[Correlation between the genotypes and clinical symptoms of human papilloma virus in male outpatients at STD clinics]

OBJECTIVE

To investigate the distribution of the human papilloma virus (HPV) and its genotypes in the male outpatients at the clinics of sexually transmitted diseases (STD) in Changshu and analyze its association with the primary clinical symptoms so as to provide some evidence for the prevention and treatment of HPV infection in men.

METHODS

We collected exfoliated cell samples from the external genitals of 602 male outpatients at the STD clinics in Changshu from February 2016 to February 2018, extracted and amplified nucleic acids from the samples, and detected the HPV genotypes using the gene chip technique. We performed statistical analyses on the types of symptoms in clinical diagnosis and their correlation with the genotypes of HPV using the chi-square test.

RESULTS

The HPV positive rate in the male STD clinics was 48.2%, of which 47.2 % fell into the low-risk type, 30.0% with multiple infections. The main genotypes included HPV types 6, 11, 39, and 52, and the main HPV-related clinical symptoms were verruca (43.1%) and erythra (41.0%). Low-risk types 6 and 11 accounted for a significantly higher percentage than the high-risk types in the verruca patients (60.0% vs 15.0%, , P < 0.05), but showed no statistically significant difference from the latter in the erythra patients (38.7% vs 38.7%, P > 0.05). The incidence of low-risk infection was remarkably higher than that of high-risk infection in the acrobystitis and balanitis patients (P < 0.05), while the high-risk types constituted a markedly higher percentage than the low-risk and high- and low-risk mixed types in the asymptomatic men at physical examination (84.6% vs 0.0% and 15.4%, P < 0.05).

CONCLUSIONS

The HPV positive rate was as high as 48.2% in the males at the STD clinics in Changshu, and the main infection type was low-risk genotype single infection. The clinical symptoms of low-risk infection were mainly verruca and prepuce balanitis, and the high-risk type was mostly asymptomatic at physical examination.

Human papilloma virus: Apprehending the link with carcinogenesis and unveiling new research avenues (Review)

Human papilloma viruses (HPV) are a small group of non‑enveloped viruses belonging to the Papillomaviridae family with strong similarities to polyoma viruses. The viral particles consist of a genome in the form of a circular double‑stranded DNA, encompassing eight open reading frames, as well as a non‑enveloped icosahedral capsid. HPV infection is considered the most common sexually transmitted disease in both sexes and is strongly implicated in the pathogenesis of different types of cancer. 'High‑risk' mucosal HPV types, predominantly types 16, 18, 31, 33 and 35, are associated with most cervical, penile, vulvar, vaginal, anal, oropharyngeal cancers and pre‑cancers. Screening for HPV is necessary for the prognosis and for determining treatment strategies for cancer. Novel HPV markers, including proteomic and genomic markers, as well as anti‑papillomavirus vaccines are currently available. The aim of this comprehensive review was to thoroughly present the updated information on virus development, cancer occurrence, treatment and prevention strategies, in an attempt to shed further light into the field, including novel research avenues.

Treatment of molluscum contagiosum in adult, pediatric, and immunodeficient populations

BACKGROUND

Molluscum contagiosum is a viral infection of the skin that is widely considered to be a self-resolving disease that can be treated with benign neglect. However, the clinical reality is that the disease can vary widely by anatomic site and by recalcitrance to treatment and remains a significant cause of morbidity worldwide.

OBJECTIVE

The purpose of this review was to compile an updated resource for clinicians that addresses the management of the broad spectrum of molluscum cases that may be encountered.

METHODS

A comprehensive PubMed search was performed to identify publications on the treatment of molluscum infection, including presentations that may be rare or difficult.

RESULTS

The specific clinical scenario of molluscum must be considered when selecting the optimal therapy because certain treatments can be more effective for specific patient subpopulations.

CONCLUSION

Further attention must be directed toward standardizing treatment for molluscum infection based on patient age and immune status.

Immunotherapeutic strategies for sexually transmitted viral infections: HIV, HSV and HPV

More than 1 million sexually transmitted infections (STIs) are acquired each day globally. Etiotropic drugs cannot effectively control infectious diseases therefore, there is a dire need to explore alternative strategies especially those based on the regulation of immune system. The review discusses all rational approaches to develop better understanding towards immunotherapeutic strategies based on modulation of immune system in an attempt to curb the elevating risk of infectious diseases such as HIV, HPV and HSV because of their high prevalence. Development of monoclonal antibodies, vaccines and several other immune based treatments are promising alternative strategies that are offering new opportunities to eradicate pathogens.

Vaginal gene therapy

In the last years, vaginal gene therapy has gained increasing attention mainly for the treatment and control of sexually transmitted infections. DNA delivery has been also suggested to improve reproductive outcomes for women with deficiencies in the female reproductive tract. Although no product has reached clinical phase, preclinical investigations reveal the potential of the vaginal tract as an effective administration route for gene delivery. This review focuses on the main advantages and challenges of vaginal gene therapy, and on the most used nucleic acid delivery systems, including viral and non-viral vectors. Additionally, the advances in the application of vaginal gene therapy for the treatment and/or prevention of infectious diseases such as the human immunodeficiency virus (HIV), the human papillomavirus (HPV) or the herpes simplex virus (HSV) are presented.

Human papillomavirus disease in adolescents: management and prevention

Human papillomaviruses (HPV) are a family of viruses that infect the epithelium of many parts of the body. Persistent infection with high-risk HPV is necessary but insufficient to cause cervical cancer. High-risk HPV types are increasingly recognized as a risk factor for cancers other than cervical cancer. A large proportion of vulvar, vaginal, anal, penile, and oropharyngeal cancers are associated with HPV. Low-risk HPV types cause genital warts. Recent advancement in the prevention of HPV infection, genital warts, and HPV-associated precancers and cancers include vaccination. Until the full potential of vaccination can be attained, cervical cancer screening remains an important component of prevention.

[The specifities of the HPV-genital infections in males]

Anogenital infections caused by Human papillomavirus (HPV) are the most frequently diagnosed sexually transmitted infections of viral origin and up to 150 HPV DNA types have been recognized so far. Anogenital warts (condylomata acuminata) are the most common lesions presented in men, however, during the last decade the other HPV-associated exaggerated lesions such as condylomata plana, penile, scrotal, and anal intraepithelial neoplasias, as well as the penile, urine bladder and prostate cancer have been studied somewhat more extensively. The clinical variations might range from clinically invisible, asymptomatic lesions to the bizarre forms of giant condyloma of Buschke-Löwenstein type, including Bowenoid papulosis, Mb. Bowen, different kinds of eryhtroplasia both in men and women and a large spectrum of HPV-induced dermatovenereological entities in genital region including high-grade intraepithelial genital neoplasias, such as penile, anal, scrotal, vulvar, vaginal etc. (thus not only cervical), and, last but not least - the anogenital warts. A prophylactic vaccine that targets these types should thus substantially reduce the burden of HPV-associated clinical diseases. 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 eliminate one of the oldest and up to now unsolved problems of the mankind. Since HPV is transmitted by sexual intercourse, treatment of both partners is necessary in order to eliminate the virus from the population. Approaches to this include prophylactic vaccines such as quadrivalent HPV vaccine for both men and women.

[Viral sexually transmitted infections: prevention, treatments and perspectives]

Viral sexually transmitted infections: prevention, treatments and perspectives Viral sexually transmitted infections (STI) represent a major public health concern. Three different types of viral STI are routinely seen by dermatologists and general practitioners. The first group is represented by HPV which has recently benefited from the development of potent preventive vaccines. Herpesviridae infections are characterized by high levels of morbidity in a context of elevated prevalence in the population. No vaccine is presently available for the prevention of Herpesviridae transmission. The third type of viral STI is HIV, which showed a stable level of incidence in Switzerland over the last years. There is also currently no efficient vaccine against HIV infection. We review here the different tools that can be used to prevent viral STI transmission. We will also review treatment modalities for skin lesions caused by viral STI.

Hepatitis C Virus Infection: Sexual or Non-Sexual Transmission Between Spouses? A Case Report and Review of the Literature

The most efficient route of transmission of hepatitis C virus (HCV) infection is through contaminated blood. Sexual transmission or other close human contact could play a role in sporadic infections. We describe a case of acute hepatitis C progressing to chronic hepatitis over a follow-up of 4 years in a 44-year-old woman having a long-standing monogamous relationship with an HCV infected partner. The infection followed the accidental exposure to her husband's contaminated blood containing a high viral load. The case reported here is the first characterized by a documented direct percutaneous HCV transmission outside the healthcare setting, and suggests that sexual exposure to HCV should be considered only after an accurate exclusion of other routes of intrafamilial spread of the infection. Such conclusion is based on a thorough and updated review of the literature concerning both sexual and household transmission of HCV.

[Kaposi's sarcoma]

In recent years large amounts of findings have accumulated about Kaposi's sarcoma, a virus induced angioproliferative disorder appearing in four clinical forms: classical, epidemic, endemic and iatrogenic, as it has been in focus of not only from the dermatologic but also from the viral tumorgenesis perspective. The common characteristics are the histopathological appearance, the causative role of the human herpesvirus 8 and the similar clinical picture (bluish-red macules, papules, and nodes). Frequency of the distinguished clinical forms differs with geographical location. Viruses, genetic -, and environmental factors have been shown to play a role in the pathomechanism of the disease, of which the most important is the human herpesvirus-8. The mechanisms by which viral proteins and virus infection enhance tumorgenesis and alter immune functions directed at cells have been studied in detail. During the initiation of tumorgenesis, virus induced viral and host cell products (cytokines, receptors and oncogens) initiate inflammatory and angiogenic polyclonal cell proliferation, which later, by the synergistic action of other viruses and/or environmental factors, give rise to malignant proliferation and allow the selected cell to clonally expand and behave like a true malignant tumor. In light of newly published results the authors not only present the clinical appearances and summarize diagnostic possibilities and the pathomechanism of the disease, but also give a thorough overview of the therapeutic tools of Kaposi's sarcoma, and share their experiences obtained during the follow-up of classical Kaposi's sarcoma patients.

Infección por Papillomavirus en el hombre. Estado actual

The Virus of the Human Papiloma (HPV), classically he/she has been related with infections of sexual transmission and processes wicked oncologists of the feminine genital apparatus and with less frequency of the masculine one. The new technical diagnostics, based on molecular biology (by means of polymerase chain reaction), they help to a better epidemic approach, an improvement in the I diagnose viral, and a correct therapeutic focus. The object of this work is to revise the current state of the HPV from the points of view etiopathogenics, epidemic, clinical, diagnosis, therapeutic and preservative.

[Diagnosis of major sexually transmitted infections in the doctor's office: viral diseases]

Sexually transmitted infections caused by viruses include infections by the Herpes simplex virus (HSV), the human papillomavirus (HPV), and the human immunodeficiency virus (HIV). The diagnosis is established on the basis of clinical presentation and the direct demonstration of the antigen or antibodies.

Chapter 17: Genital human papillomavirus infections--current and prospective therapies

Many therapies are available for the treatment of human papillomavirus (HPV)-associated disease, particularly external genital warts. However, at present, these therapies aim to remove the lesion rather than specifically target HPV infection. When disease and infection are local, as in cervical intraepithelial neoplasia (CIN), excisional therapies removing lesion and transformation-susceptible cells are highly effective. However, when infection is regional, as is usually the case for the anogenital warts, vulval intraepithelial neoplasia (VIN), anal intraepithelial neoplasia (AIN), penile intraepithelial neoplasia, and vaginal intraepithelial neoplasia, then current treatments are generally inadequate, with high recurrence rates. Future therapies will be directly or indirectly antiviral, targeting HPV protein functions or enhancing the ability of the immune system to resolve infection or inducing apoptosis indirectly in HPV-infected cells. In the short to the medium term, immunotherapies for low-grade disease are the most likely to be in the clinic. Vaccines targeting the E1 and E2 early proteins combined with immunomodulators or conventional adjuvants that induce a strong cell-mediated HPV antigen-specific response and good immune memory would be the predicted combination. Vaccines designed to target high-grade intraepithelial disease, even when used in combination with immunomodulators, are unlikely to effect lesion clearance in more than a fraction of the cases. However, they may have a role as adjunct therapy after cervical conization to prevent the recurrence of CIN or HPV reinfection. They certainly appear to have a role in multifocal disease, such as VIN and AIN, where partial clearance may be effected and lesion size reduced enough for effective ablative or excisional therapy. It seems unlikely that anti-HPV chemotherapies specifically targeting HPV protein functions will be in the clinic in the medium term. However, agents such as indole-3-carbinol have shown efficacy in small clinical trials, and if these effects are confirmed in larger, randomized, placebo-controlled trials, they could be clinically useful.

Human papillomavirus: beware the infection you can't see

BACKGROUND

Genital human papillomavirus (HPV) is a common sexually transmitted infection. In the first 10 years of sexual activity, point prevalence rates approach 25% and the lifetime risk of acquisition of this infection may be as high as 80%. There are over 200 types of HPV, of which approximately 50 infect the genital area.

OBJECTIVE

This article aims to discuss HPV detection and its role in cervical cancer development.

DISCUSSION

The HPV types that cause genital warts do not cause cervical cancer. The subclinical types (especially types 16 and 18) are most frequently found in high grade epithelial abnormalities and therefore can potentially cause anogenital cancers. Human papillomavirus is a 'necessary but not sufficient cause for cervical cancer'. Most genital HPV infection is transient. Cervical cancer is actually a rare outcome of HPV infection. However, only 5% of women in developing countries have had a Pap smear in the past five years, and worldwide approximately 250 thousand women die of this disease every year. The role of HPV DNA testing has not yet been defined, but is no doubt a potential tool for the future. Meanwhile, international vaccine trials using HPV virus-like particles are taking place, and look promising.

Sexually transmitted infections in men

The diagnosis and treatment of STDs is a common problem in primary care practice; however, newer diagnostic and therapeutic alternatives require physicians to be aware of evidence-based guidelines that are continuing to evolve. The treatment of STDs in men, in particular, is an area of evolving evidence because much of what is known is based on the treatment of STDs in women. Men represent unique challenges in diagnosis, evaluation, and follow-up that need to be considered in the treatment of urethritis, epididymitis, herpes genitalis, condyloma, prostatitis, and other syndromes. Screening for asymptomatic STDs is currently not recommended in the general population, but selected criteria can be used to identify a target population for screening in high-risk areas.

Significance of sexual route of transmission of hepatitis B and C in Russia

It is generally understood that hepatitis B and hepatitis C may be sexually transmitted. During the last decade there was a sharp growth of hepatitis B and C in Russia. In comparison to 1992 the incidence of hepatitis B in Russia rose two-fold and in 1999 there were 43.31 cases per 100,000 of population (in some cities up to 150/100,000 and even more). The incidence of hepatitis C in 1999 (19.31 per 100,000 of population) rose to six times more than in 1994. At the same time there was a dramatic growth in syphilis and other sexually transmitted infections in Russia. The proportion of sexual transmission of hepatitis B virus (HBV) and hepatitis C virus (HCV) compared with other routes of transmission increased. According to the data from Moscow City Centre of Epidemiology during the last two years, up to 40% cases of HCV and HBV were sexually transmitted. The most dramatic growth of registered cases of hepatitis was seen among the sexually active population aged 14-29. Confirmation of the sexual route of transmission of HBV and HCV in teenagers was seen when the results of the study showed various markers of HBV and HCV to be significantly more common among sexually active (n = 45) than sexually inactive (n = 341) teenagers (13.33% vs. 4.39% for HBsAg; 46.67% vs. 12.61% for HBsAg+anti-HBs+anti-HBc; 9.47% vs. 3.95% for anti-HCV, respectively).

Sexually acquired hepatitis

OBJECTIVES

To assess current knowledge of sexually transmitted viral hepatitis in relation to epidemiology, clinical presentation, management, and diagnosis with particular reference to resource-poor settings.

METHOD

A search of published literature identified through Medline from 1966 to October 2001, the Cochrane Library, and reference lists taken from each article obtained. Textword and MeSH searches for hepatitis A, B, C, D, E, G, delta, GB virus, GBV-C, and TT virus were linked to searches under the textword terms sex$, prevent$, and MeSH subheadings, microbiology, complications, drug therapy, therapy, diagnosis, epidemiology, transmission, and prevention and control.

CONCLUSIONS

In heterosexual relationships, hepatitis B is readily transmitted sexually and hepatitis C and D less so, with no evidence for sexual transmission of hepatitis A. Hepatitis types A-D are all transmissible sexually in male homosexual relationships under certain conditions. In resource-poor countries sexual transmission is generally only a significant route of transmission for hepatitis B.

Genital HPV: links to cervical cancer, treatment, and prevention

Human papillomavirus is one of the most prevalent sexually transmitted viruses. It consists of over 230 different subtypes and infects the squamous epithelial cells in humans producing cutaneous, mucosal, and epidermodysplasia verruciformis type infections. There are several risk factors for human papillomavirus infections. These include a sexually active life-style beginning at a young age, having multiple lifetime sex partners, having sex with a partner with genital warts, and long term oral contraceptive use. Approximately 80% of sexually active individuals acquire the virus in their lifetime. Clinical and laboratory detection of the virus consists of macroscopic, serologic, and molecular techniques. Although removal of the lesions is preferable, treatment of human papillomavirus infections may include cryotherapy, loop electrosurgical excision procedure, laser surgery, and drug therapy. Certain human papillomavirus subtypes, particularly human papillomavirus 16, have been linked to cervical cancer, therefore, prophylactic and therapeutic vaccines are currently being developed to prevent or fight the virus.

Sexually transmitted viral infections: epidemiology and treatment

Human papillomavirus, herpes simplex virus, and both hepatitis A and B are some of the most common sexually transmitted infections (STI) worldwide. They are preventable, but unlike bacterial STIs the person may harbor the virus in her or his body for life with periodic recurrences of active infection. Viral STIs have long-term health consequences, some of which are serious and life threatening. Nurses not only care for individuals who have a viral STI but also can provide education for prevention.

Recent advances in diagnosis and therapy of human papillomaviruses

Infection with human papillomavirus is extremely common throughout the world. Almost 50% of sexually active young women are infected with human papillomavirus and although most infections are transient, a subset has the potential to progress to invasive cancer. During the last 20 years, our understanding of the human papillomavirus life cycle and the role of human papillomavirus in human cancer has dramatically increased. Recent technological advances in human papillomavirus detection have provided the means to detect the presence of human papillomavirus with great sensitivity. In the context of patient care, there is still substantial debate regarding the optimal diagnostic and prognostic use of information derived from hybrid capture or polymerase chain reaction-based detection. The inventory of available treatment options is growing somewhat slowly. The most promising advances are being made in the clinical evaluation of candidates for prophylactic vaccination. This review is focused on the current status and future directions of prevention, diagnosis and therapy.

Classic Kaposi's sarcoma after multiple-partner heterosexual behavior in Central Africa

We present a case of a possible sexual transmission of classic Kaposi's sarcoma. To our knowledge, this is the first report of such a case. We noted a long delay between the probable contaminant contact and onset of lesions, suggesting that human herpesvirus 8 has longer incubation periods in healthy individuals than in immunocompromised patients.

Condyloma acuminata: a fatal disease?

Condyloma acuminata is a virally mediated epithelial overgrowth caused by the human papilloma virus. Its simplest form is the common wart, which may occur almost anywhere on the body surface. Its papillary lesion forms are commonly seen in the genital, perineal, and anal areas, though it also infects the conjunctiva, nose, mouth, larynx, and tracheo-bronchial tree. Malignant degeneration may occur in any of these areas. Diagnosis is established by clinical impression and biopsy. Immunoassay methods exist but are simply indicative of the presence of infection and are not useful in predicting the course of the disease. Many treatment modalities exist and all work well for minor lesions. For large lesions such as the giant condyloma acuminata, also known as the Buschke-Lowenstein lesion, only radical surgical extirpation is considered to be appropriate treatment. This case report, as well as others referenced in this study, documents the extreme complexity of management of many of these lesions and the fatal outcome of this disease process in a significant number of cases.

Comparison of clinically directed, disease specific, and syndromic protocols for the management of genital ulcer disease in Lesotho

OBJECTIVE

To evaluate two protocols for the syndromic management of genital ulcer disease (GUD) in Lesotho, southern Africa and to compare the performance of these protocols with that of a conventional disease specific approach.

METHODS

A cross sectional study was conducted among consecutive patients with GUD attending an STD clinic in Maseru, Lesotho. The clinical diagnoses were made by using predefined criteria at the initial visit before the performance of laboratory tests. Attempts were made to detect the specific aetiology of the genital ulcers using PCR assays and syphilis serology. The results of PCR assays and syphilis serology were used as the gold standard against which the performance of the management approaches were applied.

RESULTS

Of 100 patients initially recruited into the study, Haemophilus ducreyi infection was detected in 56%, herpes simplex virus in 26%, Treponema pallidum in 23%, and lymphogranuloma venereum in 7%. No pathogens were detected in 6% of patients. 17% of patients had mixed infections. Sensitivity, specificity, positive and negative predictive values of the three management protocols for GUD were compared after applying each to the study population. Theoretically, the lowest correct treatment rate would have been obtained by using the disease specific protocol (62%) compared with more than 90% in both syndromic management protocols. Considerable overtreatment for primary syphilis would occur following application of both syndromic protocols. This would be the result of the overdiagnosis of chancroid, in particular the misdiagnosis of genital herpes as chancroid, which would receive treatment for syphilis unnecessarily. The HIV seroprevalence among these patients was 36%. A significantly higher rate of HIV seropositivity was detected among the patients with herpes simplex virus infection when compared with those patients having other causes of genital ulcer disease (58% v 27%; odds ratio 3.73; 95% CI 1.26-11.26; p = 0.01).

CONCLUSIONS

Poor sensitivity, specificity, and predictive values were recorded when the disease specific protocol was applied to the study population. In contrast, the syndromic management protocols provided adequate treatment for more than 90% of patients with GUD. Protocol C, which identified a minority of cases of genital herpes, was found to have an advantage when compared with protocol B (all patients with genital ulcer disease treated for both syphilis and chancroid) in that 29% of genital herpes cases would receive appropriate counselling.

Sexually transmitted diseases update

STDs have worldwide distribution and result in immense social and economic cost. Knowledge of the clinical signs, symptoms, current clinical tests, and treatment recommendations is important for all health care professionals.

[Results of treatment of condyloma in the male and its effect on the couple in the presence of intraepithelial cervical neoplasia]

Genital papillomavirus is an infection sexually transmitted, besides it is frequently associated with cancer of the uterine cervix. It is controversial if it is useful to treat the sexual partner. The present study analyzes in a comparative way patients with CIN with treated partner and untreated partner. From 1986 to 1991 251 women treated for CIN, were prospectively studied; they had completed a one year follow up and during this time they presented, or not, treatment failure. Fifty six were examined and their sexual partners were treated for genital papillomavirus, and the control were 195 women, similar to the study group as to age, race, socio-economical level, CIN histological degree, distribution of lesions and therapeutical methods, in whom the male was not examined nor treated. Statistical methods were Umann-Whitney, homogeneity test, and the fractions difference test to compare the groups. It were obtained the persistence and recidive of the treated couple and untreated couple (41% vs 32.8% with P greater than 0.05) not significant, which shows that papillomavirus treatment of the male partner has no effect on CIN treatment failure in the woman. These statistical results should be considered with caution as it is known that the male is a virus reservoir that together with other cofactors may explain the greater risk for the woman to develop CIN.

Sexually transmitted diseases: viruses and ectoparasites. Committee on Sexually Transmitted Diseases of the American Academy of Dermatology

This review highlights recent developments in the epidemiology, pathogenesis, diagnosis, and treatment of nonbacterial sexually transmitted infections. Genital herpes simplex, anogenital human papillomavirus disease, molluscum contagiosum, pediculosis pubis, and scabies are discussed.

Genital human papillomavirus infection

Human papillomavirus is one of the most common causes of sexually transmitted diseases. In the past ten years, 60 different types of papillomavirus have been identified. Although the virus often causes asymptomatic genital infection, it has been strongly associated with lower genital tract carcinoma; therefore, its detection and eradication are important. All patients with evidence of human papillomavirus infection should undergo colposcopy and, depending on the extent of infection and the type of histology, should receive definitive treatment.

The diagnosis and treatment of genital human papillomavirus lesions

A gynecologist in solo practice reviewed three years of experience in the diagnosis and treatment of human papillomavirus (HPV). Infected women were asked to have their sexual partners diagnosed and treated. One hundred nineteen women and 57 men were examined. This article describes common HPV lesion types and examination methods for both sexes. Magnification and use of dilute acetic acid are emphasized. The most common treatments and the pros and cons of various therapeutic methods are discussed. The results of treatments with podophyllin, trichloroacetic acid, electrodesiccation, cryosurgery, CO2 laser, topical 5-fluorouracil and combinations of these also are presented. The sexual partner co-treatment is explained, and the author summarizes his choice of treatment.

Management of human papillomavirus-associated genital lesions in men

A total of 155 men with human papillomavirus (HPV)-associated genital lesions were studied to evaluate therapy for obvious and subclinical lesions. The treatment methods were selected according to type, location, size, and number of lesions. Seventy-three percent of all patients were successfully treated by the initial therapy. Eighty men with minimal disease had a significantly lower treatment failure rate than 75 men with multiple lesions (15 versus 40%; P less than .001). The type of lesions (classical condyloma versus other HPV-associated lesions), visibility (obvious condylomata versus subclinical lesions), and location did not significantly influence the cure rate (P greater than .05). Seventy-six percent of treatment failures were evident at the first follow-up examination. After a follow-up time of 1 year, 95% of men with obvious condylomata and 93% of men with subclinical lesions were disease-free. The results indicate that obvious and subclinical HPV-associated lesions in men may be successfully controlled by one or more treatment modalities adapted to the particular needs of the patient.

Sexually transmitted viruses

Human viruses known to be spread by sexual contact include herpes simplex viruses (HSV), papillomaviruses (HPV), human immunodeficiency virus (HIV), hepatitis B virus, and cytomegalovirus. Infections with the first three (HSV, HPV, and HIV) have reached epidemic proportions and pose global health concerns. Most of what we know about these human pathogens has been learned only recently, owing to the advent of DNA technologies and advances in culture techniques. In fact, our awareness of one virally transmitted venereal disease, acquired immunodeficiency syndrome, dates to the early 1980s. This paper touches on various aspects of the biology, pathogenesis, clinical manifestations, and, where applicable, oncogenicity of these agents, as well as current treatments and vaccine initiatives.

Bilateral ureteral obstruction secondary to condylomata acuminata of the urinary bladder

Condyloma acuminatum is a viral infection of near epidemic proportions. Both men and women are affected equally. Most lesions are on the external genitalia and the mucous membranes of the urethra or the vagina. A rare occurrence of condyloma acuminata is involvement of the urinary bladder. To date, only 11 cases have been reported. We describe two additional cases, both with bilateral ureteral obstruction. Current urologic management and review of the literature are presented.