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PubMed1990

The patient with refractory genital warts in the STD-clinic. Treatment failure with CO2-laser.

Sixty two patients with refractory genital warts attending a VD-clinic were treated with CO2-laser. Residual warts or new wart formation was observed in 45 of them (72%), two weeks after operation, resulting in an immediate cure rate of 27%. The cure rate obtained was independent of location, duration, and previous treatment of warts. Reoperation with CO2-laser was performed in 12 patients, and all had remaining lesions two weeks after operation. It is concluded that a single CO2-laser treatment often is an insufficient procedure for eradication of disseminated refractory genital warts.

Adult↗
PubMed1994

[A primary clinical trial of genital warts treated with domestic highly purified podophyllotoxin].

Genital warts (condyloma accunimata) are a kind of sexually transmitted disease (STD) caused by human papillomavirus (HPV). In this article, we report 75 cases of genital warts treated with highly purified podophyllotoxin. All volunteers were selected in our clinic and diagnosed according to typical skin lesions and positive 0.5% acetic acid test. Of the 74 cases 48 were male and 26 were female, with a mean age of 28.4 years (21-54). The average duration of disease was 4.4 months (2 weeks-3 years). All lesions were treated with 0.5% podophyllotoxin-ethanal solution topically 2 times per day for 3 successive days. The treatment was repeated if any warts persisted, but not more than 3 therapies in total were applied. The results showed that 41/48 (85.4%) of male and 23/26 (88.5%) of female patients were cured, the overall cure rate was 86.5% and the effectiveness rate (more than 50% lesions disappeared) was 96.15%. During another 3 months of follow-up, 9 male and 4 female patients (17.6% in total) experienced relapsed warts; these were cured with another treatment. Side effects including slight local irritation and erythema or superficial erosions were common, but 3 male and 2 female patients complained of sever pain and local swelling. All side effects were tolerable. It is concluded that our domestically produced highly purified podophyllotoxin is an effective, comparatively safe drug for the treatment of genital warts. It is also very simple to apply, and can be used for self-treatment.

Adult↗
PubMed1996

Human immunodeficiency virus infection in Mexico City. Rectal bleeding and anal warts as risk factors among men reporting sex with men.

The objectives of this study were to evaluate the frequency and determinants of rectal bleeding and the association between rectal bleeding and risk of human immunodeficiency virus (HIV) infection among homosexual/ bisexual men in Mexico City. Men who requested anonymous HIV testing at a public clinic in Mexico City and who reported engaging in any homosexual behavior were eligible to participate in this study. Trained staff collected information on demographic factors, sexual behavior, psychological states, and HIV serostatus from all consenting, eligible clients. Logistic regression modeling was used to investigate the independent effect of risk factors among 2,758 men who were tested between June 1991 and December 1992. Bleeding during anal intercourse was a common occurrence: More than one third of the men in the study reported some bleeding, and 8% reported bleeding in half or more of their intercourse episodes. The prevalence of HIV infection among bleeders was 42% as compared with 28% in nonbleeders (p < 0.0001), and the adjusted odds ratio was 1.8 (95% confidence interval (CI) 1.1-2.8) for men who bled in more than half of their anal intercourse episodes relative to nonbleeders. There was a trend of increasing HIV seroprevalence with increasing frequency of rectal bleeding (p = 0.001). Nine percent of all HIV infections and 42% of infections among frequent bleeders were attributable to rectal bleeding. Men who reported both rectal bleeding and anal warts were 3.5 (95% CI 2.1-5.8) times more likely to be HIV-infected in multivariate analysis than men reporting neither rectal bleeding nor anal warts. Determinants of rectal bleeding included older age, more education, more receptive anal intercourse than insertive intercourse, receptive digital-anal contact, anal warts, and genital ulcers. Among men reporting sex with men in Mexico City, rectal bleeding is common. It is an independent risk factor for HIV infection, and warrants attention in acquired immunodeficiency syndrome prevention efforts. Rectal bleeding that results from rupture of anal warts may be an especially effective portal of HIV transmission.

Adult↗
PubMed1983

Immunoperoxidase localization of papillomavirus antigen in cutaneous warts and bowenoid papulosis.

Using the immunoperoxidase technique and a broadly cross-reactive antiserum which detects infection with any papillomavirus, papillomavirus capsid antigen was demonstrated in 25 of 48 cutaneous papillomas and in two of 38 cutaneous dysplasias. Both positive dysplastic lesions were diagnosed on histopathologic examination as bowenoid papulosis. Antigen-positive cutaneous warts were scattered in all age categories and at all body sites. In addition, there was little variation in antigen expression by morphologic type of wart. Antigen was localized in the nucleus of superficial epithelial cells. The amount of staining was variable, with some warts showing large numbers of stained nuclei. In other warts only isolated cells stained. In both cases of bowenoid papulosis, small foci of positively stained cells were observed. The finding of papillomavirus antigen in two of 21 cases of bowenoid papulosis is suggestive of an etiologic relationship between this lesion and a papillomavirus. An examination of antigen-negative cases of bowenoid papulosis for a papillomavirus genome will be necessary to confirm these results.

Adolescent↗
PubMed2005

A genotype distribution of human papillomaviruses detected by polymerase chain reaction and direct sequencing analysis in a large sample of common warts in Japan.

There have been no large-scale epidemiological studies of human papillomavirus (HPV) genotype distribution of common warts in Japan. A total of 213 patients with common warts (104 males and 109 females) in Japan were studied to detect HPV genotype distribution by polymerase chain reaction (PCR) and direct sequencing analysis. The results were as follows: 94 HPV-1a (44.1%), 35 HPV-4 (16.4%), 30 HPV-65 (14.1%), 13 HPV-27 (6.1%), 13 HPV-2a (6.1%), 9 HPV-57b (4.22%), 3 HPV-16 (1.41%), 2 HPV-6a (0.94%), 2 HPV-63 (0.94%), and 1 case for each of HPV-3, -5, -5b, -7, -10, -21, -29, -47, -56, -57, -62, and -92 (0.47%, respectively). Four cases (1.88%) were found in which two different HPV types were detected within the lesions: one case of HPV-1a with HPV-16, one case of HPV-1a with HPV-65, one case of HPV-6a with HPV-8, and one case of HPV-65 with HPV-16. There were seven cases of mucosal types (3.3%), that is, two HPV-6a, three HPV-16, one HPV-56, and one HPV-62, and three cases of epidermodysplasia verruciformis (EV)-related types (1.41%), that is, one HPV-5, one HPV-5b (both of which belonged to a high-risk group), and one HPV-47 (which belonged to a low-risk group). To date, this is the largest sequencing-based study of HPV for common warts in Japan. It is said that common warts are induced predominantly by HPV-2, -27, and -57 in European population. However, the present results showed that in Japan they were induced mostly by HPV-1, -4, and -65. This suggests that regional differences in HPV genotype distribution may exist between European and Japanese populations.

Adolescent↗
PubMed1980

[Light-microscopic study of classified virus warts (HPV-1 and HPV-4) (author's transl)].

Histological investigations of verrucae vulgares of the hand and of plantar warts show striking differences between HPV-1-induced warts and those caused by the virus type HPV-4. In warts caused by HPV-1 massive vacuolization and disturbance of epidermal cell differentiation through the entire thickness of the epidermis is predominant whereas in HPV-4 stimulated warts cell differentiation is impaired to a much lesser degree. Despite the presence of inclusions and of vacuolized cells a thick stratum granulosum and a compact horny layer are formed in the latter type.

Adolescent↗
PubMed1978

Heterogeneous keratohyalin formation in warts.

The heterogenecity of keratohyalin (KH) has been demonstrated in rats, then in human warts where similar morphological features have been found and among them, dense homogeneous ovoïd single granules (SG) and composite granules (CG) apparently made up of single granules "coated" with a matrix. This work compares the ultrastructure of the KH of the tongue of newborn rats with that of common warts with and without post-fixation by OsO4, after oxydation by H2O2 and after pepsin treatment. The osmiophily of the SG is confirmed as well as the absence of osmiophily of the matrix of the CG. In man, however, the SG are resistant to oxydation by H2O2 and the CG matrix is oxydation sensitive whereas the opposite is observed in the case of rats. These differences show that it is impossible to deduce the composition of the KH in human warts from that of the rat despite their close ultrastructural resemblance but that important modification of the keratogenesis and KH formation are induced in the cells parasited by the virus of common warts.

Animals↗
PubMed2002

The use of diphenylcyclopropenone in the treatment of recalcitrant warts.

BACKGROUND: The treatment of recalcitrant palmoplantar and periungual warts using topical immunotherapy with diphenylcyclopropenone (DPC) was reviewed retrospectively over a seven-year period. METHODS: Two hundred eleven patients were sensitized during this time. The patients consisted of 90 males and 121 females and were between 5 and 78 years old. Twenty-three patients were lost to followup. Of the remaining, 4 were undergoing treatment at the time of evaluation, 1 patient failed sensitization, and 1 patient became pregnant. Four discontinued because of side effects, 3 because of financial reasons, and 18 patients discontinued treatment prior to completing the minimum required applications (defined as 6), producing a dropout rate of 12% (25/211). Three patients had additional treatment during the course of DPC and were not included in the study. The remaining 154 patients were classified as nonresponders or responders. RESULTS: The responders consisted of 135 individuals (87.7%) that had complete clearance of warts. Reported adverse effects were local and included with pruritus (15.6%), with blistering (7.1%), and with eczematous reactions (14.2%). The majority of the patients tolerated the treatment very well. One patient developed local impetigo. Patients had an average of 5 treatments over a 6-month period. CONCLUSIONS: Topical immunotherapy using DPC is an effective treatment option for recalcitrant warts. It should be considered as first-line treatment for warts based on its high response rate, absence of scarring, and painless application.

Adolescent↗
PubMed1985

Improved laser techniques for the elimination of genital and extragenital warts.

Two series of patients with genital warts were compared for effectiveness of treatment by means of the carbon dioxide laser. In the earlier series (1977 to 1981) laser vaporization was used to remove overt warts while surrounding normal skin was spared. Examination of anal, urethral, and other extragenital sites for possible involvement was done only when warts persisted or recurred. In the later series (1983 to 1985), patients were similarly treated by carbon dioxide laser techniques; however, two additional measures supplemented laser vaporization of gross condyloma acuminatum. The brush technique superficially coagulated skin and mucosal surfaces contiguous to warts. This methodology was hypothesized to eliminate subclinical human papillomavirus infection within normal-appearing epithelium. Compulsive examination and treatment of extragenital sites at the time of the initial laser surgical procedure eliminated the most likely locations for persistence or recurrence. The primary cure rate for the earlier series was 65.8% compared to 91% for the later series. This difference was highly significant (p less than 0.005).

Adult↗
PubMed1983

Free cottontail rabbit papillomavirus DNA persists in warts and carcinomas of infected rabbits and in cells in culture transformed with virus or viral DNA.

We have compared warts and carcinomas from cottontail and domestic rabbits for the presence of cottontail rabbit papillomavirus (CRPV) and the status of the viral DNA genome. Our studies indicate that benign warts from cottontail rabbits, whether found naturally or induced in the laboratory, contain large amounts of virus and on the average 1000 copies of the virus genome per cell. Both benign warts and carcinomas from domestic rabbits contain significantly reduced levels of virus relative to cottontail rabbit warts and an average of 100 copies of the virus genome per cell. A single sample of a naturally occurring cottontail rabbit carcinoma contained approximately 80 copies of the viral genome per cell. None of the tumors that we have analyzed thus far appear to have integrated viral genomes by Southern blot analysis of undigested and restriction endonuclease-digested DNA samples. Furthermore, the CRPV genome present in domestic rabbit carcinomas and a cottontail rabbit carcinoma appears identical by restriction endonuclease mapping to that present in papillomas of cottontail and domestic rabbits indicating that no major deletions or rearrangements of the CRPV genome had occurred during the progression of benign to malignant tumors nor was a variant of wild-type CRPV responsible for this phenomenon. Finally, we have demonstrated morphological transformation in vitro of NIH 3T3 and C127 cells upon infection with purified CRPV and upon transfection with purified CRPV DNA. Furthermore, single cell clones derived from transformed foci contain free forms of CRPV DNA that persist through continued passage in culture. Cells transformed by CRPV grow in soft agar in vitro and produce tumors in athymic nude mice.

Animals↗
PubMed1990

Condylomata acuminata in children: frequent association with human papillomaviruses responsible for cutaneous warts.

To identify the papillomavirus types associated with condylomata acuminata in children and to evaluate their mode of transmission, we studied 32 children with anogenital warts. External condylomata were found in 12 of their mothers and in 10 of their fathers. Ten mothers, including two without external lesions, had cervical condylomata. Blot hybridization studies disclosed a genital human papillomavirus (HPV) in 14 of 27 children (HPV-6 in 12 and HPV-11 in two) and in 8 of 14 patients (HPV-6 in all). HPV-6 was found in another child by the polymerase chain reaction technique. Infection occurred most likely at birth or from nonsexual contact, but sexual abuse could not be excluded in one 11-year-old girl. Cutaneous HPV-2 was found in seven children and as yet uncharacterized papillomaviruses were found in two children. Three mothers of HPV-2-infected children had common hand warts, and two children had subungual warts. This study shows the frequent nonsexual transmission of genital papillomaviruses in children and the unexpectedly high association of children's condylomata with papillomaviruses responsible for skin warts, possibly transmitted by heteroinoculation or autoinoculation.

Adult↗
PubMed1989

Interferon-gamma as adjuvant therapy for resistant warts.

A patient who for 26 years had common warts, which were resistant to various treatment modalities, was treated with a single intralesional injection of interferon-gamma after dinitrochlorobenzene immunotherapy, because immunologic studies indicated she had failed to respond to prior treatment modalities as a result of a functional impairment of her cellular immune response. Within 1 to 2 days, not only the wart injected with interferon-gamma, but also other warts, became erythematous and swollen, giving a lichen planus-like appearance. Without additional injections of interferon-gamma, all warts disappeared completely, leaving slight pigmentation. Interferon-gamma would be most effective when used with, rather than instead of, other immunotherapy.

Biopsy↗
PubMed1996

Cimetidine therapy for warts: a placebo-controlled, double-blind study.

BACKGROUND: Cimetidine, an H2-receptor antagonist, has been used successfully to treat patients with mucocutaneous candidiasis, common variable immunodeficiency, herpes simplex, and herpes zoster because of its immunomodulatory effects. Recently, some trials have suggested that cimetidine may also be useful for the treatment of warts. OBJECTIVE: The aim of the present study was to determine whether cimetidine is effective in the treatment of warts. METHODS: Seventy patients with multiple warts were included in a placebo-controlled, double-blind study. Patients were randomly allocated to treatment groups equally. The groups received cimetidine, 25 to 40 mg/kg daily, or placebo for 3 months. Patients were examined at monthly intervals. RESULTS: At the end of the therapy, 28 cimetidine-treated and 26 placebo-treated patients were examined to determine the efficacy of treatment. Cure rates obtained were 32% (9 of 28) in the cimetidine-treated group and 30.7% (8 of 26) in the placebo-treated group. No significant difference was found between cimetidine and placebo in effectiveness (p = 0.85). CONCLUSION: Our results show that cimetidine is no more effective than placebo in the treatment of patients with common warts.

Adolescent↗
PubMed2003

[Imiquimod in the treatment of recalcitrant warts: a new therapy option?].

Recalcitrants viral warts can pose a therapeutic challenge to the treating physician. In a clinical study, we documented the effect of imiquimod 5% cream (Aldara) on recalcitrants warts in 22 patients. A complete and partial clearing of the warts was achieved in 41% and 50%, respectively. In only 9% of patients no improvement could be observed. Beside the very often observed perilesional erythema, which correlated well with good treatment response, no relevant side effects were documented. Imiquimod 5% cream (Aldara) is an efficient, easy to perform ambulatory treatment modality for recalcitrants HPV induced warts with few side effects.

Adjuvants, Immunologic↗
PubMed1983

Genital warts and cervical neoplasia: an epidemiological study.

Cervical carcinoma and cervical intra-epithelial neoplasia (CIN) are likely to be associated with all sexually transmitted diseases (STDs). To help discover which (if any) of the recognised STDs might actually cause these conditions, a key question is whether one particular such association is much stronger than the others. The present study is therefore only of women newly attending an STD clinic, and compares the prevalences of cytological abnormalities of the cervix among 415 women attending with genital warts, 135 with genital herpes, and 458 with trichomoniasis or gonorrhoea. Significantly more genital wart patients (8.1%) than trichomoniasis or gonorrhoea patients (1.9%) showed dyskaryotic changes (adjusted relative risk (RR) = 5.8 with 95% limits 2.5-13.5) at, or a few months before, first attendance, while no excess whatever was seen in women with genital herpes. Moreover, half the women had a subsequent smear (at an average of 3-4 years after first attendance) and, although the diagnosis at first attendance was not related to the onset rate of dyskaryotic changes observed in these subsequent smears, it was related to the onset rate of grade III cervical intra-epithelial neoplasia (CIN III), which was found in 7 previous genital wart patients, in 2 previous trichomonas patients, but in 0 previous genital herpes patients. Thus, our findings suggest that herpes is not directly relevant to dyskaryotic change, but that one or more of the human papilloma viruses that cause genital warts may be.

Adult↗
PubMed1996

A new method of intralesional bleomycin therapy in the treatment of recalcitrant warts.

We have used a new technique of bleomycin injection to treat intractable palmar, plantar and periungual warts. Following local anaesthesia with topical EMLA (lignocaine and prilocaine) cream, 1 mg/ml bleomycin solution was dropped on to the wart and 'pricked' into the wart using a Monolet needle. We achieved 92% success rate which compares well with other authors whose success rates with intralesional bleomycin vary between 33 and 92%. We conclude that this technique of intralesional bleomycin therapy is an effective, safe and generally well tolerated treatment for recalcitrant warts.

Adolescent↗
PubMed1999

Recalcitrant viral warts: results of treatment with the KTP laser.

We report the use of a potassium-titanyl-phosphate (KTP) continuous wave laser in an open study to treat 25 patients with multiple nongenital warts that had failed to respond to conventional therapies. All patients were treated monthly using the 532 nm KTP continuous wave laser and robotic scanner. Twenty patients (80%) responded to treatment with warts: in 12 patients there was complete clearing. Moderate discomfort was reported during the procedure but subsequent morbidity was slight with no evidence of scarring. Follow-up by postal questionnaire revealed that warts recurred in those patients who had stopped treatment early but not in those whose warts had been treated to complete clearance.

Adolescent↗
PubMed2003

Successful treatment of multiple filiform facial warts with imiquimod 5% cream in a patient infected by human immunodeficiency virus.

Imiquimod, an imidazoquinoline amine, is approved for the topical treatment of external anogenital warts induced by human papilloma virus. Several clinical trials have shown imiquimod to be an effective and safe drug for treatment of anogenital warts. Consequently, it was considered that imiquimod might be effective on warts caused by the same aetiological agent located on other skin areas. We describe the favourable outcome of a case of multiple facial verrucae in a human immunodeficiency virus (HIV)-infected patient treated with imiquimod 5% cream. This is a promising finding which supports those of two previous reports. We feel that imiquimod could be used in HIV-infected patients with multiple facial warts in whom conventional therapies are ineffective or produce significant side-effects.

AIDS-Related Opportunistic Infections↗