospective study in the referral centre for sexually transmitted infections (STIs) in Singapore to describe the epidemiology and treatment outcome of patients with anogenital warts. SUBJECTS AND METHODS: We reviewed the case records of 301 patients with anogenital warts who were seen over a 1-year period (1999). We also attempted to interview every patient by telephone to find out if they had any clinical recurrences for which treatment was sought elsewhere. RESULTS: There were 255 males and 46 females with a mean age of 34 years. Two hundred and nineteen (72.8%) presented with symptoms lasting 12 weeks or less. In males, warts occurred most frequently in the preputial cavity (52.5%) and on the penile shaft (40.8%). In females, they occurred most frequently on the external genitalia (91.3%). Two hundred and thirty-five males were treated with cryotherapy and 69% (95% CI, 62.6% to 74.8%) achieved clinical resolution after a mean of 6 treatment cycles. Seven males were treated with podophyllin 0.25% in ethanol and 71% (95% CI, 29.0% to 96.3%) were clinically cured after a mean of 4 treatment cycles. Thirty-nine females were treated with cryotherapy and 67% (95% CI, 49.8% to 80.9%) achieved clinical cure after a mean of 4 treatment cycles. Of the 290 patients treated at the centre, 212 (73%; 95% CI, 67.3% to 77.8%) patients (184 males, 28 females) achieved clinical cure after a mean of 7 weeks (range, 1 to 34 weeks); 90% (95% CI, 86.0% to 93.2%) of them by 15 weeks. Seven-two patients defaulted follow-up and 6 responded partially to treatment. Of the 212 patients who achieved clinical cure, 195 were interviewed by telephone, on an average, 17.7 months after clinical resolution. Thirty-seven (19%; 95% CI, 13.7% to 25.2%), all males, relapsed clinically after a mean of 100 days (range, 5 to 329 days); 90% (95% CI, 84.6% to 93.6%) relapsed by 228 days. CONCLUSIONS: Podophyllin 0.25% in ethanol was the most cost-effective treatment for males. One in 5 patients had a recurrence of their warts and most had their recurrence within 8 months of initial resolution.

Condyloma eradication: self-therapy with 0.15-0.5% podophyllotoxin versus 20-25% podophyllin preparations--an integrated safety assessment.

Topical application of podophyllin solution, long considered the therapy of first choice against condylomata acuminata, can no longer be recommended due to its low efficacy and gross toxicity. Self-treatment with 0.15-0.5% purified podophyllotoxin preparations, applied twice daily for 3 days, is now advocated as the alternative first-line therapy of choice, when significant improvement is conveniently, and cost-effectively, accomplished within a few weeks. This review provides a summary of the comparative efficacy and utility of podophyllin versus podophyllotoxin as well as a compilation of in vivo and in vitro safety evaluations. In light of overwhelming safety and efficacy data in favor of podophyllotoxin-derived products, it is concluded that podophyllin preparations have no place in the modern treatment portfolio for anogenital warts.

Prevalence of human papilloma virus genital infections in sexually transmitted diseases clinic attendees in Ibadan.

All patients, who presented at the Sexually Transmitted Disease clinic of the University College Hospital, Ibadan, between the period of August 1996 and January 1998 were included in this study. They were examined for genital infections in order to determine the prevalence rate of Human papilloma virus genital infection (genital warts) among them. Out of the 1,373 patients seen in the clinic during the period, 861 (62.71%) had STD while the remaining 512 (37.29%) had other conditions. Out of these 861 cases, 69 (8.01%) had HPV genital infection, while the remaining 792 (91.9%) had other STDS. Of these 69 cases of genital warts, 35 (50.7%) were males while 34 (49.3%) were females. Their ages ranged between 17 and 74 years, with the peak incidence in the 20-29 years age group. 32 (46.4%) had concurrent genital infections with non-gonococcal urethritis and cervicitis 9(13%) constituting the most common type. The highest incidence (36.2%) of this condition was found among petty traders while the lowest was found among the business executives and applicants. In 67 (97%) of these patients, the nature of sexual intercourse was vaginal, while in 1 (1.5%) it was oral and another 1 (1.5%) both vaginal and oral. 26 (37.7%) of the patients had just one sexual partner, while 7 (8.1%) had 2 or more. Only 2 (2.9%) admitted to have had any sexual contact with commercial sex workers. The sites of warts in males include the shaft of the penis, the glans penis, perineum and intrameatum. In females, warts were found in the vulva, vagina, cervix, perineum and perianal regions. 42 (60.9%) of these patients were placed on 20% podophyllin on tincture of benzoin, 17 (24.6%) on cryotherapy and 1 (1.5%) on both. They all did well on the different treatment regimens except for 1 (1.5%) that had to change from podophyllin to cryotherapy when there was no reduction in size. 11 (15.9%) were however lost to follow up.

Sexually transmitted infections and use of sexual health services among young Australian women: women's health Australia study.

Our objective was to examine associations between self-reported sexually transmitted infections (STIs) and sociodemographic, lifestyle, health status, health service use and quality of life factors among young Australian women; and their use of family planning and sexual health clinics and associations with health, demographic and psychosocial factors. The study sample comprised 14,762 women aged 18-23 years who participated in the mailed baseline survey for the Australian Longitudinal Study on Women's Health, conducted in 1996. The main outcome measures are self report of ever being diagnosed by a doctor with an STI, including chlamydia, genital herpes, genital warts or other STIs, and use of family planning and sexual health clinics. The self-reported incidence of STI was 1.7% for chlamydia, 1.1% genital herpes, 3.1% genital warts, and 2.1% other STIs. There was a large number of demographic, health behaviour, psychosocial and health service use factors significantly and independently associated with reports of having had each STI. Factors independently associated with use of family planning clinic included unemployment, current smoking, having had a Pap smear less than 2 years ago, not having ancillary health insurance, having consulted a hospital doctor and having higher stress and life events score. Factors independently associated with use of a sexual health clinic included younger age, lower occupation status, being a current or ex-smoker, being a binge drinker, having had a Pap smear, having consulted a hospital doctor, having poorer mental health and having higher life events score. This study reports interesting correlates of having an STI among young Australian women aged 18-23. The longitudinal nature of this study provides the opportunity to explore the long-term health and gynaecological outcomes of having STIs during young adulthood.

Transmission of genital human papillomavirus infections is unlikely through the floor and seats of humid dwellings in countries of high-level hygiene.

To evaluate the transmission of genital human papillomavirus (HPV) through the floor and seats of humid dwellings, samples were collected with a toothbrush from the floor and seat surfaces of humid dwellings; showers, saunas and dressing rooms. The survey included 3 bathing resorts, 1 indoor swimming pool, 2 schools and 2 private homes. Polymerase chain reaction (PCR) was used to amplify the human beta-globin gene and HPV DNA. The results for HPV DNA amplification were confirmed by Southern blot hybridization under low stringency using a probe mixture of HPV types 6, 16, 18 and 31. beta-globin could be amplified only from 3 sample taken from a dressing room of and indoor public swimming pool. No HPV DNA-positive samples were found. These results indicate that transmission of genital HPV infection via floor or seat surfaces in the above dwellings in general or family use is highly unlikely.

Tratamiento de la infección genital por virus del papiloma humano durante la gestación / Treatmentof genital infections by human papiloma virus during pregnancy

La infección genital por Virus del Papiloma Humano (VPH) puede afectar mujeres, varones e incluso estos. En algunos sitios es incluso la enfermedad de transmisión sexual más frecuente. En las últimas dos décadas ha tomado crecimiento importancia por la posibilidad de afectar al bebé a su paso por el canal del parto infectado provocándole Papilomatosis Laríngea Juvenil así como lesiones virales en conjuntiva e incluso en genitales. Se ha propuesto que la realización de operación cesárea evita dicho riesgo. Información reciente muestra que este abordaje no solo es insuficiente, sino que es exagerado en la mayoría de los casos. Se propone como alternativa efectuar un abordaje integral que incluya realización de colposcopía y biopsia de las lesiones sospechosas, seguido de tratamiento de las zonas infectadas y seguimiento estrecho. Los recursos terápeuticos más valiosos con la crioterapia, laser, electrocauterio y ácido tricoloroacético. La realización de operación cesárea se limitaría entonces a los casos refractarios a tratamiento, aquellos diagnosticados tardíamente o en los que las lesiones voluminosas provoquen distocia. El manejo debe inclir valoración diagnóstica de la(s) pareja(s) sexual(es) de la mujer así como del neonato, con tratamiento subsecuente -de ser necesario- según el caso

Human papillomavirus infection and genital warts: update on epidemiology and treatment.

The treatment of genital warts remains frustrating since it is often painful, expensive, and unsuccessful. Moreover, little is known about the infectivity and natural history of exophytic genital warts or subclinical genital infection with human papillomavirus. The traditional goals of therapy for sexually transmitted diseases--eradication of infection, elimination of symptoms, prevention of long-term sequelae, and interruption of transmission--are currently not attainable for or applicable to genital warts. The medical literature from January 1988 to August 1993 was reviewed for recent studies on the treatment of exophytic warts. The following treatments were included in the reviewed studies: podofilox (which was recently approved by the Food and Drug Administration), podophyllin, cryotherapy, topical 5-fluorouracil, intralesional interferon, systemic interferon, and laser surgery. No single treatment modality was superior to another, and recurrence rates associated with all modalities were high. Treatment of genital warts should be guided by preferences of the patient, and a specific therapeutic regimen should be chosen with consideration of expense, efficacy, convenience, and potential for adverse effects.

An audit of treatment of genital warts: opening the feedback loop.

An audit of the treatment of patients (100 men and 90 women) presenting with a first episode of anogenital warts to the Genitourinary Medicine Department at Leeds General Infirmary was performed. Treatment of patients was monitored for a period of 6 months from the time of presentation. The management of patients with genital warts lacked a clearly defined strategy and treatment was unselective and poorly monitored. Excluding patients who defaulted, at follow-up 44 (44%) men and 36 (38%) women still had genital warts at 3 months. Of those patients clear of warts at 3 months, the mean time to remission for men and women was 7.1 and 8.3 weeks respectively. Podophyllin 25% in tincture of benzoin was by far the predominant therapeutic modality used. A total of 96 (96%) men and 76 (84%) women received treatment with podophyllin. Both male and female patients had a mean of 5 treatments with podophyllin 25% (range 1-19 and 1-12 respectively). Physical methods of treatment i.e. cryotherapy and electrocautery, were underutilized, both as primary therapies and when topical agents had failed. Patients saw an average of 3 (range 1-7) doctors over the course of their treatment. Patients with warts affecting 2 or more sites, male patients with anal/perianal warts, and female patients with cervical and vaginal warts had higher failure rates from treatment at 3 months. On the basis of these findings, specific treatment protocols for the management of anogenital warts have been devised.