Peripheral blood CD4+ T cell count predicts recurrence of condyloma acuminatum after photodynamic therapy in HIV-positive patients.

BACKGROUND: Few studies have reported postoperative relapse of condyloma acuminatum (CA) after 5-aminolevulinic acid photodynamic therapy (ALA-PDT) in human immunodeficiency virus (HIV) positive patients. METHODS: The clinical data of HIV-positive CA patients treated with ALA-PDT from October 2018 to December 2019 were analyzed retrospectively. Univariate and multivariate Cox regression was used to analyze the variables related to postoperative recurrence. Pearson correlation test was employed to analyze the correlation between CD4+ T cell count and postoperative recurrence rate. Kaplan-Meier method was used to compare the CA recurrence after ALA-PDT in low CD4 group and high CD4 group. RESULTS: A total of 38 HIV-positive patients with CA were included in the study. Among them, 26 patients experienced CA recurrence within 6 months, and the recurrence rate was 68.4%. CD4+ T cell count was 187.0 (79.0-596.0) cells/µl in relapsed patients and 406.0 (89.0-612.0) cells/µl in non-relapsed patients, showing a statistically significant difference (p = .005). Pearson correlation coefficient analysis revealed a negative correlation between CD4+ T cell count and postoperative recurrence rate (p = .005, r = -.443). Univariate regression analysis showed that CD4+ T cell count was correlated with postoperative recurrence, hazard ratio (HR) was 0.99 [95% Confidence interval (CI) = 0.99-1.0, p = .012]. Multivariate Cox regression analysis showed that with the low CD4+ T cell count as the reference, the high CD4+ T cell count was negatively correlated with postoperative recurrence (HR = 0.09, 95% CI 0.01-0.87, p = .038). CONCLUSIONS: Peripheral blood CD4+ T cell count can predict the CA recurrence rate after ALA-PDT in HIV-positive patients.

Cronkhite-Canada syndrome associated with perianal condyloma acuminatum with malignant transformation: A case report.

RATIONALE: Cronkhite-Canada syndrome (CCS) is a rare non-familial polyposis syndrome characterized by multiple gastrointestinal polyps with the ectodermal triad. To date, many complications of CCS have been reported in the literature, but perianal condyloma acuminatum with malignant transformation has not been included. PATIENT CONCERNS: This report presents the case of a 52-year-old Chinese man who presented with diarrhea, loss of appetite, and weight loss. He developed skin pigmentation and atrophy of the fingernails and toenails. Upper gastrointestinal endoscopy, colonoscopy, capsule endoscopy, and enteroscopy revealed diffuse polyps along the entire digestive tract. Histopathological examination revealed polyps of different pathological types dominated by hamartoma. Physical examination revealed a crissum cauliflower-like neoplasm (2.5 × 2.0 cm). After perianal tumor resection, pathology suggested that this was a perianal condylomatous lesion with malignant transformation, as well as well-differentiated squamous cell carcinoma. DIAGNOSES: These clinical features and endoscopic findings were consistent with CCS which associated with perianal condyloma acuminatum with malignant transformation. INTERVENTION: Clinical remission was achieved with glucocorticoid, azathioprine, and nutritional support. OUTCOME: At the 4-year follow-up, the patient had no diarrhea or loss of appetite, had gained 13 kg in weight, and the perianal tumor had not recurred. LESSONS: No previous report has described CCS in a patient with perianal condyloma acuminatum with malignant transformation. As both conditions are related to immune disorders, their occurrence may be correlated.

An unusual case of oral condyloma lata.

Cutaneous secondary syphilis presents with various manifestations, including condyloma lata (confluented moist papules). This article reports an unusual case of oral condyloma lata. A 56-year-old man presented with a 2-month history of foreign body sensation and sore throat. Physical examination revealed a hypertrophic, reddish-brown, flat-topped, moist plaque in the right amygdaloid fossa. This raised clinical suspicion of lymphoma. However, further enquiry revealed that the patient had extramarital sexual history with a female sex worker. Rapid plasma regain and Treponema pallidum particle agglutination tests were both positive. The patient's wife was diagnosed with early latent syphilis. Both the patient and his wife were treated with penicillin G benzathine, and the lesion in the male patient disappeared in 2 weeks. To the authors' knowledge, a single condyloma lata in the amygdaloid fossa mimicking lymphoma has not been reported previously. Awareness of the usual manifestations of syphilis can avoid unnecessary biopsy, and early diagnosis and treatment may prevent irreversible complications. Partner notification is very important to reduce the risk of transmission, and persistent or recurrent infection.

Condyloma Acuminatum of Urinary Bladder: Relation to Squamous Cell Carcinoma.

Condyloma acuminatum rarely occurs in the urinary bladder and is considered to be a risk factor for squamous cell carcinoma, although there are only a few publications with limited cases. We studied 51 cases of condyloma acuminatum of the urinary bladder from transurethral resections of the urinary bladder of 38 patients from the consult files of one of the authors. Transurethral resections of the urinary bladder were obtained from 25 males with a median age of 73 years (range: 41 to 87 y) and 13 females with a median age of 68 years (range: 30 to 86 y). The follow-up period ranged from 15 months to 20 years (median: 6 y). Bladder lesions were accompanied by urethral lesions in 4 men. Eight patients (8/38; 21.0%) had a history of immunosuppression. Seven patients (7/8; 87.5%) from this group had multiple and/or recurrent condylomas. One patient (1/38; 2.6%) with renal transplantation had 10 separate bladder condylomas over time. One patient (1/38; 2.6%) had extensive anogenital condylomas and anal intraepithelial neoplasia grade 3. One patient (1/8; 12.5%) with renal transplantation presented with a solitary condyloma with synchronous squamous cell carcinoma in situ. Three female patients (3/38; 7.9%) had a history of premalignant vagina/cervix lesions. In total, 17 patients (17/38; 44.7%) had squamous cell carcinoma of the bladder, either invasive or in situ. In all cases, the squamous cell carcinoma (either in situ or invasive) was diagnosed either concurrent with the diagnosis of bladder condyloma or within 1 year of the condyloma diagnosis). In total, 9 of 38 (23.7%) patients had invasive squamous cell carcinoma with or without in situ squamous cell carcinoma. Eight of 38 (21.0%) patients had squamous cell carcinoma in situ only (without a definitive invasive component-in 3 cases invasive squamous cell carcinoma could not be excluded with certainty). In total, 19 patients (19/38; 50%) were positive for either low-risk human papillomavirus (LR-HPV) or high-risk human papillomavirus (HR-HPV) or both (3 were positive for both LR-HPV and HR-HPV, 12 patients for only LR-HPV, and 4 for only HR-HPV). Of the 19 patients that were negative for both LR-HPV and HR-HPV, 9 of 19 (47.4%) patients had associated squamous cell carcinoma. Of the 12 patients with only LR-HPV, 4 (33.3%) had associated squamous cell carcinoma (either invasive or in situ). Of the 7 patients with HR-HPV (with or without LR-HPV), 4 (57.1%) has associated squamous cell carcinoma. In summary, condyloma acuminatum of the urinary bladder shows a strong association with squamous cell carcinoma of the bladder, regardless of the condyloma's HPV in situ hybridization results. Immunosuppression is associated with condylomas of the bladder. It is important to distinguish bladder condylomas from papillary urothelial carcinoma, given their different risks for panurothelial disease and risk of squamous cell carcinoma. Recognition of bladder condylomas histologically is often challenging given their rarity, and that they can be negative for both LR-HPV and HR-HPV. The lack of a history of other anogenital human papillomavirus-related lesions further increases the difficulty in establishing the correct diagnosis.

[Correlation of human papillomavirus (HPV) and HPV vaccines with male reproductive health].

HPV is a very common virus worldwide spread by direct contact and involved in male reproductive health-related diseases such as infertility, condyloma acuminatum, and penile cancer. The development of HPV vaccines has contributed to the effective prevention of various subtypes of HPV and protection of males from HPV infection, especially the partners of HPV-positive females, the men who have sex with men, and those with a psychological fear of HPV infection. Therefore, HPV vaccines play an important role in the protection of males.

Vulvar Cancer as a Result of GATA2 Deficiency, a Rare Genetic Immunodeficiency Syndrome.

BACKGROUND: Vulvar cancer has become more prevalent, and its causes include chronic dermatoses and human papillomavirus (HPV)-mediated disease. Younger immunocompromised women can also be affected. We describe a case of vulvar carcinoma as a result of GATA2 deficiency. CASE: A 19-year-old woman presented to our gynecologic oncology clinic for management of a large vulvar mass. She was diagnosed with stage IB vulvar carcinoma after vulvectomy. GATA2 deficiency was the contributing factor causing vulvar carcinoma. CONCLUSION: GATA2 deficiency causes immunodeficiency in young women, and patients with early-onset HPV-related disease, a family or personal history of leukemia, recurrent infection, or immune irregularities should be screened. Health care providers for these women are often obstetrician-gynecologists, who can provide diagnosis, treatment, referral, and prevention of HPV-related diseases.

Anogenital warts in children: Analysis of a cohort of 34 prepubertal children.

Anogenital warts are caused by infection with the human papillomavirus. We reviewed the clinical data of 34 children younger than 13 with anogenital warts referred to the department of dermatovenereology of a tertiary care hospital. Suspicion of sexual abuse was raised in 11 (32.4%). Human papilloma virus testing and genotyping was performed in 19 (55.9%) children, and human papilloma virus type 16 was found in 4, which raises the question regarding what type of follow-up is required for children infected with high-risk oncogenic HPV types. Although the diagnosis of anogenital warts in children raises concerns regarding sexual abuse, our study supports that pediatric anogenital warts can be associated with nonsexual transmission.

US Health Care Clinicians' Knowledge, Attitudes, and Practices Regarding Human Papillomavirus Vaccination: A Qualitative Systematic Review.

Clinicians' recommendation for the human papillomavirus (HPV) vaccine appears to be an important driver of parental decisions about vaccination. Our aim was to synthesize the best available evidence exploring the perceptions and experiences regarding HPV vaccination, from the perspective of the US clinician. We conducted a comprehensive literature search of Academic Search Complete, CINAHL Plus, Communication & Mass Media Complete, Consumer Health Complete (EBSCOhost), ERIC, Health and Psychosocial Instruments, MEDLINE with full text, and PsycINFO databases. We identified 60 eligible articles: 48 quantitative and 12 qualitative. We extracted the following information: study purpose, use of theory, location, inclusion criteria, and health care provider classification. Results were organized into 5 categories: 1) clinicians' knowledge and beliefs about HPV and the HPV vaccine, 2) clinicians' attitudes and beliefs about recommending HPV vaccines, 3) clinicians' intention to recommend HPV vaccines, 4) clinicians' professional practices regarding HPV vaccination, and 5) patient HPV vaccination rates. Although clinicians were generally supportive of HPV vaccination, there was a discrepancy between clinicians' intentions, recommendation practices, and patient vaccination rates. Studies reported that clinicians tended not to provide strong, consistent recommendations, and were more likely to recommend HPV vaccines to girls versus boys and to older versus younger adolescents. Analyses revealed a number of facilitating factors and barriers to HPV vaccination at the clinician, parent/patient, and systems levels, including clinician knowledge, clinician beliefs, and office procedures that promote vaccination. This review provides an evidence base for multilevel interventions to improve clinician HPV vaccine recommendations and vaccination rates.

The Direct Medical Costs of Diseases Associated with Human Papillomavirus Infection in Manitoba, Canada.

BACKGROUND: The total direct cost of screening and treating all human papillomavirus-related diseases (HPV-RD) has not been measured in a single study. Accurate cost estimates are needed to inform decisions on intervention priorities and evaluate the cost-effectiveness of existing programs. We used province-wide clinical, administrative, and accounting databases to measure direct medical costs of HPV infection in Manitoba (Canada). METHODS: All persons 9 years or older with health insurance coverage in Manitoba between April 2000 and March 2015 were eligible. We identified all persons with an incident HPV-RD and aggregated all medical costs (in 2014 Canadian dollars) related to that condition, including prescription drugs, diagnostic procedures, in-hospital and outpatient treatment, and physician visits. RESULTS: We found that the median cost of treating a case of anogenital warts was $130. An episode of cervical dysplasia had a median cost of $220, compared to $1300 for an episode of cervical carcinoma in situ. The cost of treating HPV-related invasive cancer varied from $15,000 for cervical cancer to $33,000 for oral cavity cancer. Overall, 80% ($145 million) of the total cost was attributable to HPV infection. Cervical screening and follow-up accounted for $96 million (66%) of all costs and this cost component has declined following the introduction of new screening guidelines. CONCLUSIONS: Overall, the average direct medical cost of HPV infection was $720 per newborn. The economic burden of HPV remains significant, although changes in cervical screening guidelines, prompted by the introduction of a public HPV vaccine program, appear to have promoted a promising trend towards lower costs.

Case of rapidly progressing condylomatous squamous cell carcinoma of the uterine cervix associated with low-risk human papillomavirus type 6.

Condylomatous, or warty squamous cell carcinoma (SCC) of the uterine cervix, is a rare variant of invasive SCC. Here, we describe a case of aggressive condylomatous SCC of the uterine cervix. A 43-year-old woman was monitored for 3 years for suspected low-grade squamous intraepithelial lesion. A whitish papillary mass occupied the cervix, and the colposcopic diagnosis was condyloma acuminatum. A cervical biopsy revealed papillary proliferating thick squamous epithelium, which consisted of koilocytes and atypical cells with enlarged nuclei. Hysterectomy specimens showed a thick layer of atypical squamous epithelium with koilocytosis invading the stroma. Immunohistochemistry revealed negative p16 expression. Hysterectomy specimens tested positive for low-risk human papillomavirus type 6, but negative for other high-risk human papillomavirus types. The bilateral pelvic and para-aortic lymph nodes were positive for metastases. In spite of adjuvant chemotherapy, the case relapsed with multiple lymph nodes and lung metastases shortly after the operation.

Prevalence and correlates of cervical HPV infection in a clinic-based sample of HIV-positive Hispanic women.

OBJECTIVES: Puerto Rico (PR), is the fifth highest jurisdiction of the United States of America (US) with respect to HIV prevalence and the leading in cervical cancer incidence. This cross-sectional study describes the prevalence and correlates of cervical HPV infection among a clinic-based sample of 302 women living with HIV/AIDS in PR. METHODS: Data collection included questionnaires, blood and cervical samples. Multivariable logistic regression models were used to estimate the magnitude of association (adjusted Prevalence odds ratio [aPOR]) between HPV cervical infection and other covariates. RESULTS: Mean age of participants was 40.3 years (± 10.3SD). The prevalence of HPV infection was 50.3%; 41.1% for low-risk types and 29.5% for high-risk types. Having ≥ 10 lifetime sexual partners (aPOR = 2.10, 95% CI:1.02-4.29), an abnormal Pap (aPOR = 3.58, 95% CI:1.93-6.62), active genital warts (aPOR = 3.45, 95% CI:1.60-7.42), and CD4 counts ≤ 200 (aPOR = 4.24, 95% CI: 1.67-10.78) were positively associated with any cervical HPV infection. Similar results were observed for HR HPV infection. CONCLUSIONS: A high burden of HPV co-infection exists among women living with HIV/AIDS in this population. Given the high incidence of HIV in PR and the higher risk of cervical cancer among women living with HIV/AIDS, HPV vaccination should be promoted in this population.

Anogenital warts in pediatric population.

The approach to children with anogenital warts in the context of sexual abuse is a challenge in clinical practice. This study aims to review the current knowledge of anogenital warts in children, the forms of transmission, and the association with sexual abuse and to propose a cross-sectional approach involving all medical specialties. A systematic review of the literature was conducted in Portuguese and English from January 2000 to June 2016 using the ISI Web of Knowledge and PubMed databases. Children aged 12 years or younger were included. The ethical and legal aspects were consulted in the Declaration and Convention on the Rights of Children and in the World Health Organization. Non-sexual and sexual transmission events of human papillomavirus in children have been well documented. The possibility of sexual transmission appears to be greater in children older than 4 years. In the case of anogenital warts in children younger than 4 years of age, the possibility of non-sexual transmission should be strongly considered in the absence of another sexually transmitted infection, clinical indicators, or history of sexual abuse. The importance of human papillomavirus genotyping in the evaluation of sexual abuse is controversial. A detailed medical history and physical examination of both the child and caregivers are critical during the course of the investigation. The likelihood of an association between human papillomavirus infection and sexual abuse increases directly with age. A multidisciplinary clinical approach improves the ability to identify sexual abuse in children with anogenital warts.

Podofilotoxina 1, 5 mg/g e imiquimode 50 mg/g para condilomas acuminados decorrentes de infecção por papilomavírus humano (HPV) / Podofilotoxin 1. 5 mg / g and imiquimod 50 mg / g for condyloma acuminata due to human papillomavirus (HPV) infection

CONTEXTO: Condilomas acuminados, ou verrugas anogenitais, são lesões provocadas pela infecção por HPV. Trata-se de uma infecção sexualmente transmissível, de alto contágio. A maior parte dasinfecções por HPV são assintomáticas e o organismo elimina o vírus em poucos meses. Contudo, em alguns casos o vírus permanece nas genitálias, ânus ou na orofaringe e se observa o surgimento de lesões, como os condilomas acuminados, bem como o risco do desenvolvimento de diversas neoplasias. A transmissibilidade da infecção por HPV é maior quando há condilomas acuminados. Não há tratamentos que eliminem ou interfiram na história natural da infecção por HPV. No entanto, existem procedimentos e alternativas farmacológicas para a eliminação dos condilomas acuminados. Os procedimentos e alguns medicamentos são de administração exclusiva por profissionais médicos. Outros medicamentos podem ser aplicados pelo próprio paciente. No Brasil, há registro sanitário para podofilotoxina 1,5 mg/g (ou 0,15%) ou imiquimode 5% (ou 50 mg/g), ambos administráveis pelo paciente. No SUS, estão disponíveis o medicamento podofilina, em concentrações variando entre 100 mg/mL e 250 mg/mL (ou 10% a 25%), e os procedimentos de excisão cirúrgica e de tratamento geral de infecção sexualmente transmissível. TECNOLOGIAS: Podofilina 100 mg/mL a 250 mg/mL solução, podofilotoxina 1,5 mg/g creme e imiquimode 50 mg/g creme. PERGUNTAS: Podofilotoxina é mais eficaz/efetiva e segura em relação a podofilina para o tratamento de pacientes com condilomas acuminados associados à infecção por HPV? Para pacientes com verrugas anogenitais o uso de imiquimode comparado ao placebo ou a outro tratamento farmacológico há regressão completa ou parcial das verrugas após o tratamento? EVIDÊNCIAS CIENTÍFICAS: Evidências clínicas: foram elaborados dois Pareceres Técnico-Científicos, um para cada pergunta de pesquisa. Apenas um estudo comparou diretamente podofilotoxina 0,15% em relação a podofilina 25%. Neste estudo, não houve diferença significativa entre elas para a completa remissão de condilomas acuminados após quatro semanas de tratamento, com proporção de cura de, respectivamente, 44,8% e 44,9%. Este estudo também avaliou a utilização de podofilotoxina 0,5% e esta tecnologia foi significativamente mais eficaz, com 60,0% dos pacientes com remissão completa em quatro semanas. Em outro estudo, podofilotoxina 0,5% não foi significativamente mais eficaz que podofilina 20% na cura em quatro semanas, com eficácia em, respectivamente, 81,2% e 59,3% dos pacientes em seus grupos. Em outros estudos, observou-se que a eficácia de podofilotoxina é significativamente maior que placebo e semelhante a outrastecnologias. Podofilotoxina 0,5% proporciona maior risco para a ocorrência de eventos adversos locais. Já podofilotoxina 0,15% e as variadas concentrações de podofilina proporcionam perfil de segurança semelhante entre si. Sobre a eficácia e segurança de imiquimode 5%, observou-se que o medicamento é mais eficaz que placebo (RR: 4,03; IC 95%: 2,03 a 7,99). Um estudo de metanálise envolvendo comparações diretas e indiretas (Mixed Treatment Comparison), a eficácia de imiquimode 5% foi semelhante à de podofilina de 20% a 25% (OR: 1,07; ICr 95%: 0,15-3,45). Neste estudo, podofilotoxina 0,5% foi significativamente mais eficaz que podofilina ou imiquimode, contudo não avaliou podofilotoxina 0,15%. O perfil de segurança de imiquimode 5% foi considerado semelhante a podofilina e melhor que o de podofilotoxina 0,5%. Não houve comparação em relação a podofilotoxina 0,15%. AVALIAÇÃO DE IMPACTO ORÇAMENTÁRIO: A avaliação de podofilotoxina 0,15% e de imiquimode 5% considerou o período entre os anos de 2018 e 2022, as projeções populacionais calculadas pelo IBGE, a prevalência de condilomas acuminados na população, a cobertura da atenção básica pelo SUS e a população sexualmente ativa nos últimos 12 meses. A estimativa de impacto orçamentário total em cinco anos para a potencial incorporação de podofilotoxina 0,15% foi de R$ 758.049,13 para novos casos e R$ 102.159.244,64 para os casos prevalentes. Para imiquimode 5% foi de, respectivamente, R$ 895.438,59 e R$ 120.674.671,98. Considerando os casos prevalentes, o impacto orçamentário médio por habitante para podofilotoxina 0,15% e imiquimode 5% foi de, respectivamente, R$ 0,48 e R$ 0,57. Análises de sensibilidade demonstraram maior que a variação na prevalência afeta mais o resultado do impacto orçamentário em relação ao preço dos tratamentos. As variações nas taxas de difusão das tecnologias proporcionam maior amplitude nas estimativas do impacto orçamentário. RECOMENDAÇÃO DA Conitec: Os membros da CONITEC presentes na 60ª reunião da CONITEC, realizada na data de 04/10/2017, consideraram que a podofilina 10 mg/mL a 250 mg/mL não deve ser excluída do SUS e que a podofilotoxina 1,5 mg/g creme e de imiquimode 50 mg/g creme devem ser incorporados ao SUS. CONSULTA PÚBLICA: A Consulta Pública nº 60/2017 foi realizada entre os dias 25/10/2017 e 13/11/2017. Foi recebida uma contribuição sobre experiência com os tratamentos. DELIBERAÇÃO FINAL: Os membros da CONITEC presentes na 62ª reunião da CONITEC, 06/12/2017, deliberaram por recomendar a incorporação de podofilotoxina 1,5 mg/g creme, a incorporação do imiquimode 50mg/g creme e a não exclusão de podofilina 100 mg/mL para o tratamento de pacientes com verrugas anogenitais causadas pela infecção por vírus papiloma humano (HPV). Respectivamente, foram assinados os registros de deliberação nº 307/2017, nº 308/2017 e nº 321/2017. DECISÃO: A Portaria nº 64, de 28 de novembro de 2018, publicada no DOU nº 228,seção 1, página 142, tornou pública a decisão de incorporar a podofilotoxina 1,5 mg/g creme e imiquimode 50 mg/g creme e não excluir podofilina 100 mg/mL para o tratamento de pacientes com verrugas anogenitais causadas pela infecção por vírus papiloma humano (HPV), no âmbito do Sistema Único de Saúde - SUS.

The Impact of Human Papillomavirus Catch-Up Vaccination in Australia: Implications for Introduction of Multiple Age Cohort Vaccination and Postvaccination Data Interpretation.

We used transmission-dynamic modeling to estimate the added effectiveness of vaccinating multiple cohorts of females (12-26 years) in Australia compared with the theoretical introduction of routine-only (12-13 years) vaccination. Our results suggest that vaccinating multiple cohorts produced markedly faster direct/herd effects, and it added benefits that last for 20-70 years. Furthermore, the number needed to vaccinate to prevent 1 anogential warts (AGW) case or cervical cancer (CC) was similar for routine + catch-up (AGW = 9.9, CC = 678) and routine-only vaccination (AGW = 9.9, CC = 677), thus providing similar levels of efficiency per person vaccinated.

Anogenital warts in pediatric population

Abstract: The approach to children with anogenital warts in the context of sexual abuse is a challenge in clinical practice. This study aims to review the current knowledge of anogenital warts in children, the forms of transmission, and the association with sexual abuse and to propose a cross-sectional approach involving all medical specialties. A systematic review of the literature was conducted in Portuguese and English from January 2000 to June 2016 using the ISI Web of Knowledge and PubMed databases. Children aged 12 years or younger were included. The ethical and legal aspects were consulted in the Declaration and Convention on the Rights of Children and in the World Health Organization. Non-sexual and sexual transmission events of human papillomavirus in children have been well documented. The possibility of sexual transmission appears to be greater in children older than 4 years. In the case of anogenital warts in children younger than 4 years of age, the possibility of non-sexual transmission should be strongly considered in the absence of another sexually transmitted infection, clinical indicators, or history of sexual abuse. The importance of human papillomavirus genotyping in the evaluation of sexual abuse is controversial. A detailed medical history and physical examination of both the child and caregivers are critical during the course of the investigation. The likelihood of an association between human papillomavirus infection and sexual abuse increases directly with age. A multidisciplinary clinical approach improves the ability to identify sexual abuse in children with anogenital warts.

[Proctology for internists]. / Proktologie für Internisten.

In proctology patients can often be helped with very little effort. With knowledge of the most common disease symptoms the treating physician can in many cases correctly recognize the cause of the complaints and initiate the appropriate therapy or arrange referral to a proctological institution. This article aims to briefly and succinctly present the most common diseases in proctology (e.g. mariscae, hemorrhoids, anal fissures, perianal venous thrombosis, abscesses and fistulas, condyloma acuminatum and anal carcinoma) and to provide the treating internist, even outside of gastroenterology, assistance with the management of proctological symptoms.

Prevalence of anogenital HPV infection, related disease and risk factors among HIV-infected men in inner-city Johannesburg, South Africa: baseline findings from a cohort study.

BACKGROUND: Persistent high-risk human papillomavirus (HR-HPV) infection is associated with the development of anogenital cancers, particularly in men living with HIV (MLWH). We describe the prevalence of anogenital HPV infection, abnormal anal cytology and anogenital warts (AGWs) in MLWH in Johannesburg, and explore whether HPV infection and receipt of antiretroviral treatment is associated with detection of abnormal anal cytology and AGWs. METHODS: We enrolled a cohort of 304 sexually-active MLWH ≥18 years, who completed a questionnaire and physical examination. Genital swabs were collected from all men and intra-anal swabs from 250 (82%). Swabs were tested for HPV DNA and genotypes, and anal smears graded using the Bethesda classification. Factors associated with anogenital disease were assessed by logistic regression models. RESULTS: Two thirds were receiving antiretroviral treatment, for a median 33 months (IQR = 15-58) and 54% were HIV-virologically suppressed. Only 5% reported ever having sex with men. Among 283 genital swabs with valid results, 79% had any HPV, 52% had HR-HPV and 27% had >1 HR-HPV infection. By comparison, 39% of the 227 valid intra-anal swabs had detectable HPV, 25% had any HR-HPV and 7% >1 HR infection. While most anal smears were normal (51%), 20% had ASCUS and 29% were LSIL. No cases had HSIL or cancer. Infection with >1 HR type (adjusted OR [aOR] = 2.39; 95%CI = 1.02-5.58) and alpha-9 types (aOR = 3.98; 95%CI = 1.42-11.16) were associated with having abnormal cytology. Prevalence of AGWs was 12%. Infection with any LR type (aOR = 41.28; 95%CI = 13.57-125.62), >1 LR type (aOR = 4.14; 95%CI = 1.60-10.69), being <6 months on antiretroviral treatment (aOR = 6.90; 95%CI = 1.63-29.20) and having a CD4+ count <200 cells/µL (aOR = 5.48; 95%CI: 1.60-18.78) were associated with having AGWs. CONCLUSIONS: In this population, anogenital HR-HPV infection and associated low-grade disease is common, but severe anal dysplasia was not detected. Findings reinforce the need for HPV vaccination in men for preventing both AGWs and HR-HPV infection. Given the absence of anal HSILs, however, the findings do not support the use of anal screening programmes in this population.

Infección genital masculina por virus de papiloma humano / Male genital infection by human papiloma virus

El virus del papiloma humano (VPH) es una de las enfermedades de transmisión sexual más comunes. Puede afectar tanto el aparato genital masculino y femenino, como también el área perianal, ano, y diversas áreas de cabeza y cuello y otorrinolaringológicas, ya sea como lesiones benignas o como promotor de lesiones malignas. Las lesiones benignas por VPH en genitales masculinos se caracterizan fundamentalmente por la aparición de lesiones verrugosas, aunque también puede manifestarse mediante lesiones planas atípicas. En algunos casos hay ausencia de lesiones macroscópicamente visibles que pueden hacerse evidentes con la prueba de ácido acético. La biopsia de la lesión, su evaluación anatomopatológica y, sobre todo, la determinación de la existencia y el tipo de virus involucrado mediante PCR (reacción en cadena de la polimerasa) permiten confirmar el diagnóstico. En algunas ocasiones es necesario realizar una cistoscopia para diagnosticar lesiones intrauretrales y vesicales. Los tratamientos propuestos son muy variados y de eficacia dispar, desde las topicaciones y la electrocirugía o la criocirugía, hasta el empleo de la tecnología láser. La prevención con el uso de protección durante el acto sexual así como la educación sexual son fundamentales. En los últimos 10 años se ha implementado el uso de la vacuna para el VPH en niñas con el fin de disminuir la incidencia de lesiones de alto grado y de cáncer de cuello uterino, pero su indicación en varones es menos clara y aún no ha sido consensuada. (AU)

Human papiloma virus (HPV) is one of the most common sexual transmitted diseases. It can affect the male genitalia, as well as the perianal and anal regions and multiple areas of the head and neck and otorhinolaryngological structures, as benign lesiones or as a promoter of malignant lesions. Benign male genitalia lesions are characterized mainly by verrucous lesions, although flat atypical lesions can be found, as well as the abscence of macroscopic visible lesions that in some cases can become evident using the acetic acid test. Lesion biopsy, its histological evaluation, and the determination of the existence and type of virus using PCR (Polymerase Chain Reaction) can confirm the diagnosis. In some cases is necessary to do a cistoscopy to diagnose intraurethral and vesical lesions. Proposed treatments are varied and with a wide range of efficacy, from topications to electro or cryosurgery, and the use of laser technology. Sexual education and the use of sexual protection are essential in prevention. In the last 10 years the use of VPH vaccine in girls was widely spread, in order to decrease the incidence of high grade lesions and cervix cancer. Its indication in male patients is less clear and not yet consented among specialists. (AU)

Demographic characteristics and risk factors in Turkish patients with anogenital warts.

Anogenital warts (AGW) are one of the most common sexually transmitted diseases worldwide. The determination of groups vulnerable to contracting anogenital warts (AGW) leads to the development of policies for disease control and of prevention programs. The aim of our study was to investigate the demographical features and risk factors of Turkish patients with AGW. This study included 200 patients with AGW and 200 healthy individuals as a control group. The age, gender, education and marital status, age of first sexual intercourse, number of sexual partners, sexual orientation, and smoking status were recorded in both groups. In this study, 88% of the patients were male, and 12% were female. The mean age of the patients was 35.21±0.77 years, and the majority of patients were below 35 years old (63%). Furthermore, 46.0% of the patients were educated at the university level, and 33.5% had graduated high school. No significant differences were found based on sexual orientation or condoms between the patient and control groups. In the patient group, the mean age of first sexual intercourse was significantly earlier, and the number of single individuals and sexual partners were significantly higher. Also, 61% of the patients were current smokers, which was significantly higher than the control group. The duration of smoking and the duration of AGW were found to be correlated. All patients were tested for anti-HIV antibodies, and only one patient was found to be infected. AGW were more common in patients younger than 35 years old, among men, and among those who had graduated from high school or university. Early age of first sexual intercourse, a high number of sexual partners, being single, and smoking were also risk factors for the development of anogenital warts.