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Rideg O, Oszter A, Makk E, Kálmán E, Farkas K, Tornóczky T, Kovács K. Wide Spectrum Analysis of Human Papillomavirus Genotypes in External Anogenital Warts. Vaccines (Basel) 2021; 9:604. [PMID: 34198774 PMCID: PMC8230260 DOI: 10.3390/vaccines9060604] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/31/2021] [Accepted: 06/04/2021] [Indexed: 12/26/2022] Open
Abstract
External anogenital warts (EGW) are primarily associated with the low-risk human papillomavirus (HPV) genotypes 6 and 11, though coinfection with other low-risk and oncogenic high-risk HPV genotypes also occurs. Although there have been many studies on HPV-associated disease, the prevalence of HPV genotypes associated with EGW is not well characterized. The objective of our retrospective study was to determine the prevalence of HPV genotypes among patients diagnosed with EGW in the south-west of Hungary. Archived formalin-fixed paraffin-embedded tissues from 94 patients were processed in our study. HPV genotypes were determined, applying HPV Direct Flow CHIP test. The overall prevalence of HPV DNA in the EGW samples was 100%, yielding 131 infections among the 94 samples. Of these cases, 72.3% were mono while 27.6% were multi-infections. Out of the 131 infections, the cumulative prevalence of HPV 6 and 11 was 71%. A total of 98.9% of the samples were carrying at least one of these genotypes, while 19.1% of the cases occurred with at least one high-risk genotype. Data from our study could provide invaluable information concerning the prevalence of HPV types among patients with EGW, enabling improved assessment of the actual and future efficacy of vaccination programs, vaccine development, and forecast changes in infection patterns.
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Affiliation(s)
- Orsolya Rideg
- Department of Pathology, Medical School and Clinical Center, University of Pécs, 7624 Pécs, Hungary; (O.R.); (A.O.); (E.M.); (E.K.); (K.K.)
| | - Angéla Oszter
- Department of Pathology, Medical School and Clinical Center, University of Pécs, 7624 Pécs, Hungary; (O.R.); (A.O.); (E.M.); (E.K.); (K.K.)
| | - Evelin Makk
- Department of Pathology, Medical School and Clinical Center, University of Pécs, 7624 Pécs, Hungary; (O.R.); (A.O.); (E.M.); (E.K.); (K.K.)
- Department of Medical Imaging, Medical School and Clinical Center, University of Pécs, 7624 Pécs, Hungary
| | - Endre Kálmán
- Department of Pathology, Medical School and Clinical Center, University of Pécs, 7624 Pécs, Hungary; (O.R.); (A.O.); (E.M.); (E.K.); (K.K.)
| | - Kornélia Farkas
- Institute of Bioanalysis, Medical School and Clinical Center, University of Pécs, 7624 Pécs, Hungary;
| | - Tamás Tornóczky
- Department of Pathology, Medical School and Clinical Center, University of Pécs, 7624 Pécs, Hungary; (O.R.); (A.O.); (E.M.); (E.K.); (K.K.)
| | - Krisztina Kovács
- Department of Pathology, Medical School and Clinical Center, University of Pécs, 7624 Pécs, Hungary; (O.R.); (A.O.); (E.M.); (E.K.); (K.K.)
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Leung AK, Barankin B, Leong KF, Hon KL. Penile warts: an update on their evaluation and management. Drugs Context 2018; 7:212563. [PMID: 30622585 PMCID: PMC6302884 DOI: 10.7573/dic.212563] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 11/17/2018] [Accepted: 11/22/2018] [Indexed: 01/02/2023] Open
Abstract
Background Penile warts are the most common sexually transmitted disease in males. Clinicians should be familiar with the proper evaluation and management of this common condition. Objective To provide an update on the current understanding, evaluation, and management of penile warts. Methods A PubMed search was completed in Clinical Queries using the key terms 'penile warts' and 'genital warts'. The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews. Results Penile warts are caused by human papillomavirus (HPV), notably HPV-6 and HPV-11. Penile warts typically present as asymptomatic papules or plaques. Lesions may be filiform, exophytic, papillomatous, verrucous, hyperkeratotic, cerebriform, fungating, or cauliflower-like. Approximately one-third of penile warts regress without treatment and the average duration prior to resolution is approximately 9 months. Active treatment is preferable to watchful observation to speed up clearance of the lesions and to assuage fears of transmission and autoinoculation. Patient-administered therapies include podofilox (0.5%) solution or gel, imiquimod 3.75 or 5% cream, and sinecatechins (polypheron E) 15% ointment. Clinician-administered therapies include podophyllin, cryotherapy, bichloroacetic or trichloroacetic acid, oral cimetidine, surgical excision, electrocautery, and carbon dioxide laser therapy. Patients who do not respond to first-line treatments may respond to other therapies or a combination of treatment modalities. Second-line therapies include topical/intralesional/intravenous cidofovir, topical 5-fluorouracil, and topical ingenol mebutate. Conclusion No single treatment has been shown to be consistently superior to other treatment modalities. The choice of the treatment method should depend on the physician's comfort level with the various treatment options, the patient's preference and tolerability of treatment, and the number and severity of lesions. The comparative efficacy, ease of administration, adverse effects, cost, and availability of the treatment modality should also be taken into consideration.
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Affiliation(s)
- Alexander Kc Leung
- Department of Pediatrics, The University of Calgary, Alberta Children's Hospital, Calgary, Alberta, Canada
| | | | - Kin Fon Leong
- Pediatric Institute, Kuala Lumpur General Hospital, Kuala Lumpur, Malaysia
| | - Kam Lun Hon
- Department of Pediatrics, The Chinese University of Hong Kong, Shatin, Hong Kong
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Puharić D, Borovac JA, Petrov B. Attitudes of adolescents towards sexual health in three cities from Croatia and Bosnia and Herzegovina. Int Nurs Rev 2014; 62:294-302. [PMID: 25521534 DOI: 10.1111/inr.12160] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM This study aimed to determine the attitudes of adolescents towards sexual health and to assess their understanding of contraception use and knowledge about sexually transmitted infections in three ethnically different areas of Croatia and Bosnia and Herzegovina. METHODS A total of 146 adolescent high school students between 17 and 19 years of age from three different cities were enrolled in this cross-sectional study. The participants completed two anonymous questionnaires: one that measured attitudes towards safe sex practice and another that measured contraception and general sexual health knowledge. RESULTS Shame was identified as the main factor why adolescents did not seek information about sexual health and contraception. On average, respondents correctly answered only 35% of questions regarding sexual health. Adolescents from East Mostar, with a predominantly Bosniak population, had more positive attitudes towards safe sex and showed less contraception knowledge in comparison to their colleagues from two cities in Croatia. LIMITATIONS Our study design might be burdened by socially desirable reporting and other biases inherent to the survey design. CONCLUSION Adolescents from Croatia and Bosnia and Herzegovina, countries that experienced war and are still undergoing post-communist socio-economic transition, generally did not have adequate knowledge with respect to safe sex lifestyles. Respondents had major problems identifying sexually transmitted infections and their knowledge about contraception was insufficient. IMPLICATIONS FOR NURSING AND HEALTH POLICY Providing care for adolescent populations should address specificities in local ethnical and socio-economical circumstances. There is a need for further studies to determine social, cultural and religious factors influencing the knowledge and attitudes towards sexual health in order to provide most effective interventions for specific adolescent populations.
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Affiliation(s)
- D Puharić
- School of Medicine, University of Split, Split, Croatia
| | - J A Borovac
- School of Medicine, University of Split, Split, Croatia
| | - B Petrov
- School of Medicine, Mostar University, Mostar, Bosnia and Herzegovina
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Thornsberry L, English JC. Evidence-based treatment and prevention of external genital warts in female pediatric and adolescent patients. J Pediatr Adolesc Gynecol 2012; 25:150-4. [PMID: 22530225 DOI: 10.1016/j.jpag.2011.10.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
External anogenital warts, or condylomata acuminata, are caused by the proliferation of squamous epithelial cells secondary to human papillomavirus infection. In sexually active adults and adolescents, anogenital warts are a common sexually transmitted disease, but in children they may be a sign of sexual abuse. There are several treatment options available for anogenital warts, but no treatment has been proven to be the most efficacious, and recurrence after clinical clearance is common. Evidence-based treatment of genital warts is challenging because of the lack of controlled trials comparing treatments, especially in pediatric and adolescent populations. This paper discusses various treatment modalities such as physical destruction, cytotoxic agents, and immunomodulating therapies. Many variables influence the selection of a treatment, such as the size, quantity, and location of the warts; and the patient and provider preference, and its availability and cost. All treatments can cause local side effects, and patient tolerability must also be factored into treatment selection. Many treatments have similar clearance and recurrence rates, and none of the treatments completely eliminates the virus. With the numerous challenges surrounding the treatment of anogenital warts, the primary prevention of HPV infection through vaccination is a key component in decreasing the incidence of the disease.
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Affiliation(s)
- L Thornsberry
- University of Pittsburgh Department of Dermatology, Pittsburgh, PA 15213, USA
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Ankerst DP, Diepolder H, Horster S. Topical treatment of anogenital human papillomavirus infection in male patients. Future Virol 2009. [DOI: 10.2217/fvl.09.57] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background: Human papillomavirus (HPV)-associated anogenital warts have a prevalence of up to 78% in sexually active men. Some HPV subtypes bear a considerable oncogenic potential. Materials & methods: Original papers on the treatment of external anogenital warts were included in a meta-analysis to assess the most effective topical treatment. Results: Clearance rates were 0–6.5% for placebo treatment, 76.6% for podophyllotoxin 0.15% cream administered for 4 weeks, 61.5% for podophyllotoxin 0.5% solution (2–6 weeks) and 53.7% for imiquimod 5% cream (12–16 weeks). For male patients, the intent-to-treat analysis demonstrated statistically significant superiority of podophyllotoxin preparations versus imiquimod (p < 0.0001 and p < 0.005, respectively). Clearance rates of locally ablative treatments, such as surgery, cryotherapy, electrocautery and carbon dioxide laser, differed widely without clear superiority of a specific ablative technique. In HIV-positive patients, all treatment options yielded lower clearance rates and higher recurrence rates. Conclusion: While preventive vaccines might reduce HPV-associated morbidity for future generations, those with active HPV disease still need to be treated with customary treatment options. In male patients, podophyllotoxin preparations yielded higher response rates than imiquimod.
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Affiliation(s)
- Donna P Ankerst
- Department of Mathematics, Technical University Munich, Boltzmannstr.3, 85747 Garching, Germany
| | - Helmut Diepolder
- Medizinische Klinik und Poliklinik II Klinikum Großhadern der Ludwig-Maximilians-Universität, Marchioninistr. 15, 81377 München, Germany
| | - Sophia Horster
- Medizinische Klinik und Poliklinik II Klinikum Großhadern der Ludwig-Maximilians-Universität, Marchioninistr. 15, 81377 München, Germany
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Tao XH, Shen JG, Pan WL, Dong YE, Meng Q, Honn KV, Jin R. Significance of SHP-1 and SHP-2 expression in human papillomavirus infected Condyloma acuminatum and cervical cancer. Pathol Oncol Res 2008; 14:365-71. [PMID: 18543080 DOI: 10.1007/s12253-008-9065-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2008] [Accepted: 05/06/2008] [Indexed: 12/15/2022]
Abstract
Human papillomaviruses (HPVs) are a group of DNA viruses that infect the skin and mucous membranes. Type HPV6/11 is closely related to Condyloma acuminatum, while HPV16/18 is the principal cause of cervical cancer. In this study, we examined the expression of protein tyrosine phosphatases SHP-1 and SHP-2 in Condyloma acuminatum, cervical cancer and the relationship between SHP-1/SHP2 expression and HPV infection. Forty Condyloma acuminatum cases, 20 cervical cancer cases and 20 normal human foreskins were examined for HPV infection by in situ hybridization and the expression of SHP-1 and SHP-2 were examined by immunohistochemistry. Results demonstrated that positive expression rates of HPV6/11, HPV16/18, and HPV31/33 were 98%, 10%, and 7.5% in Condyloma acuminatum, 10%, 85%, and 25% in cervical cancer. Only one normal foreskin demonstrated positive staining for HPV16/18. Positive expression rates of SHP-1 and SHP-2 were 80% and 85% in Condyloma acuminatum, 85% and 90% in cervical cancer. The SHP-1 and SHP-2 expressions were mainly distributed in the prickle layer of Condyloma acuminatum and were diffusely distributed in cervical cancer cells. Only 35% and 30% of foreskins demonstrated weak staining in the basal layer cells. There were statistically significant correlations among the infection of HPV and the expression of SHP-1 and SHP-2 in both Condyloma acuminatum and cervical cancer (P < 0.05). SHP-1 expression has a positive correlation with SHP-2 expression. Our results demonstrate putative roles of SHP-1 and SHP-2 in the progression of both Condyloma acuminatum and cervical cancer after HPV infection.
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Affiliation(s)
- Xiao-hua Tao
- Department of Dermatology, Zhejiang Province People's Hospital, Hangzhou, China
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Morris SK, Nguyen CK. The human papillomavirus vaccine in Canada. Canadian Journal of Public Health 2008. [PMID: 18457284 DOI: 10.1007/bf03405456] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Clinical studies have shown the human papillomavirus (HPV) vaccines to be very effective at preventing persistent infection by vaccine serotypes. The development of these new vaccines heralds a new era in cancer prevention. Gardasil, Merck's quadravalent HPV vaccine, has recently been licensed in Canada for women aged 9 to 26 years of age. It necessitates that health professionals become familiar with the vaccine, the evidence supporting its effectiveness and issues related to vaccine strategy, cost effectiveness, and remaining research questions. The vaccine is recommended in Canada for females aged 9 to 13 years and should also be offered to females aged 14 to 26 years. Ongoing research will determine the duration of protection conferred by the vaccine, and the potential need for booster doses. In conjunction with continued screening programs, the HPV vaccine offers the potential to dramatically reduce the burden of cervical cancer in Canada, and to do so in a cost-effective manner.
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Affiliation(s)
- Shaun K Morris
- Division of Infectious Diseases, The Hospital for Sick Children and The University of Toronto, Toronto, ON.
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Wagstaff AJ, Perry CM. Topical imiquimod: a review of its use in the management of anogenital warts, actinic keratoses, basal cell carcinoma and other skin lesions. Drugs 2008; 67:2187-210. [PMID: 17927284 DOI: 10.2165/00003495-200767150-00006] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Topical imiquimod 5% cream (Aldara) is an immune response modulator that is indicated for the treatment of external anogenital warts, superficial basal cell carcinoma and actinic keratoses. The cream is applied two to five times per week for varying periods, depending on the indication. Topical imiquimod cream has also been evaluated in the treatment of several other skin conditions. Immunomodulatory therapy with topical imiquimod 5% is an effective option for the approved indications. The drug appears to be relatively well tolerated, with the option of breaks from treatment as required for local skin reactions (which are common). Systemic reactions have been reported. Treatment of human papillomavirus- and UV-associated skin lesions with topical imiquimod offers a noninvasive, tissue-sparing alternative to ablative treatment options. However, well designed trials of the sustained, long-term efficacy and tolerability of topical imiquimod versus those of common treatment approaches including surgery and other topical alternatives are required before the place of the drug in the management of these lesions can be finalised. Nonetheless, while other treatments for anogenital warts, superficial basal cell carcinoma or actinic keratoses are available, the advantages of self treatment linked with the demonstrated efficacy of topical imiquimod offer an attractive alternative for many patients.
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Hagiwara M, Sasaki H, Matsuo K, Honda M, Kawase M, Nakagawa H. Loop-mediated isothermal amplification method for detection of human papillomavirus type 6, 11, 16, and 18. J Med Virol 2007; 79:605-15. [PMID: 17385684 PMCID: PMC7166959 DOI: 10.1002/jmv.20858] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
A new method was developed for detection of human papillomavirus (HPV) by loop‐mediated isothermal amplification (LAMP), which was compared with the polymerase chain reaction (PCR), and real‐time PCR for specificity and sensitivity. All initial validation studies with the control DNA proved to be type‐specific. In order to evaluate the reliability of HPV type‐specific LAMP detecting HPV DNA from clinical samples, tissue specimens were obtained from 27 patients with external genital polypoid lesions. The histologic diagnoses included condyloma acuminatum (n = 21), bowenoid papulosis (n = 2), seborrheic keratosis (n = 2), epidermolytic acanthoma (n = 1), and hairy nymphae (n = 1). HPV‐6 DNA and HPV‐11 DNA were detected in 18 and 3 of 21 condylomata acuminata, respectively, and there was no simultaneous infection. HPV‐16 DNA was detected in one of two bowenoid papuloses. HPV DNA was not detected in the seborrheic keratoses, epidermolytic acanthoma, and hairy nymphae. These results correlated perfectly with those from real‐time PCR analysis. Most positive samples contained high copy numbers of HPV DNA. HPV‐11 DNA was detected in one case that could not be detected by PCR. The average reaction time was about 59 min. There was a linear correlation between the genome quantity and reaction time to reach the threshold. The LAMP method has an additional advantage as a quantitative method, and is superior in terms of sensitivity, specificity, rapidity, and simplicity, and can potentially be a valuable tool for the detection of HPV DNA. J. Med. Virol. 79:605–615, 2007. © 2007 Wiley‐Liss, Inc.
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