Autogenous vaccine: the best therapy for perianal condyloma acuminata?

PURPOSE

Treatment of perianal condyloma acuminata is frustrating because most treatment options are fraught with high recurrence rates and patient discomfort. We propose that surgical excision followed by vaccination with an autogenous condyloma acuminata vaccine is the most effective therapy available in primary and recurrent perianal condyloma acuminata.

METHODS

Eighty-three patients with perianal condyloma acuminata were treated from 1985 to 1992. Treatment was divided for patients as follows: surgical excision, 20; bichloroacetic acid, 10; podophyllin and interferon A, 5; excision followed by autogenous condyloma acuminata vaccination twice weekly using 0.1 ml subcutaneously for three weeks increasing to 1.0 ml subcutaneously for seven weeks, 43. Syphilis was diagnosed in seven patients; two were human immunovirus-positive. All but three patients were male. Of those patients treated with the vaccination protocol, 25 had primary and 18 had recurrent disease.

RESULTS

Recurrence rates were: excision alone and bichloroacetic acid, 50 percent; podophyllin and interferon A, 85 percent; whereas only 4.6 percent recurred when treated with excision and vaccination. Mean follow-up was 13 (range, 6-23) months. All patients treated with the vaccination protocol tolerated the full course of therapy.

CONCLUSION

We believe that excision of perianal condyloma acuminata followed by autogenous condyloma acuminata vaccination for approximately ten weeks is the most effective and definitive treatment option and, moreover, should be considered in all patients with perianal condyloma acuminata.

[The correction of the vaginal microflora in patients with a papillomavirus infection associated with cervical intraepithelial neoplasia by using the new bacterial preparation Zhlemik]

The microbiological study of vaginal microflora in 40 patients of the reproductive age (20-30 years) with papilloma virus infection in association with cervical intraepithelial neoplasia of the uterine neck revealed dysbiotic disturbances in vaginal microflora, manifested by a decrease in the isolation rate and amount of lacto- and bifidobacteria and by excessive growth of opportunistic microorganisms. The 10-day course of corrective therapy with the new bacterial preparation "Zhlemik" was carried out. Group 1 (81 women) received the preparation intravaginally on a tampon, group 2 (19 patients) received the preparation in the form of vaginal suppositories. The results of this treatment were indicative of a high sanative effect of the preparation irrespective of the method of its application. This was demonstrated by the results of the bacteriological study made after bacterial correction: the amount of the Lactobacillus was restored, and they could be isolated from all patients; the level of contamination of the cervicovaginal niche with opportunistic microbial strains considerably decreased. The positive clinical effect after bacterial therapy with "Zhlemik" was observed in 93-95% of cases, depending on the form of its application.

Interferon as an adjuvant treatment for genital condyloma acuminatum

OBJECTIVE

To evaluate the effect of alpha-interferon as an adjuvant to laser or fluorouracil treatment in patients with recurrent genital human papillomavirus (HPV) infection.

METHODS

Sixty-two females and 21 males were treated for recurrent HPV infection, with either fluorouracil (Efudex 5%) cream or laser ablation of the lesions. Half of the patients were then randomly treated with adjuvant alpha-interferon, to the lesions for patients treated with fluorouracil, or beneath areas previously treated by laser, once a week, for 8 weeks. The other half of the patients did not receive interferon adjuvant. Evaluation of both groups was done using colposcopy and acetic acid, to assess recurrence rates up to 1 year after treatment.

RESULTS

Of the 83 patients followed for 1 year, colposcopy revealed recurrent anogenital lesions in 3 of 45 receiving interferon, compared with 9 of 38 patients treated without adjuvant interferon.

CONCLUSION

Interferon is effective as adjuvant treatment in controlling the recurrence of genital HPV.

Comparative study of systemic interferon alfa-2a plus isotretinoin versus isotretinoin in the treatment of recurrent condyloma acuminatum in men

OBJECTIVES

Purpose of the present study was to evaluate the effectiveness of isotretinoin versus interferon alfa-2a plus isotretinoin in the treatment of recurrent condyloma acuminatum in 86 men.

METHODS

Men were randomly assigned to group A (n = 42) who received isotretinoin 1 mg/kg orally daily until remission was achieved, but not more than 3 months, or to group B (n = 44) who received interferon alfa-2a 3 x 10(5) IU subcutaneously three times weekly until remission was achieved, but not more than 8 weeks, plus isotretinoin in the same dosage as in group A.

RESULTS

The reduced duration of treatment to achieve remission was statistically significant in group B (2.18 versus 2.5 months; P < 0.01) and the recurrence rate was less in group B (4 of 44 versus 16 of 42; P < 0.01).

CONCLUSIONS

The results of this study are encouraging and demonstrated that the combination of isotretinoin plus interferon alfa-2a achieves higher remission rates and a shorter duration of treatment than isotretinoin alone.

Interferon resistance is independent from copy numbers in benign HPV-induced lesions

Interferons (IFNs) are successfully used in treatment of different human papillomavirus (HPV)-related diseases, such as condyloma acuminatum. Unresponsiveness can be seen in a number of patients which is related to a differential expression of early (E7) and late (L1) viral genes, according to our preliminary studies rather than to impaired IFN-signalling. The molecular basis for this differential expression might imply differential viral replication (copy numbers) in responder vs. nonresponder patients. PCR analysis revealed that the two groups did not differ significantly in HPV copy numbers before treatment. In contrast E7 and L1 levels significantly differed in responders versus nonresponders, regardless of copy numbers. Also, the IFN-mediated antiproliferative effect was mostly influenced by other factors rather than just the copy number. Our data imply that the unresponsiveness of certain patients to IFN treatment may relate to differential viral gene transcription rather than different copy numbers of infecting HIVs.

A randomized, double-blind, placebo-controlled trial of systemically administered interferon-alpha, -beta, or -gamma in combination with cryotherapy for the treatment of condyloma acuminatum

One hundred fifty-two patients were enrolled in a study to evaluate 3 interferon (IFN) preparations used in combination with cryotherapy for treatment of anogenital warts. Subjects received subcutaneous injections (2 x 10(6) units/m2) of IFN-alpha n1, -beta, -gamma or placebo 3 times a week for 6 weeks and cryotherapy with liquid nitrogen. Subjects were followed < or = 1 year. Among patients followed > or = 12 weeks, two-thirds had a complete response. No significant differences in rates of complete response (P = .37) or reappearance of a wart at the initial site (P = .20) were noted among the treatment groups. However, patients who received IFN-beta or -gamma developed new warts at a significantly lower frequency (P = .02). IFN administration was associated with side effects but was well tolerated. IFN-beta was the least toxic of the 3 preparations and had the best therapeutic ratio.

Management of genital warts in women with human leukocyte interferon-alpha vs. podophyllotoxin in cream: a placebo-controlled, double-blind, comparative study

The purpose of this double-blind, placebo-controlled, comparative study was to evaluate the specific clinical efficacy and tolerance of human leukocyte interferon-alpha (2 x 10(6) IU/g) and podophyllotoxin 0.5% incorporated in a hydrophilic cream to cure genital warts. Preselected Asian women (n = 60) aged 18-40 years (mean 22.9), with a clinical and biopsy-confirmed diagnosis of genital warts, harboring 322 lesions (mean 5.36) were randomly assigned to three parallel groups to receive one of the two test drugs or placebo. Each patient received a precoded tube (40 g) containing either human leukocyte interferon-alpha, podophyllotoxin, or identically appearing placebo cream for 3 days' usage. In addition to written instructions, each subject was shown how to apply a minimal amount of trial medication on their lesions thrice daily for 3 consecutive days per week (maximum nine topical applications per week). Patients were examined on a weekly basis, and a cure was considered to be a biopsy-confirmed, total elimination of a lesion. Moreover, patients cured during the study period were spared further therapy, and were requested to return in 16 weeks to monitor for the occurrence of a relapse. The remaining patients' empty tubes were collected, and similarly precoded replacement tubes were given to continue the treatment; a total of 214 tubes were used. The study was scheduled for 16 weeks with 4 weeks of active treatment. Individuals were excluded from the study due to pregnancy, breast feeding, or the receiving of any type of antiviral therapy during the 4 weeks preceding enrollment.(ABSTRACT TRUNCATED AT 250 WORDS)

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.

[The treatment with intramuscular interferon of female genital condylomatosis: beta-IFN vs alfa-2a-IFN]

The authors have investigated the efficacy of i.m. therapy with interferon (IFN) in the treatment of female genital condylomatosis: 94 consecutive patients underwent a randomized therapy with two different IFNs: beta-IFN and alpha-2A-IFN (3,000.000 UI i.m. on alternate days for 4 weeks). A total and/or partial response was observed in 76.5% of cases (72/94). Observed response was unrelated with used IFN, independently of type and seat of treated lesion. There was only an important difference between the two treatments in the incidence of side-effects and drop-out (31% and 6.3% with alpha-2A-IFN and 14.8% and 2.1% with beta-IFN). Systemic therapy with IFN is a good alternative to destructive techniques in the treatment of HPV-associated pathology of female lower genital tract.

Detection with the polymerase chain reaction of human papillomavirus DNA in condylomata acuminata treated with CO2 laser and microwave

BACKGROUND

The recurrence rates of condyloma acuminata are high. The reasons for the relatively high relapse rates with different treatments are unknown.

METHODS

Twelve specimens of condylomata acuminata of the vulva were excised from 12 patients and divided into three parts. One part was untreated, the second and the third parts were treated with CO2 laser and microwave, respectively. DNA was then extracted from tissue by proteolytic digestion and amplified by the polymerase chain reaction. Dot blots were performed with the use of radiolabeled consensus and human papilloma virus (HPV) type-specific probes.

RESULTS

HPV DNA was amplified in 100% of untreated specimens (6-HPV 6; 6-HPV 11), and in 83.3% and 50% of specimens treated with CO2 laser and microwave, respectively. There was a significant difference in detection between untreated and microwave-treated specimens (chi 2 = 4.18, P < 0.05).

CONCLUSION

Microwave damages HPV DNA more effectively than CO2 laser.

[The medical treatment of condylomatosis of the lower genital tract. A multicenter outpatient study]

Beta-interferone (Frone, Serono) has been used to treat 56 patients with clinical diagnosis of genital condylomatosis in quantity of 3 million UI/die. Controls have been effected at 3 months since the end of therapy. 30 patients were cured after 3 months of therapy, while at 6 months follow-up we have reported a complete regression in 78.6% of cases.

Treatment of verrucous carcinoma with recombinant alfa-interferon

BACKGROUND

Verrucous carcinoma is an uncommon neoplasm whose medical treatment is not well defined.

OBJECTIVE

We report the clinical effects of recombinant alpha-interferon (IFN) with varying dispensing routes on the tumor size in 3 patients exhibiting three different subtypes of verrucous carcinoma.

OBSERVATIONS

In case 1, an oral florid papillomatosis of the upper gingiva, a stabilization of the lesion size was observed after the administration of a cumulative dose of 45 million IU of IFN alfa-2b. The patient died after discontinuation of the treatment due to hepatic toxicity. In case 2, a giant condyloma acuminatum of the penis, treatment with a cumulative dose of 522 million IU of IFN alfa-2a first resulted in stabilization of the disease, and no evidence of recurrence was observed after surgical treatment. In case 3, a verrucous carcinoma of the leg, a mild decrease in lesion size was observed after the administration of a cumulative dose of 174 million IU. Surgery was finally required.

CONCLUSION

In reducing the growth of the tumor, treatment by IFN appears to be an adjuvant therapy of verrucous carcinoma, but it never prevents surgery or death.

[Local therapy and adjuvant interferon therapy in genital papilloma virus infections]

OBJECTIVE

Is it possible to reduce the recurrence rates of HPV-positive genital tract lesions by systemic interferon alfa-2a in addition to local therapy?

METHODS

Thirty-three of 63 patients with first manifestation of papillomavirus infection or monolocal manifestation were treated by local therapy. The other 30 patients with recurrent or multiorgan infections received 3 courses with 12 x 10(6) IU interferon alfa-2a subcutaneously.

RESULTS

For the remaining 47 patients (16 were lost to follow-up) we found a significantly lower recurrence rate of 21% (5 of 24) in the group of interferon-treated patients compared to 52% (12 of 23) of patients treated without interferon.

CONCLUSIONS

The systemic treatment of HPV-positive genital tract lesions with interferon alfa-2a in addition to CO2 laser surgery or cone biopsy seems to reduce the recurrence rates of HPV-positive lesions.

Human leukocyte interferon-alpha versus podophyllotoxin in cream for the treatment of genital warts in males. A placebo-controlled, double-blind, comparative study

BACKGROUND

The incidence of overt genital warts, a common sexually transmitted disease of high prevalence, has been on the rise for the last few years. The infection is caused by several types of human papillomaviruses (HPVs), some of which have been accepted as a factor in the pathogenesis of genital squamous-cell carcinomas.

OBJECTIVE

The aim of this double-blind, placebo-controlled study was to compare and evidence differences in clinical efficacy and tolerance between human leukocyte interferon-alpha (2 x 10(6) IU/g) and podophyllotoxin (0.5%), incorporated in a hydrophilic cream base to cure genital warts in Asian males.

METHODS

Sixty patients, circumcised, who ranged in age from 18 to 40 years (mean 25.0), diagnosed with the evidence of penoscopy and HPV DNA (Southern dot blot) as harboring 396 lesions (mean 6.6), were randomized to three parallel groups. Each subject was allocated a precoded tube (40 g) containing one of two trial preparations or matching placebo for 3 days' (consecutive) usage, thrice daily. The study lasted 16 weeks with 4 weeks of active treatment. The patients were examined on a weekly basis, and a clinically and HPV-DNA-confirmed total regression of lesions was recorded as cured. Patients cured during the treatment were spared further therapy and were requested to visit us as scheduled for poststudy follow-up.

RESULTS

Findings indicated that patients treated with leukocyte interferon-alpha cream had shown comparatively better results than the podophyllotoxin-treated group (90 vs. 55%, p < 0.0285) or the placebo group (15%). Mild and transient localized erythema (8.3%), burning sensation (6.6%) and transitory increase in body temperature (> 38 degrees C; 6.6%) were the most frequent adverse symptoms with no dropout. The study was followed up for 1 year, and out of 32/60 (53.3%) cured patients 3 had a relapse after 10 months.

CONCLUSION

Leukocyte interferon-alpha (2 x 10(6) IU/g) has shown comparatively better results than 0.5% podophyllotoxin and placebo in a hydrophilic cream base, thus leukocyte interferon-alpha in cream may provide an alternative and effective regimen to treat genital warts in males.

Perianal condylomata acuminata

Perianal condylomata, a result of clinical infection with human papillomavirus, are an increasing problem. The warts lead to bleeding, itching, and discomfort in the anal region and also may be associated with anal canal neoplasia. Treatment options are numerous and include chemical caustic agents, surgical ablative methods, and immunotherapy. A high rate of recurrence is encountered despite the best of efforts.

Anogenital warts in patients attending the sexually transmitted diseases clinic in Ibadan, Nigeria

One hundred and forty-eight cases of anogenital warts comprising 98 males and 50 females were seen at the Special Treatment Clinic, University College Hospital, Ibadan between May 1977 and 1984. The ages of the patients ranged from 11 months to 49 years. Ten cases occurred in children under 9 years. The peak incidence was in the 20-24 years age group. Local applications with podophyllin was the most frequently recommended therapy as the first line of treatment and produced a cure rate of 38.8% in those treated for three weeks. Thirty-three percent of the patients treated with podophyllin showed marked improvement before they were lost to follow up. Cryotherapy gave a cure rate of 85% but was recommended only for 20 patients. The clinical implication of these findings as well as the limitations encountered in the management of anogenital warts in a developing country are discussed.

A randomised, double-blind, parallel group study to compare subcutaneous interferon alpha-2a plus podophyllin with placebo plus podophyllin in the treatment of primary condylomata acuminata

OBJECTIVES

The primary objective was to determine if six weeks treatment with subcutaneous interferon alpha-2a (IFN) and podophyllin 25% W/V administered twice per week, preceded by IFN alpha-2a three times weekly for one week showed a greater complete response rate in patients with primary condylomata acuminata when assessed at week 10 than treatment with podophyllin and placebo injections in the same schedule. The secondary objective was to compare recurrence rates in complete responders at six months in the two treatment groups.

DESIGN

Randomised, double-blind parallel group study.

SETTING

Multicentre study in six genitourinary clinics within the U.K.

PATIENTS

One hundred and twenty-four patients with primary anogenital warts.

MAIN OUTCOME MEASURES

Complete response rate at week 10, and recurrence rate at week 26 in complete responders.

RESULTS

At week 10 analysis of the efficacy population showed complete response in 36% (15/42 patients) of IFN-treated group and 26% (11/43 patients) in the placebo group (no significant difference). Analysis of the safety population at week 26 showed persistence of the complete response in 57% (8/14 patients) of the IFN-treated group and 80% (12/15 patients) of the placebo group (no significant difference). Adverse effects were more common in IFN-treated patients, involved particularly application site reaction and malaise but were generally mild.

CONCLUSIONS

At the dose and with the regime described treatment with IFN alpha-2a in combination with podophyllin is no more effective in the treatment of primary anogenital warts than podophyllin alone and is associated with more adverse events.