Condylomata acuminata und andere HPV-assoziierte Krankheitsbilder von Genitale, Anus und Harnröhre

[Skin manifestations of the external male genitals]

The urological examination includes the inspection of the external male genitals. Harmless normal variants, such as heterotopic sebaceous glands and pearly penile papules must be differentiated from malignant and infectious manifestations. Lichen sclerosus et atrophicus is a frequent connective tissue disease that can lead to functional impairments and an associated high level of suffering for those affected. Both conservative and invasive treatment options are available. Sexually transmitted diseases, such as syphilis, are gaining increasing importance in routine clinical and daily practice due to the increasing incidence in recent years. An early diagnosis and treatment of malignant neoplasms, such as Queyrat's erythroplasia can be carried out by routine inspection of the genital skin.

Clinical observation of laser combined with 5-aminolevulinic acid photodynamic therapy for female vulva condyloma acuminatum

BACKGROUND

Condylomata acuminata, or genital warts (GW), are exceedingly prevalent, with human papilloma virus infection accounting for 90% of cases. It can be treated in a variety of methods, but the high recurrence rate and cervical scars make it difficult to choose the best treatment option. Hence, the study aims to find the effect of laser combined with 5-aminolevulinic acid (ALA) photodynamic therapy for condyloma acuminata in the vulva, vagina, and cervix.

METHODS

A total of 106 female patients with GW of the vulva, vagina, and cervical condyloma acuminata were treated in the Dermatology Department of Subei People's Hospital in Yangzhou from May 2020 to July 2021. All these patients were treated with laser combined with 5-ALA photodynamic therapy to observe the therapeutic effect.

RESULTS

About 84.9% of patients responded to the first session of ALA-photodynamic treatment. Five patients relapsed in the 2nd week, two patients relapsed in the 4th week, one relapsed in the 8th week, one relapsed in the 12th week, and the relapsed patients were given 1-3 times of photodynamic therapy again, and no recurrence was seen in the 24th week. After four courses of treatment in 106 patients, the wart clearance rate was 100%.

CONCLUSION

Laser combined with 5-ALA photodynamic therapy for female vulva, vagina, and cervix condyloma acuminata has a reliable curative effect, low recurrence rate, few adverse reactions, and less pain. It is worth promoting in female vulva, vagina, and cervical condyloma acuminata.

Condylomata acuminata: A retrospective analysis on clinical characteristics and treatment options

BACKGROUND

Anogenital HPV is the most frequent sexually transmitted disease (STD) worldwide. There is no obligation to officially register HPV infections in Germany and thus the epidemiology of condylomata acuminata (CA) is not well characterized.

OBJECTIVES

To provide a better understanding of the epidemiology of CA and outline the treatment options that are available to patients with this disease.

METHODS

Data of 1124 patients with a confirmed diagnosis of CA, presenting in our university hospital outpatient consultation between 2011 and 2015 were retrospectively evaluated and the efficacy of various types of treatments was addressed.

RESULTS

A large patient cohort of 1124 predominately young (mean age 36.5 years old), male (83.9 %), single (50.2 %), heterosexual (92.8 %) Germans (62.5 %) received consults in our outpatient clinic for STDs. Nearly 60 % of the diagnosed patients presented with first-time CA, indicating a considerable proportion of roughly 40 % recurrent infections as well. Only 13.7 % of patients were previously immunized against HPV.

CONCLUSIONS

The evaluation of a large patient cohort provided a better understanding of the present epidemiology of CA in an outpatient hospital setting in Germany. An effective three-scale therapeutic regime and preventive measures were outlined.

Trends and targets in antiviral phototherapy

Photodynamic therapy (PDT) is a well-established treatment option in the treatment of certain cancerous and pre-cancerous lesions. Though best-known for its application in tumor therapy, historically the photodynamic effect was first demonstrated against bacteria at the beginning of the 20^th century. Today, in light of spreading antibiotic resistance and the rise of new infections, this photodynamic inactivation (PDI) of microbes, such as bacteria, fungi, and viruses, is gaining considerable attention. This review focuses on the PDI of viruses as an alternative treatment in antiviral therapy, but also as a means of viral decontamination, covering mainly the literature of the last decade. The PDI of viruses shares the general action mechanism of photodynamic applications: the irradiation of a dye with light and the subsequent generation of reactive oxygen species (ROS) which are the effective phototoxic agents damaging virus targets by reacting with viral nucleic acids, lipids and proteins. Interestingly, a light-independent antiviral activity has also been found for some of these dyes. This review covers the compound classes employed in the PDI of viruses and their various areas of use. In the medical area, currently two fields stand out in which the PDI of viruses has found broader application: the purification of blood products and the treatment of human papilloma virus manifestations. However, the PDI of viruses has also found interest in such diverse areas as water and surface decontamination, and biosafety.

[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.

Application of a Thulium Laser for Treatment of Cervical Neoplasias and Condylomas: A Feasibility Study

OBJECTIVE

Evaluation of safety, feasibility, and possibilities of the thulium laser, Vela(®), with a wavelength of 1.9 μm for laser treatment of the portio, vagina, and/or vulva.

BACKGROUND DATA

Laser techniques have been used for many years in the gynecological setting for the treatment of cervical, vaginal, and vulval intraepithelial neoplasias (CIN, VAIN, VIN) and also for the treatment of condylomas. To date, the most commonly used laser for this treatment is the CO2 laser.

METHODS

After indication was made for laser treatment, the patients were treated using the thulium laser, Vela. Follow-up examination usually took place after 1-2 weeks, 3 months, and 6 months, when colposcopy and, where necessary, a cytological smear were performed.

RESULTS

During the period from January 2012 to January 2014, 18 patients were treated using the thulium laser. Three patients had a CIN I, 12 had condylomas, two had CIN I and condylomas, and one had CIN II and condylomas. During the follow-up, 40% (n = 6) of patients had a relapse of condylomas. No relapse occurred in cases of CIN. Itching, burning, pain, bleeding, discharge, and skin irritation were listed as side effects of the procedure.

CONCLUSIONS

This feasibility study shows that the use of the thulium laser for the treatment of cervical neoplasias and condylomas offers a good alternative to the standard treatment using a CO2 laser.

[Conservative treatment of anogenital HPV infections]

Despite some recent hopeful therapeutic developments such as topical green tea derivatives, the therapy of anogenital warts remains a medical problem. Both physician- and self-administered therapeutic approaches are not fully satisfactory. The high recurrence rates associated with the current therapy of anogenital warts together with their increasing incidence and burden of disease further support the use of the prophylactic quadrivalent VLP HPV 6,11,16,18 vaccine for control of HPV-associated neoplasias in women and men.