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Chang KC, Chen YC, Ding DC. Condyloma acuminatum mimicking cervical cancer in a pregnant woman and treatment with cryotherapy: A case report. Medicine (Baltimore) 2022; 101:e32273. [PMID: 36626521 PMCID: PMC9750563 DOI: 10.1097/md.0000000000032273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
RATIONALE Condyloma acuminata and anogenital warts are protruding papillomatous lesions caused by human papillomavirus. In pregnant women, condyloma acuminata over the cervical region may grow rapidly, mimicking cervical cancer. PATIENT CONCERNS A pregnant woman at 14 weeks of gestation with condyloma acuminatum mimicking cervical cancer was referred to our hospital for further management. DIAGNOSIS Condyloma acuminata. INTERVENTIONS Tumor biopsy was performed twice, and the pathology confirmed condyloma acuminatum. Immunohistochemistry revealed focal positivity for p16 and Ki-67. Cryotherapy was performed and regular follow-up was performed at 2-week intervals. A small residual condyloma acuminata was found and treated with cryotherapy. OUTCOME During the follow-up period, no recurrence of condyloma acuminata was noted. She delivered a baby at 37 weeks of gestation via cesarean section, without complications. LESSONS Condyloma acuminata of the cervix may grow faster during pregnancy, mimicking cervical cancer. Multiple factors must be considered when treating condyloma acuminata during pregnancy. Cryotherapy is proposed as a 1st-line treatment in all trimesters because of its safety, convenience, and cost-effectiveness. Serial follow-up at 2-week intervals to observe post-cryotherapy conditions is recommended.
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Affiliation(s)
- Kai-Chieh Chang
- Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, and Tzu Chi University, Hualien, Taiwan ROC
| | - Yen-Chang Chen
- Department of Anatomical Pathology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan ROC
- Department of Pathology, School of Medicine, Tzu Chi University, Hualien, Taiwan ROC
| | - Dah-Ching Ding
- Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, and Tzu Chi University, Hualien, Taiwan ROC
- Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan ROC
- * Correspondence: Dah-Ching Ding, Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Foundation, No. 707, Chung-Yang Rd., Sec. 3, Hualien 970, Taiwan ROC (e-mail: )
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Sindhuja T, Bhari N, Gupta S. Asian guidelines for condyloma acuminatum. J Infect Chemother 2022; 28:845-852. [PMID: 35341674 DOI: 10.1016/j.jiac.2022.03.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 02/16/2022] [Accepted: 03/08/2022] [Indexed: 11/18/2022]
Abstract
The present guidelines aim to provide comprehensive information on genital condyloma acuminata, including the epidemiology, clinical features, diagnosis and management. The guidelines provide evidence-based recommendations on the diagnosis, prevention and treatment of genital condyloma acuminata in adults in Asia, including patients with HIV co-infection. METHODOLOGY A PubMed search was performed, using the keywords "condyloma acuminata", "anal wart", "anogenital wart", "genital wart" and "genital HPV". A total of 3031 results were found in publications during last six years. A careful review of the titles and abstracts was done to find all the studies pertaining to epidemiology, clinical features, diagnosis, treatment and prevention of condyloma acuminata. DIAGNOSIS Various diagnostic procedures described are: 1. PCR (LE: 2b). 2. Serology (LE: 2b). 3. In-situ hybridization (LE: 3). PREVENTION 1. Vaccination (LE: 1a): Quadrivalent vaccine reduced the frequency of anogenital warts in both vaccinated and unvaccinated contacts. According to the update Advisory Committee on Immunization Practices (ACIP) recommendations, the following protocol is recommended: (a). HPV vaccination at age 11 or 12 years for both males and females. (b). Catch-up vaccination for all persons through age 26 years. (c). Shared clinical decision-making regarding potential HPV vaccination for persons aged 27-45 years, who are at risk of new HPV infection. 2. Male circumcision (LE: 2a): conflicting evidence. HIV AND CONDYLOMA ACUMINATA In HIV-affected individuals, the course of HPV is more aggressive, with a greater risk of treatment resistance, increased chances of intraepithelial neoplasia as well as cancers. TREATMENT Physician administered. 1. Photodynamic therapy (LE: 1a). 2. Laser (LE: 2b). 3. Surgery (LE: 1a). 4. Electrosurgery (LE: 2c). 5. Cryotherapy (LE: 1b). 6. Immunotherapy (LE: 1b). 7. Podophyllin (LE: 1b). Provider administered. 1. Imiquimod 5%(LE: 1a). 2. Podophyllotoxin (LE: 1b). 3. Sinecatechins (LE: 1a). 4. Cidofovir (LE: 3). 5. 5- Fluorouracil (LE: 1a). 6. Interferon (LE: 1a).
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Affiliation(s)
- Tekumalla Sindhuja
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - Neetu Bhari
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - Somesh Gupta
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India.
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Suzuki S, Hayata E, Hoshi SI, Sekizawa A, Sagara Y, Tanaka M, Kinoshita K, Kitamura T. Current status of cervical cytology during pregnancy in Japan. PLoS One 2021; 16:e0245282. [PMID: 33411854 PMCID: PMC7790376 DOI: 10.1371/journal.pone.0245282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 12/24/2020] [Indexed: 11/18/2022] Open
Abstract
In Japan, uterine cancer screening during pregnancy is subsidized by public funds. We examined the current status of the results of cervical cytology conducted during pregnancy in Japan. We requested 2,293 obstetrical facilities to provide information on cervical cytology in pregnant women who delivered between October 2018 and March 2019. A total of 1,292 obstetrical facilities responded, with valid information on a total of 238,743 women. The implementation rate of cervical cytology during pregnancy was 86.8% in Japan. The prevalence of abnormal cervical cytology during pregnancy was 3.3% in total and 4.9% using a spatula/brush with liquid-based cytology (LBC). The prevalence of positive high-risk human papillomavirus (HPV) in teenagers with atypical squamous cells of undetermined significance (ASC-US) was significantly higher than women of other ages (p < 0.01). Because HPV vaccine coverage has dropped to less than 1% in Japan, a further study with various conditions will be needed to improve the accuracy of cervical cancer screening during pregnancy.
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Affiliation(s)
- Shunji Suzuki
- Department of Obstetrics and Gynecology, Japanese Red Cross Katsushika Maternity Hospital, Tokyo, Japan
- Japan Association of Obstetricians and Gynecologists, Tokyo, Japan
- * E-mail:
| | - Eijiro Hayata
- Japan Association of Obstetricians and Gynecologists, Tokyo, Japan
| | - Shin-ichi Hoshi
- Japan Association of Obstetricians and Gynecologists, Tokyo, Japan
| | - Akihiko Sekizawa
- Japan Association of Obstetricians and Gynecologists, Tokyo, Japan
| | - Yoko Sagara
- Japan Association of Obstetricians and Gynecologists, Tokyo, Japan
| | - Masanobu Tanaka
- Japan Association of Obstetricians and Gynecologists, Tokyo, Japan
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Matsumoto K, Sakamoto N, Murakami T, Yatagai N, Tsuyama S, Fukushima H, Ueyama H, Shibuya T, Yao T, Nagahara A. Long-term relapse-free treatment with endoscopic submucosal dissection combined with magnifying narrow-band imaging for a pregnant patient with flat-type condyloma acuminatum: a case report. Clin J Gastroenterol 2021; 14:439-445. [PMID: 33394332 DOI: 10.1007/s12328-020-01288-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 10/28/2020] [Indexed: 11/28/2022]
Abstract
Condyloma acuminatum, in the form of genital warts, usually results from an infection by human papillomavirus, one of the most common causes of sexually transmitted diseases. It develops after an incubation period of 3 weeks to 8 months after infection; flat lesions are significantly rare. Condyloma acuminatum is prevalent in the genitals, particularly in the anus of immunodeficient patients. This also occurs in women during menstrual period and pregnancy. Although a common treatment option for rectal and anal lesions, surgical resection is highly invasive and results in a high rate of recurrence. Recently, endoscopic submucosal dissection has been performed for anorectal lesions, but data on its long-term follow-up are not available. We report the case of an immunocompromised patient due to pregnancy who remained recurrence-free 27 months after en-bloc resection by endoscopic submucosal dissection, with adequate visualisation of the flat lesion's safety margin, combined with magnifying narrow-band imaging.
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Affiliation(s)
- Kenshi Matsumoto
- Department of Gastroenterology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
| | - Naoto Sakamoto
- Department of Gastroenterology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Takashi Murakami
- Department of Gastroenterology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Noboru Yatagai
- Department of Gastroenterology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Shou Tsuyama
- Department of Human Pathology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Hirofumi Fukushima
- Department of Gastroenterology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Hiroya Ueyama
- Department of Gastroenterology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Tomoyoshi Shibuya
- Department of Gastroenterology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Takashi Yao
- Department of Human Pathology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Akihito Nagahara
- Department of Gastroenterology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
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Dias MC, Stuqui B, Provazzi PJS, Bittar C, Candido NM, de Matos RPA, Badial RM, do Bonfim CM, Melli PPDS, Quintana SM, Cordeiro JA, Rahal P, Calmon MDF. Analysis of Nucleotide Alterations in the E6 Genomic Region of Human Papillomavirus Types 6 and 11 in Condyloma Acuminatum Samples from Brazil. Adv Virol 2019; 2019:5697573. [PMID: 31186642 PMCID: PMC6521423 DOI: 10.1155/2019/5697573] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 02/27/2019] [Accepted: 03/17/2019] [Indexed: 11/17/2022] Open
Abstract
Condyloma acuminata (CA), or genital warts, are benign proliferative epidermal or mucous lesions that are caused by infection with human papillomavirus (HPV), mainly the low-risk types 6 and 11. HPV variants are defined as viral sequences that share identity in the nucleotide sequence of the L1 gene greater than 98%. Based on this criterion, HPV6 and 11 variant lineages have been studied, and there are ongoing attempts to correlate these genetic variants with different clinical findings of infection. Therefore, the aims of this study were to detect variants and nucleotide alterations present in the E6 regions of HPV types 6 and 11 found in CA samples, to correlate the HPV presence with the clinical-pathological data of the patients, and to determine phylogenetic relationships with variants from other places in the world. The E6 regions of 25 HPV6 samples and 7 HPV11 samples from CA were amplified using PCR with specific primers. The products were ligated to a cloning vector and five colonies of each sample were sequenced to observe the nucleotide alterations. Twelve samples were identified as the HPV6B3 variant, presenting the mutation (guanine) G474A (adenine), and one of them also showed the mutation (thymine) T369G. The other 13 patients were positive for HPV6B1 without nucleotide alterations. In the analysis of the HPV11 samples, all patients showed the mutations T137C and (cytosine) C380T. One patient also presented the nucleotide alteration T410C. None of the mutations found in the 32 analyzed samples resulted in amino acid changes. Patient age, local occurrence, and HIV infection did not show significant association with HPV infection. Besides, the data found in this study did not show a relationship with the geographical region of isolation when compared to other data from different regions of the world. In this way, despite the nucleotide alterations found, it was not possible to observe amino acid changes and variants grouping according to geographical region.
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Affiliation(s)
- Marina Carrara Dias
- Institute of Biosciences, Letters and Exact Sciences of São Paulo State University, São José do Rio Preto, SP, Brazil
| | - Bruna Stuqui
- Institute of Biosciences, Letters and Exact Sciences of São Paulo State University, São José do Rio Preto, SP, Brazil
| | - Paola Jocelan Scarin Provazzi
- Institute of Biosciences, Letters and Exact Sciences of São Paulo State University, São José do Rio Preto, SP, Brazil
| | - Cíntia Bittar
- Institute of Biosciences, Letters and Exact Sciences of São Paulo State University, São José do Rio Preto, SP, Brazil
| | - Natália Maria Candido
- Institute of Biosciences, Letters and Exact Sciences of São Paulo State University, São José do Rio Preto, SP, Brazil
| | - Renata Prandini Adum de Matos
- Institute of Biosciences, Letters and Exact Sciences of São Paulo State University, São José do Rio Preto, SP, Brazil
| | - Rodolfo Miglioli Badial
- Institute of Biosciences, Letters and Exact Sciences of São Paulo State University, São José do Rio Preto, SP, Brazil
| | - Caroline Measso do Bonfim
- Institute of Biosciences, Letters and Exact Sciences of São Paulo State University, São José do Rio Preto, SP, Brazil
| | | | | | | | - Paula Rahal
- Institute of Biosciences, Letters and Exact Sciences of São Paulo State University, São José do Rio Preto, SP, Brazil
| | - Marilia de Freitas Calmon
- Institute of Biosciences, Letters and Exact Sciences of São Paulo State University, São José do Rio Preto, SP, Brazil
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Suzuki S, Hoshi SI, Sekizawa A, Sagara Y, Tanaka M, Kinoshita K, Kitamura T. Current status of Neisseria gonorrhoeae cervicitis in pregnant women in Japan. PLoS One 2019; 14:e0211595. [PMID: 30730922 PMCID: PMC6366733 DOI: 10.1371/journal.pone.0211595] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 01/16/2019] [Indexed: 11/19/2022] Open
Abstract
We evaluated the current prevalence of gonococcal cervicitis among pregnant women in institutes that either do or do not routinely screen for gonococcal infection in Japan. We requested 2,330 obstetrical facilities to provide information on Neisseria gonorrhoeae cervicitis in pregnant women. A total of 1,876 (80.5%) of them responded. The universal screening test for gonococcal cervicitis, involving nucleic acid amplification for all pregnant women, was performed in 281 institutes (13.9% of institutes across Japan). The total rate of pregnant women with gonococcal cervicitis was 1.3% in the institutes performing the screening test during pregnancy, while it was only 0.2% (p < 0.01) in those not performing it. This suggests that 84% of infected women may have been missed in the institutes that do not routinely perform the screening test for gonococcal cervicitis. It may be time to examine the cost-effectiveness of providing gonococcal screening for all pregnant women in Japan.
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Affiliation(s)
- Shunji Suzuki
- Department of Obstetrics and Gynecology, Japanese Red Cross Katsushika Maternity Hospital, Tokyo, JAPAN
- Japan Association of Obstetricians and Gynecologists, Tokyo, JAPAN
- * E-mail:
| | - Shin-ichi Hoshi
- Japan Association of Obstetricians and Gynecologists, Tokyo, JAPAN
| | - Akihiko Sekizawa
- Japan Association of Obstetricians and Gynecologists, Tokyo, JAPAN
| | - Yoko Sagara
- Japan Association of Obstetricians and Gynecologists, Tokyo, JAPAN
| | - Masanobu Tanaka
- Japan Association of Obstetricians and Gynecologists, Tokyo, JAPAN
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Abstract
OBJECTIVE We examined the clinical characteristics and obstetric outcomes in adolescent pregnancies in Japanese women. METHODS The present study was a retrospective investigation of all primiparous Japanese women with singleton pregnancies who gave birth at ≥22 weeks' gestation aged ≤18 years old (adolescent pregnancy, n = 325) and aged 28-30 years old (n = 2029) at Japanese Red Cross, Katsushika Maternity Hospital between 2002 and 2016. RESULTS The frequencies of smoking, economic problems, an unmarried single status at delivery and the start of prenatal care in the first trimester in the adolescent pregnancy group were significantly higher than in the control group (p < .01). The incidences of Chlamydia trachomatis, Condyloma acuminatum, and mental disorders in the adolescent pregnancy group were significantly higher than in the control group (p < .01). Pregnancy in adolescence was not related to adverse obstetric outcomes except preterm delivery (p = .02). CONCLUSIONS Adolescent pregnancy was not associated with adverse obstetric outcomes; however, adequate social, economic, and mental support is needed for adolescent pregnant women.
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Affiliation(s)
- Shunji Suzuki
- a Department of Obstetrics and Gynecology , Japanese Red Cross Katsushika Maternity Hospital , Tokyo , Japan
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Suzuki S, Sekizawa A, Tanaka M, Okai T, Kinoshita K, Kitamura T. Current status of syphilis in pregnant women in Japan. J Matern Fetal Neonatal Med 2016; 30:2881-2883. [PMID: 27894194 DOI: 10.1080/14767058.2016.1266477] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
We examined the current status of syphilis-infected pregnant Japanese women, according to the results of syphilis screening and confirmation tests of women who gave birth in Japan between October, 2015 and March, 2016. We requested 2458 obstetrical facilities to provide information of syphilis screening tests and 78.1% of them responded. Considering the response rate and the rate of implementation of confirmation tests, the number of syphilis-infected pregnant Japanese women was estimated to be 250 (1/4022) per year.
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Affiliation(s)
- Shunji Suzuki
- a Department of Obstetrics and Gynecology , Japanese Red Cross Katsushika Maternity Hospital , Tokyo , Japan
| | - Akihiko Sekizawa
- a Department of Obstetrics and Gynecology , Japanese Red Cross Katsushika Maternity Hospital , Tokyo , Japan
| | - Masanobu Tanaka
- a Department of Obstetrics and Gynecology , Japanese Red Cross Katsushika Maternity Hospital , Tokyo , Japan
| | - Takashi Okai
- a Department of Obstetrics and Gynecology , Japanese Red Cross Katsushika Maternity Hospital , Tokyo , Japan
| | - Katsuyuki Kinoshita
- a Department of Obstetrics and Gynecology , Japanese Red Cross Katsushika Maternity Hospital , Tokyo , Japan
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