Recurrence of condylomata acuminata of the urethra after conventional and fluorescence-controlled Nd:YAG laser treatment

A new option for the treatment of condyloma acuminatum in the male urethra: Multimodal ultrasound image-guided scraping and photodynamic therapy (USP)

OBJECTIVES

Condyloma acuminatum (CA) is a sexually transmitted disease with a high recurrence rate due to the rapid replication of human papillomavirus (HPV) and its subtle immune escape mechanism, which makes the diagnosis and treatment of CA in the male urethra particularly difficult. This study aims to evaluate the efficacy of comprehensive treatments for male urethral CA after accurate localization of warts under ultrasound guidance.

METHODS

The study included 15 men with intraurethral CA. Before treatment, the urethra was examined by ultrasonography and HPV-PCR. After examination of the invisible urethral warts, wart curettage (penetrating operation with a special stainless steel medical curettage tool) combined with ALA-PDT was used for treatment. The ultrasound and HPV load were reviewed 1 week after treatment, and again at 1, 3, and 6 months after treatment.

RESULTS

All patients achieved satisfactory results 1 week after the last treatment. The viral load of human papilloma was significantly reduced or turned negative, ultrasound imaging exploration showed no neoplasm in the urethra, and no obvious intraoperative or postoperative complications were observed. The side effects in patients included a mild burning or tingling sensation confined to the treated area. After a 6 month follow-up period, only 2 patient relapsed.

CONCLUSION

The combined diagnosis and treatment of CA in the male urethra under the guidance of multi-mode ultrasound imaging is an effective, economical, safe, and well-tolerated treatment method.

Holmium:YAG Laser for the Treatment of Genital and urethral Warts: Multicentre Prospective Evaluation of Safety and Efficacy

Introduction: Genital condylomatosis is a highly contagious disease caused by the human papilloma virus (HPV). The aim of this prospective multicentre study was to evaluate the safety and efficacy of the Holmium:YAG (yttrium-aluminium-garnet) laser in the treatment of genital and intra-urethral warts; the secondary aim was to assess the patients' postoperative satisfaction and cosmetic results. Methods: From December 2016 to March 2019, patients with genital warts were prospectively enrolled in three hospitals. The inclusion criteria were male gender, age over 18 years-old and treatment-naïve. External and urethral genitalia warts were treated by the Holmium YAG laser. The follow-up analysis consisted of physical examination, flexible urethro-cystoscopy in case of meatal lesions, and administration of Dermatology Quality of Life Index (DLQI) and Patient Global Impression of Improvement (PGI-I) questionnaires at 1, 3, 6 and 12 months after surgery and subsequently yearly. Results: Sixty patients were enrolled. The single treatment was effective in 57/60 patients (95%). At a mean follow-up of 26 months, recurrences occurred in 8 patients (13.3%). No peri- or post-operative complication occurred. An improvement in pre-operative condition was highlighted with PGI-I and DLQI questionnaires. Conclusion: Our prospective multicentre study showed that holmium laser surgery seems to be a safe and effective treatment for external genital and urethral warts. Good dermatological outcomes aid to further improve patient satisfaction.

Local hyperthermia at 44 ºC is effective to clear cervical high-risk HPVs: a proof of concept, randomized, controlled clinical trial

BACKGROUND

Persistent infection by high risk human papillomavirus (HPV) is the leading cause of cervical intraepithelial neoplasia and cervical carcinoma. Local hyperthermia at 44ºC has been proven efficacious to clear cutaneous or anogenital warts caused by HPV infection. This study aims to assess the effect of hyperthermia at 44ºC on the clearance of high-risk HPV.

METHODS

A randomized, patient blind, sham treatment-controlled trial was conducted in four medical centers. We enrolled patients with positive high-risk HPVs and normal or insignificant cytological findings (Negative/ASCUS/LSIL). Participants were randomly assigned (1:1) to receive either hyperthermia at 44 ºC or 37 ºC, for 30mins in each session. Patients in both groups received treatment once a day for three consecutive days, plus two more sessions 10 ± 3 days later. The primary outcome was clearance rate of HPV three months after the treatment.

RESULTS

After a 3-month follow-up, hyperthermia treatment at 44 ºC and 37 ºC achieved HPV clearance rates of 85.19% (23/27) and 50% (13/26), respectively (p=0.014). There was no significant difference of treatment response between patients with single and multiple type of HPV by 44 ºC hyperthermia treatment. There were no significant adverse events recorded during the treatment period in both groups.

CONCLUSIONS

Local hyperthermia at 44 ºC safely and significantly aids in clearing cervical high-risk HPVs, the effect of which helps halting the progression of cervical transformation and transmission of the virus.

Update on the Medical and Surgical Management of Urethral Condyloma

INTRODUCTION

Condyloma acuminata (CA) of the urethra presents a management challenge due to high recurrence rates, difficulty in accessing urethral lesions, risk of stricture formation, and potential for sexual dysfunction. While standard treatment modalities are acceptable for some external genital condyloma, they are not always feasible or appropriate for urethral lesions.

OBJECTIVES

We sought to review the literature on epidemiology, presentation, diagnosis and treatment of urothelial CA with a focus on surgical treatment options.

METHODS

We performed a comprehensive literature search of PubMed to identify all studies pertaining to urethral CA through November 2020.

RESULTS

Urethral CA is a relatively rare, but challenging disease to manage with a considerable amount of treatment side effects and downstream morbidity associated. In our comprehensive review we have found a wide selection of treatment modalities ranging from minimally invasive strategies to surgical reconstructive techniques. Proper follow-up to monitor for disease recurrence at the 3-4 month mark is appropriate and will determine subsequent treatment strategies as needed. Future studies and treatment directions include novel drug delivery models to optimize minimally invasive topical drug efficacy.

CONCLUSION

Treatment of urethral CA should be approached in a step-wise fashion. Medical therapy would be an appropriate option for asymptomatic or minimally symptomatic patients with small lesions who desire to avoid any interventions. If patient is symptomatic, has extensive disease burden or has failed medical therapy intervention should be considered with options including PDT, laser ablation or surgical excision with or without urethral reconstruction. Appropriate selection depends on patient characteristics and preferences along with prior treatment history. Kim CJ, Campbell SP, Allkanjari A, et al. Update on the Medical and Surgical Management of Urethral Condyloma. Sex Med Rev 2021;xxx:xxx-xxx.

The place of 5-aminolaevulinic acid-photodynamic therapy in the treatment landscape of urethral warts: A systematic review

BACKGROUND

Human papilloma virus (HPV) infection is the most common sexually transmitted disease worldwide and the main cause of genital warts. Clear recommendations for the management of urethral warts, which are often hard to detect and difficult to treat, are still lacking.

OBJECTIVE

To summarize all available data describing treatment modalities of urethral warts, compare their efficacy and side effects, and provide physicians a treatment strategy outline.

MATERIAL AND METHODS

Till June 2020, we conducted a systematic review of articles studying the different treatment modalities of urethral condylomas. A chi-square test was used to compare the recurrence rates between treatment modalities, the complete clearance rates at first follow-up and the rates of adverse events.

RESULTS

A total of 26 articles with 1730 patients were included in our review. 61 % of patients were deemed completely cured on the first follow-up while 21 % recurred. 5-aminolevulinic acid (ALA) mediated photodynamic therapy (PDT) was the most common treatment and yielded the lowest recurrence rate (7.5 %) followed by laser therapy (24 %) and topical therapy (31 %) (p < 0.01). ALA-PDT resulted in a higher rate of clearance on follow up (96 %) compared to laser therapy (69 %) and topical therapy (14 %) (p < 0.01). Adverse events were more frequent in the ALA-PDT group (69 %) compared to laser therapy (28 %) and topical treatment (30 %) (p < 0.01).

CONCLUSION

ALA-PDT appears to be the most effective treatment of urethral condylomas in term of clearance and recurrence rate, but with a higher risk of adverse events. Management should be tailored to the type of lesion found at presentation.

[Consensus on HPV of the Portuguese Society of Andrology, Sexual Medicine and Reproduction: Treatment]

The treatment of condyloma is generally a challenge in clinical practice. Although the spontaneous resolution rate is high, a significant proportion of patients seek treatment, not because of symptomatology, but mainly for aesthetic issues and concerns related to the transmission or worsening of existing lesions. The available treatments should be applied only for clinically evident macroscopic lesions. Ideally, available therapies should have rapid action onset and clearance, resolve symptoms, reduce recurrence rate and viral load, be effective in treating small lesions, and be well tolerated. However, none of the currently available treatments is clearly more effective than the others and there is no ideal treatment for all patients or for all condyloma. Therefore, the therapeutic decision should be based on the clinician's experience, available resources, lesion morphology, size, number and location, primary or recurrent lesions, disease severity, patient preference and expectations, patient's immune competence, convenience, tolerance, cost of treatment and results of previous therapies. The available treatments are divided into three groups: applied by the patient himself (imiquimod 3.75 or 5%, podophyllotoxin .5%, synecatekines 10% or 15%), applied by the health care provider (bi- and tricloacetic acids 80%-90%, intralesional interferon alpha, cryotherapy, surgical removal, electrofulguration, laser ablation) and experimental or alternative therapies (topical cidofovir, intralesional bleomycin, photodynamic therapy). Treatment methodologies can be further divided into their action - ablative or destructive treatment (cryotherapy, electrofulguration, laser ablation, surgical excision), cytotoxic or proapoptotic treatments (podophyllotoxin .5%, 5-fluoruracil, bleomycin) and immunomodulatory treatments (imiquimod 3.75% or 5%, synecatekines 10% or 15%, intralesional interferon alpha). The overall success rate of the various treatments available ranges from 23% to 94%. Only treatments that include cryotherapy or surgical excision are suitable in condyloma with any anatomical location and that have the highest success rate in monotherapy. Recurrences are common regardless of the treatment received. In contrast, immunomodulatory therapies despite having lower initial clearance rates appear to have higher probabilities of cure in the medium term, with low recurrence rates. Some treatments may be combined with each other and the effectiveness of combined therapies appears to be superior to monotherapy (proactive sequential treatment). The consensuses for the treatment of HPV also consider special situations: immunocompromised patients, meatus and intraurethral lesions and treatment of the partner.

The Male Urethra: Imaging and Surgical Approach for Common Pathologies

Urethral pathology is common in clinical practice and important to recognize. It is essential to recognize urethral pathology on imaging and to understand how to best image the urethra. In this way, the radiologist can provide the urologist with the necessary information prior to intervention. Basic knowledge of commonly performed urethral surgeries can help the radiologist understand the expected appearance of the post-treatment urethra and common postoperative complications.

5-aminolevulinic acid photodynamic therapy for condyloma acuminatum of urethral meatus

Objectives: Condyloma acuminatum are the most common sexually transmitted diseases worldwide, and they are closely associated with human papillomavirus (HPV) infection. Urethral meatus is one of the places that warts occur. Many treatments for uretheral warts have limitations. In this study, we performed 5-aminolevulinic acid-photodynamic therapy (ALA-PDT) on patients and investigated the effectiveness of reducing HPV viral loads. Materials and Methods: In our study, 21 patients diagnosed with urethral condyloma acuminatum were included. After 4 h treatment of ALA, patients received PDT. Each patient received HPV test before every PDT cycle. The frequency of PDT was dependent on viral load changes. Results: All patients achieved complete clinical remission after the last session of ALA-PDT. There were significant differences in HPV viral loads between pretherapy and after one or three rounds of PDT treatment. Conclusions: ALA-PDT is a safe and effective method for treatment of condyloma acuminatum in urethra meatus. Dynamic monitoring of HPV viral loads can more objectively demonstrate the effectiveness and guide the treatment of PDT.

[Human papillomavirus disease burden in men : HPV prevention is a man's business]

Due to the lack of an established school-based immunization program, the initial German public funded girls-only human papillomavirus (HPV)-vaccination strategy failed. Over the last decade, the female coverage rates have not exceeded much more than 40%, thus, missing herd immunity for boys. Therefore, the German HPV immunization program has been revised and currently recommends a gender-neutral HPV vaccination for all children aged 9-14 years to prevent all HPV-related tumors which can be prevented by immunization. In order to correct the mistaken German impression of this being an  issue relevant only to females, this article highlights the HPV disease burden in men which mostly can be prevented by timely immunization of boys. German urologists have started a campaign: HPV prevention is a man's business.

[Anogenital warts and HPV-associated precancers : Looking into the recently passed German S2k guideline]

Anogenital warts are the most frequently sexually transmitted disease caused by viral infections worldwide. People's lifetime risk to suffer from this disease or HPV-associated precancers counts to more than 10%. The therapy and the recurrence rates of both disorders continue to be challenging in Germany because the coverage rate of the preventive HPV vaccination is still insufficient. This underlines the importance of a recently passed interdisciplinary German guideline on anogenital HPV lesions. This article summarizes the main aspects of the new guideline. Specialists should be consulted by children, pregnant women, individuals suffering from immunodeficiency and people frequently having relapses of HPV-associated diseases or having lesions being accessible only endoscopically.

Efficacy and safety of combined high-dose interferon and red light therapy for the treatment of human papillomavirus and associated vaginitis and cervicitis: A prospective and randomized clinical study

BACKGROUND

We evaluated the efficacy and safety of combined high-dose interferon (IFN) and red light therapy for the treatment of subclinical and latent human papillomavirus (HPV) infections.

METHODS

Ninety women diagnosed with subclinical or latent HPV infection were randomized to receive topical application of low-dose recombinant IFNα-2b (1 million IU), high-dose IFNα-2b (9 million IU), or a combination of high-dose IFNα-2b and red light therapy on the cervix and vagina. All patients received treatment once daily for 4 weeks. HPV titer was measured immediately and 4, 8, and 12 weeks after treatment to determine the rates of viral clearance and infection cure. Treatment of HPV-associated vaginitis and cervicitis was also evaluated.

RESULTS

Results showed that immediately and 4, 8, and 12 weeks after treatment, the HPV clearance rates and infection cure rates were higher in the high-dose IFN and combination groups compared to the low-dose IFN group. High-dose IFN and combination therapies were significantly effective against both low-risk and high-risk HPV infections. Although the cure rates for vaginitis and cervicitis were significantly higher in the high- compared to the low-dose IFN group, rates were even higher in the combination group compared to the high-dose IFN group. Mild adverse effects were reported by a very small subset of patients (3/30) in the combination group.

CONCLUSIONS

This study suggests that combination of high-dose IFN and red light therapy is safe and effective against subclinical and latent HPV infections.

5-aminolevulinic acid photodynamic therapy for anal canal condyloma acuminatum: A series of 19 cases and literature review

BACKGROUND

Anal canal condyloma acuminata are common, sexually transmitted lesions, most often caused by the human papillomavirus. The relatively high recurrence rate of anal canal condyloma acuminata can be attributed to the unsuccessful elimination of viruses in areas of subclinical and latent infection. This study aimed to observe and evaluate the effectiveness of 5-aminolevulinic acid-photodynamic therapy combined with monitoring of human papillomavirus load changes in patients with anal canal condyloma acuminata.

METHODS

A total of 19 patients with anal genital warts were recruited for this study. Firstly, visible warts around the anus were removed. Next, an anoscope examination was performed. Human papillomavirus detection, using real-time polymerase chain reaction assays, was performed before every cycle of treatment. Absorbent cotton rolls soaked with a concentration of 20% 5-aminolevulinic acid were inserted into the anus for 3 h. Finally, photodynamic therapy was applied to the lesions. Each patient required multiple PDT sessions to achieve complete response.

RESULTS

All patients achieved complete clinical remission one week after the last session of treatment, and human papillomavirus loads decreased significantly. Six months follow-up after completion of therapy, none of the patients had recurrence.

CONCLUSIONS

5-aminolevulinic acid-photodynamic therapy is an effective and safe approach for anal canal condyloma acuminata. Dynamic human papillomavirus viral quantitative monitoring can aid in the evaluation of therapeutic effects and lead to better treatment outcomes.

Risk Factors for Urethral Condyloma among Heterosexual Young Male Patients with Condyloma Acuminatum of Penile Skin

To our knowledge, this is the first study that focuses on risk factor of urethral condyloma (UC). The subjects of our study included genital warts patients who had been diagnosed as having condyloma acuminatum of penile skin (CAPS) with/without UC. Relationship with UC of number of life time female partners, co-infection with urethritis, circumcision status, number of CAPS and wart diameter were studied by use of multivariate analysis. Co-infection with urethritis, circumcision status were risk factors of UC in heterosexual young male patients with CAPS. This information will be helpful for providing more professional counseling to patients with genital warts.

[Urethral condylomata acuminata]

Condyloma acuminata are the most frequent cause of infections in the anal genital area. They are caused by the human papilloma virus (HPV). Risk factors are early onset of sexual activity, multiple sexual partners, a history of sexually transmitted disease, and immunosuppression. The urethra is afflicted in only 20% of cases; of these, 80% of the warts are at the meatus and 20% in the proximal urethra. This article reports on two cases with condyloma acuminata affection of the total urethra. The current diagnostic, different treatment modalities, and prophylaxis are reviewed.

Periurethral and vulval condylomata acuminata: an unusual juvenile venereal disease in a 3-year-old girl

We present a case of giant condyloma acuminatum (CA) in a 3-year-old girl with rapidly growing vulval and periurethral lesions, which was investigated thoroughly and successfully treated with excision biopsy. Genital warts in the form of giant alarming vestibular, vulval and periurethral lesions of CA are very rare in children. There is need for a multidisciplinary approach with potential sociomedicolegal implications. Surgical excision is safe, effective and provides an opportunity to assess the extent of the lesion and tissue for accurate diagnosis. Genital warts in the form of giant alarming vestibular, vulval and periurethral lesions of CA are very rare in children. Indications for surgical treatment include large, recurrent or refractory lesions, as well as the need for histological identification and acquiring tissue for immunotherapy when necessary. The strategy of an extended follow-up is recommended so as to ensure identification of any risk situations.

[Urethral condyloma in a patient with neurogenic bladder dysfunction: a therapeutic challenge]

Urethral condyloma is a therapeutic challenge. This article reports the case of a patient with spinal cord injury with the incidental finding of a massive spread of urethral condyloma. After removal of the condyloma with biopsy forceps neither recurrence of the condyloma nor a urethral stricture occurred. In patients where intermittent catheterization is performed, condyloma may be dispersed into the bladder, therefore, prompt endoscopic removal is crucial. As condyloma frequently recurs even after complete removal regular controls are mandatory.

Treatment of perianal condyloma acuminate with topical ALA-PDT combined with curettage: outcome and safety

OBJECTIVE

The purpose of this study was to evaluate the treatment outcome and safety of topical photodynamic therapy (PDT) with aminolevulinic acid (5-ALA) combined with surgical curettage for perianal condyloma acuminata.

BACKGROUND DATA

Condyloma acuminata is the most common sexually transmitted disease, with a high relapse rate, especially in the perianal area. The outcomes of many treatment methods for perianal genital warts are not satisfactory.

METHODS

In this study, 40 cases of perianal condyloma acuminata were treated with topical aminolevulinic acid photodynamic therapy (ALA-PDT) combined with curettage. First, the warts were removed with the patient under local anesthesia. The depth of the ablation and curettage reached the dermal layer. Then, the first session of PDT was performed after 2 days. Ten percent 5-ALA cream was applied to lesional skin with occlusive dressing for a 3-h incubation period and the lesions of warts were irradiated for 10 min by using a 635-nm laser beam of 177 mW/cm(2) intensity. The ALA-PDT was repeated after 1 and 3 weeks. Follow-up evaluation was performed at our outpatient clinic at 1 and 3 months after completion of therapy. Before treatment and at each follow-up visit, the lesions were photographed; the treatment outcome was evaluated as recurrence rate, and patient satisfaction was surveyed.

RESULTS

After three PDT sessions following surgical curettage, all 40 patients were cured and there was no recurrence at 1 month off treatment. At 3 months off treatment, six cases relapsed, corresponding to a recurrent rate of 15%. The satisfaction rate of patients was 100% at 1 month and 95% at 3 months after treatment.

CONCLUSIONS

Combination of surgical curettage and topical PDT has been proven to be a safe and effective procedure, and may offer a wide clinical application for the treatment of perianal condyloma acuminata.

E-cadherin expression in male urethral smears and correlation with PCR-based detection of human papillomavirus infection

We performed cytological examination of urethral brushing to study aberrant E-Cadherin expression as a possible marker for papillomavirus in cytological samples. A total of 30 cytobrush male urethral smears were examined E-cadherin expression and human papillomavirus (hpv) was confirmed using PCR-DNA. The age range was 19-36 years (mean: 27 years), 17 (56.7%) cases corresponded to low-risk HPV and 13 (43.3%) cases were high-risk HPV. The mean age ranges were 25.77 +/- 5.90 years for high-risk HPV and 26.77 +/- 4.31 years for low-risk HPV. Pap smears showed dyskeratosis in 23 (76.7%) cases, koilocytes in 13 (43.3%) cases, infection or bacterial background in 14 (43.7%) cases, suggestive changes of Gardnerella infection in 7 (23.3%) cases, and Chlamydia in 3 (10%) cases. Immunohistochemistry was positive for membrane E-Cadherin; there was weak expression in 13 (43.3%) cases, moderate expression in 11 (36.7%) cases (P = 0.109) (Figs. 3a and b), and strong expression in 6 (20%) cases. There were a statistically significant correlations between E-Cadherin expression and koilocytes (P = 0.007), individual cell dyskeratosis (P = 0.041), and HPV risk (P = 0.000). We concluded that the loss of E-Cadherin membrane expression was greater in high-risk HPV cases and was associated with individual cell dyskeratosis features and koilocytes. There were statistically significant correlations between E-Cadherin expression and dyskeratosis (P = 0.043), koilocytes (P = 0.007), and type of HPV (P = 0.000). Using male urethral smears to test for the loss of E-Cadherin membrane expression is simple, rapid, specific and more sensitive than conventional morphologic observations. We concluded that E-Cadherin can be used to discriminate between high- and low-risk papillomavirus in urethral cytologic specimens.

Treatment of genital warts in males by pulsed dye laser

OBJECTIVE

To determine the safety and efficacy of the flashlamp-pumped pulsed dye laser for the treatment of uncomplicated genital warts in adult males.

METHODS

This was a prospective observational study set in the outpatient clinics of the Department of Andrology and Sexually Transmitted Diseases, National Institute of Laser Enhanced Sciences, the Dermatology Clinic, Cairo University, and the Department of Dermatology and Venereology, Suez Canal University. A total of 174 adult male patients with 550 uncomplicated anogenital warts were included. Selective photothermolysis and photocoagulation of the lesions with the flashlamp-pumped pulsed dye laser was carried out. A pulsed dye laser (wavelength 585 nm, 450 s pulse duration; Cynosure, USA) was used with the following settings: spot size 5-7 mm; fluence 9-10 J/cm2.

RESULTS

Complete resolution of treated warts was achieved in 96% of lesions. Side effects were limited, transient and infrequent. Lesion recurrence rate was 5%.

CONCLUSION

The pulsed dye laser has been found to be safe, effective and satisfactory for the treatment of anogenital warts in males. It could be used to selectively destroy warts without damaging the surrounding skin.

Photodynamic diagnosis in urology: state-of-the-art

OBJECTIVES

To provide an overview on the methodology and clinical relevance of fluorescence diagnosis with exogenous fluorochromes or fluorochrome prodrugs in urology.

METHODS

The methodology is summarised on the basis of our experience and the relevant literature. Clinical results and perspectives are reported and concluded after we scanned and evaluated sources from PubMed. Search items were "aminolev*" or "hypericin" or "photodyn*" or "porphyrin" or "fluorescence" or "autofluorescence" and "bladder" or "prostate" or "kidney" or "peni*" or "condylo*". Some literature was also obtained from journals not indexed.

RESULTS

A large number of clinical trials have shown that photodynamic diagnosis (PDD) improves the ability to detect inconspicuous urothelial carcinoma of the bladder. Fluorescence diagnosis has recently been approved in Europe for the detection of bladder cancer after instillation of a hexaminolevulinate (Hexvix) solution. PDD is recommended by the European Association of Urology for the diagnosis of carcinoma in situ of the bladder. To date, the major weakness of PDD for the detection of bladder cancer is its relatively low specificity. Initial results with PDD for the detection of penile carcinoma, prostate cancer, kidney tumours, and urethral condylomata are promising.

CONCLUSIONS

To determine the actual impact of PDD on recurrence and progression rates of bladder cancer, further long-term observational studies are necessary. These studies also will clarify whether PDD is cost efficient.

[Condylomata acuminata: an indication for prophylactic HPV vaccination?]

HPV infection is one of the most common sexually transmitted infections worldwide. Although most infections are transient, persistent ones can lead to condylomata acuminata, genital intraepithelial neoplasia and genital cancer. The recent approval of vaccines against HPV has raised great hopes. Since 1990, 5,392 urological investigations for HPV were carried out in 1,792 men in special HPV centres. We report on the epidemiology and natural course of condylomata, techniques for HPV detection, treatment surveillance and long-term sequelae. Condylomata acuminata proved to be pathognomonic; partner infections were diagnosed in 50% and more. Systematic HPV DNA analyses in partner investigations or as screening investigations cannot be recommended. Ultimately, within the spectrum of therapeutic options for condylomata, no method is really superior to others; recurrences occurred in 30-70% of cases. We definitely need the HPV vaccination programme to get rid of one of the oldest and up to now unsolved problems of mankind.

Local And Systemic Human Papillomavirus Type 6b-Specific Cellular Immune Responses in Patients with Recurrent Genital Warts

Anogenital warts are a common clinical manifestation of genital infection with human papillomavirus type 6b (HPV-6b). Accumulating data indicate that an effective cellular immune response is required for the control of HPV infections. However, in a minority of patients there is a high rate of recurrence of wart lesions. We report the characterization of both local and systemic HPV-specific cellular immune responses in three patients with a history of recurrent genital warts. Although the patients had chronic recurrent wart lesions, we have shown that each had both detectable intralesional and peripheral HPV-specific T lymphocytes. Interestingly, the lesion-infiltrating T cells were specific for only one HPV antigen, focusing on only a few epitopes. Conversely, the T cells derived from peripheral blood recognized a broader range of HPV antigens. The characteristics of the HPV-specific cellular immunity that we have shown in these patients may be indicative of a failure to mount an effective response against the virus. This would be consistent with the chronic nature of the disease in these specific individuals. These observations could be relevant to the design and immunomonitoring of immunotherapeutic vaccines for persistent HPV infections.

Condylomata acuminata of external urethral meatus causing infravesical obstruction

Condyloma acuminata is one of the most common virally transmitted diseases. The most common sites for condyloma in males are the balanopreputial sulcus, frenulum and the glans' mucosa. Condylomata in the urethra is rarely seen occur and most often situated in the distal part of the urethra. A 24-year-male admitted to our clinic with complaint of papillary lesion at the urethral meatus and urinary retention. Physical examination revealed that multiple papillary lesions along the anterior urethra until 1 cm distance from the urethral meatus. Under the clinical diagnosis of condyloma acuminata, he was treated conservatively with radical local excision of the lesion and condyloma acuminatum was verified by histopathological examination. Four months after surgery, there has been no local or remote recurrence.

Urethral condyloma acuminata following urethral instrumentation in an elderly man

A 70-year-old man had undergone urethral dilatation with bougie for 8 months following transurethral resection of the prostate and complained papillary masses at the urethral meatus. Physical and endoscopic examination revealed multiple tumors from the urethral meatus to the bulbous urethra. These tumors were resected transurethrally and 5-FU cream was instilled into urethra. Microscopic examination revealed urethral condyloma acuminata. Human papillomavirus types 6/11 were detected in the condylomas. As high prevalence rate of genital human papillomavirus was reported in penile skin of healthy men, urethral instrumentation including transurethral surgery might cause dissemination of penile skin human papillomavirus into the urethral lumen.