High prevalence of antibodies to the 2009 pandemic influenza A(H1N1) virus in the Norwegian population following a major epidemic and a large vaccination campaign in autumn 2009.

The prevalence of antibodies reactive to the 2009 pandemic influenza A(H1N1) was determined in sera collected before the start of the pandemic, during the early phase, and after the main epidemic wave and nationwide vaccination campaign in Norway. A substantial rise in prevalence of antibodies at protective titres, from 3.2% to 44.9%, was observed between August 2009 and January 2010. The highest prevalence, 65.3%, was seen in the age group of 10-19 year-olds.

Antibodies against human papillomavirus type 6 capsids are elevated in men with previous condylomas.

Serum samples from 47 men with current condylomas, 32 men with a history of condylomas and from 205 men with no history of genital wart disease, who were attending sexually transmitted disease (STD) clinics at two different hospitals in Stockholm, were analyzed for the presence of immunoglobulin G (IgG) and A (IgA) antibodies to capsids of human papillomavirus types 6 and 11. IgG to HPV type 6 was found among 35% of patients with a history of condylomas compared to 10% of controls (p = 0.0003), but only among 27% of patients with current condylomas. Antibodies to HPV 6 and to HPV 11 showed a very limited correlation, suggesting that the antibodies are HPV-type restricted. The results strengthen conclusions from a previous serological study indicating that IgG antibodies against HPV 6 develop late during condylomatous disease and mostly reflect previous exposure to the virus.

Blood cortisol and dehydroepiandrosterone sulphate (DHEAS) levels and CD4 T cell counts in HIV infection.

OBJECTIVE: Blood cortisol and dehydroepiandrosterone sulphate (DHEAS) levels, and CD4 T cell counts were assessed in a group of 44 patients with HIV infection (17 asymptomatic and 27 symptomatic). The steroid levels were compared to those in 80 healthy subjects. RESULTS: The mean cortisol level did not differ between the HIV patients and controls. However, a broad variability existed among the patients; thus, asymptomatic HIV patients revealed a significantly higher mean level than the controls (348 nmol/l vs. 280 nmol/l; p < 0.01). Furthermore, 20 patients had levels above, 16 within, and 8 below the confidence limits of the cortisol levels in controls. This variability might reflect differences in adrenocortical responses to psychological stress and adaptive reactions among patients with HIV infection. The mean DHEAS was markedly lowered in the patient group (1450 nmol/l in patients vs. 3300 nmol/l in controls; p < 0.001). A decrease below the confidence limits of the controls existed in 41 (93%) of the 44 patients. A significant correlation was also found between the low DHEAS levels and low CD4 T cell counts in the patients (p < 0.01), while no such correlation existed for cortisol. CONCLUSION: Whether low DHEAS levels might contribute to some of the pathophysiologic features and/or symptoms seen in HIV infection needs to be investigated.

Cutaneous cytodestructive potency of lignans. I. A comparative evaluation of influence on epidermal and dermal DNA synthesis and on dermal microcirculation in the hairless mouse.

The four lignans: podophyllotoxin, 4'-demethyl-podophyllotoxin, alpha-peltatin and beta-peltatin represent the podophyllin ingredients believed to exert lesional necrosis after application to condylomata acuminata. This study comparatively evaluates cutaneous cytodestructive potency of these drugs, as evaluated by measurement of epidermal and dermal 3H-thymidine incorporation and injury of dermal microcirculation at intervals in the range of 9--168 h after application to hairless mouse skin. Influence on DNA-synthesis was measured using a disc technique for isolation of standardized skin areas followed by alkali extraction of DNA from respective tissues after separation through potassium bromide incubation. Any capillary injury was demonstrated by visual assessment of leakage of i.v. injected trypan blue to test areas. An analytical method compensating for variations in DNA synthesis in individual controls is presented. Using 0.5% preparations of the lignans, podophyllotoxin most consistently influenced the variables indicating cytodestructive effect, while 4'-demethyl-podophyllotoxin exerted the weakest degree of damage.

Genitoanal papillomavirus infection: diagnostic and therapeutic objectives in the light of current epidemiological observations.

During the past decade a wide span of heterogeneity has been demonstrated for human papillomaviruses (HPVs), and some basic properties of the HPV genome have been revealed. The use of hybridization assays for HPV DNA detection in infected epithelia, and the recent introduction of synthetic HPV peptides for detection of type-specific circulating antibodies, have resulted in a major rethinking of HPV epidemiology. Recent data indicate that various HPVs may be transmitted perinatally during early infancy and that a long latency with periodic reactivation seems to be quite common. The present review attempts to assess recent epidemiological data with the concept of genitoanal papillomavirus infection (GPVI) as a predominantly sexually transmitted disease. Some diagnostic and therapeutic aspects are outlined with a pragmatic approach to the clinical relevance of GPVI.

Efficacy of chemical and/or surgical therapy against condylomata acuminata: a retrospective evaluation.

In order to estimate treatment resistance of condylomas, standardized records of 230 males aged 17-80 years (mean 27) attending at an STD clinic were analysed retrospectively. Anal warts occurred in 38 (17%) men; in 19 (50%) intranal warts were extensive enough to require further referral to the Department of Surgery. Urinary meatal warts occurred in 30 men; 9 of them (30%) were referred to the Department of Urology. The remaining 202 (88%) men were treated in the STD clinic with simple surgery and/or home-treatment with 0.5% podophyllotoxin-ethanol twice a day for one or more 3 day sessions. After a follow-up of at least one year, 46 (23%) patients still had condylomas. However, 77 (49%) of the remaining 156 men were cured after a single therapeutic session, and after 1-4 sessions the cumulative cure rate was 77%.

Efficacy of surgical and/or podophyllotoxin treatment against flat acetowhite penile human papillomavirus associated lesions.

In order to investigate the efficacy of treatment modalities favoured by us against flat acetowhite penile human papillomavirus (HPV)-induced lesions, we studied retrospectively standardized medical records of 81 men who had been treated for this condition. The patients were treated surgically with diathermy (n=32) or with a combination of both chemical (topical application of podophyllotoxin) and surgical treatment (n=49). The mean number of clinic visits was 9.1 (range 1-19), during a follow-up time of mean 30.9 (range 1-104) months for 78 of the men, 3 of them only visited the clinic once. The mean time for cure was 19.9 (range 0-103) months. Only 12 (15%) patients were healed after one single treatment session, while as many as 50 (62%) required > 4 sessions. The mean number of surgical treatment sessions required for cure differed significantly (P=0.0006) between the previously treated patients who needed a mean of 5.6 treatment sessions, compared to the previously untreated men who required surgery a mean of 3.4 times for cure.

Penile human papillomavirus carriage among men attending Swedish STD clinics.

Using the polymerase chain reaction (PCR) technique, we found that up to 84% of 228 men consecutively attending two Swedish STD clinics harboured human papillomavirus (HPV) types 6 or 16. Mean age of the patients was 28 years (range 17-58); 70% were between 17 and 30 years old. Among men without a previous history of, or contact with, condylomata the frequency of HPV 6 detection was 76% using the PCR/dot blot (DB) analysis and 43% with the PCR/agarose gel (AG) technique. The corresponding figures for HPV 16 were 46% and 13%, respectively. These figures were comparable to those found in men with existing condylomata infection or sexual exposure to a partner with condylomata. Although the test group represents a selected high-risk population for STD including HPV, our results indicate that a high frequency of occult HPV carriage exists among sexually-active males. The significance of these findings is discussed.

Adolescent girls investigated for sexual abuse: history, physical findings and legal outcome.

OBJECTIVE: The aim of the study was to summarize the history of assault and record the results of medicolegal examination in adolescent girls under investigation for alleged sexual abuse, and to monitor the outcome of the legal process. The investigation period was 1990-94. METHOD: A consecutive series of 94 0-para girls, aged 9-22, median age 15.0 years, were examined in the head-to-toe manner including anogenital examination. Girls were referred from investigating police and social authorities. Only non-acute examinations were performed. Findings considered consistent with abusive vaginal penetration were hymenal distortion including deep clefts, hymenal and vestibular scarring, and introital diameter permitting vaginal inspection with a 17 mm speculum in the absence of consensual intercourse. Perianal scarring was recorded. STD sampling was made on indication. Findings were documented on body sketches. Medicolegal conclusions were grouped into three categories according to history and physical findings. Information on the outcome of legal procedures was collected from referring authorities. RESULTS: For 82% (77/94) of the girls, referring agencies provided examining physicians with a detailed and consistent history of abuse, presented results comprise these 77 girls. Intrafamiliar abuse was alleged by 81% (62/77), onset prior to menarche by 53% (41/77), and repeated abuse by 74% (57/77) of the girls. Abusive genital penetration was reported by 77% (59/77) and anal penetration by 19% (14/77). Sequelae after admitted self-inflicted injury were found in 15% (12/77). Deep hymenal clefts and/or vestibular scars were found in 59% (35/59) of the girls reporting penetrative abuse, compared with 6% (1/16) when non-penetrative abuse was alleged, P < 0.001. Girls with experience of voluntary intercourse could all be examined with a 25 mm speculum. Of the 17 girls without experience of consensual intercourse but alleging abusive penetration, 47% (17/36) could easily be examined with a 17 mm speculum, compared to none of 13 reporting non-penetrative abuse, P < 0.001. Non-specific anal abnormalities occurred in 10 (13%) girls; more often when anal abuse was reported, P < 0.001. No specific STDs were found. The medicolegal conclusion supported a history of abusive genital penetration in 41 (69%) cases; findings were non-specific in 11 cases and a normal anogenital status was found in 25 cases. The alleged abuse of 34 of the 77 (44%) girls was tried in court. One suspect was acquitted, 32 men were convicted of the abuse of 33 girls. Eleven perpetrators admitted abuse, and their histories were in concordance with the abuse alleged by the victims, as well as with the physical findings. CONCLUSION: A medicolegal diagnosis of alleged non-acute cases of sexual abuse relies on a detailed history. Adolescent girls alleging abuse may exhibit signs of admittedly self-inflicted extragenital injury. Our findings confirm that non-penetrative sexual acts leave no lasting genital signs, but that repeated abusive genital penetration significantly more often than non-penetrative abuse leaves deep posterior hymenal clefts and/or vestibular scarring, and a hymenal opening allowing examination with 17-25 mm specula also in girls without experience of voluntary intercourse. In cases with a confessing perpetrator, no discordance was found between the history of the victim, medicolegal conclusion and the history of the perpetrator.

Diagnosis and clinical presentation of premalignant lesions of the penis.

Although a considerable number of penile cancers may arise de novo, certain potentially premalignant conditions do exist. We account in some detail for precancerous growths, which may initially be misclassified and not submitted to proper therapy and follow-up. At one end of the spectrum disorders exist that are generally considered as medically benign, such as warty tumors; at the other end growths occur that are highly indicative of being potentially invasive, i.e. giant condylomas, bowenoid papulosis, eythroplasia of Queyrat and Bowen's disease. We also focus on elucidating the clinical behavior of some inflammatory conditions, which may either be of pathogenic significance for squamous cell carcinoma development or give rise to differential diagnostic problems, most importantly lichen sclerosus et atrophicus (balanitis xerotica obliterans). We advocate a vigilant approach for histopathological evaluation whenever any clinical diagnostic uncertainty or therapeutic recalcitrance exists. We also favor the administration of highly active topical therapy against penile chronic inflammatory conditions such as lichen sclerosus et atrophicus, careful clinical follow-up of these cases and surgical treatment of phimosis.

Etiology of squamous cell carcinoma of the penis.

OBJECTIVE: To review the epidemiology of invasive cancer of the penis based on scientific publications identified by a Medline search from 1966-2000 for the keywords penis/penile, cancer/carcinoma and risk as well as the cited references in the identified papers. RESULTS: Strong risk factors (OR >10) identified by case-control studies included phimosis, chronic inflammatory conditions such as balanopostitis and lichen sclerosus et atrophicus and treatment with psoralen and ultraviolet A photochemotheraphy (PUVA). A consistent association was found between penile cancer and smoking that was dose-dependent and not explained by investigated confounding factors such as sexual history. Sexual history and self-reported history of condyloma were associated with a 3-5-fold increased penile cancer risk. Cervical cancer in the wife was not consistently associated with cancer of the penis in the husband. Circumcision was associated with penile cancer risk in ecological studies. In a case-control study, circumcision neonatally, but not after the neonatal period, was associated with a 3-fold decreased risk, albeit 20% of penile cancer patients had been circumcised neonatally. In a large number of case series, human papillomavirus (HPV) DNA was identified in penile neoplastic tissue. In penile intraepithelial neoplasia, between 70 and 100% of lesions were HPV DNA positive, whereas invasive penile cancer was positive in only 40-50% of cases. A few serological case-control studies and one prospective study also identified an association between HPV type 16 and penile cancer risk. An association between penile cancer risk and HPV prevalence in the population was also suggested by ecological studies. CONCLUSION: The evidence on risk factors for penile cancer suggests that preventive measures that could be considered include prevention of phimosis, treatment of chronic inflammatory conditions, limiting PUVA treatment, smoking cessation and prophylactic prevention of HPV infection.

Epidemiology of human papillomavirus infection.

Anogenital human papillomavirus (HPV) infection is a sexually transmitted disease (STD) that typically follows a self-limiting transient course for both sexes. The HPV incidences and prevalences vary greatly, because they reflect the sexual activity of the individuals studied and of the population they are in contact with. Higher prevalences are seen in young, sexually active groups and in high-risk areas for cervical and penile cancer, e.g. in Colombia. There has also been an increasing trend with time in Western Europe, paralleling the spread of other STDs and changes in sexual behavior. Penile intraepithelial neoplasia is usually positive for high-risk HPV DNA, mostly of type 16, whereas only approximately 50% of invasive penile cancers are positive for HPV DNA. This is similar to the role of high-risk HPV in vulvar carcinoma, where the attributable proportion is also approximately 40-50%. Moreover, in both sites similar histologic types of squamous cell carcinoma, i.e. the basoloid and basaloid/warty types, are mainly associated with high-risk HPV types. The studies performed so far have indicated that HPV has an etiological role in penile cancer, although the attributable proportion may be only approximately 40-50%.