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PubMed2005

[Efficacy and safety of 5% imiquimod cream in external genital warts: a 6 month follow-up evaluation].

INTRODUCTION: One of the main issues raised by the management of external genital warts is their potential risk of recurrence. However, nearly all studies assessing recurrences have been conducted with a 3 month follow-up. Since the latency of the human papillomavirus is long, such 3 month follow-up might be too short to detect the true recurrence rate. We therefore conducted a study evaluating patients with external genital warts, treated with an immune response modifier, 5% imiquimod cream, and followed up to 6 months after total clearance. METHODS: This was an open, non comparative, multicenter study conducted in 51 private or hospital practices in France. 5% imiquimod cream was applied 3 times per week until the clearance of external genital warts, with a maximum application period of 16 weeks. Patients were followed-up for 6 months after complete clearance. RESULTS: One hundred ninety-one patients (103 males and 88 females), with a mean age of 31.4 years (18.1-70.4) were included in this study, between November 29 1999 and February 1st 2001. Complete clearance of external genital warts was noted in the ITT analysis in 103/191 cases (54 p. 100; CI95 p. 100: 40-61). Fifteen out of 92 (16 p. 100; CI95 p. 100: 9.4-25.5) had a recurrence within the 6 months follow-up period, 13 of these 15 recurrences were noted at the 3 month follow-up visit. CONCLUSION: The rate of recurrence of external genital warts at 6 months was similar to the rate noted at 3 months, suggesting that after the 3-month period, the risk of developing a recurrence was low. The mode of action of imiquimod through the induction of cytokines and the stimulation of the local immune response could explain these results.

Adjuvants, Immunologic↗
PubMed1988

Modulation of male mouse genital sniff, attack, and mount behaviors by urogenital substances from estrous females.

The modulation of attacks, genital sniffs, and mounts in male SJL/J mice by ovarian-dependent urogenital substances in the urine voided by estrous females was examined. Urogenital substances were applied onto the external urogenital areas of ovariectomized mice. When compared with urine voided by estrous females, which stimulated genital sniffing, mounting, and reduced aggression, bladder urine was ineffective. Genital sniffing and mounting was stimulated by estradiol-17 beta, vaginal fluids, and preputial extract. Aggression was reduced by estradiol-17 beta, urethral catheterized urine, and vaginal fluids. Preputialectomy reduced, but did not eliminate, urinary stimulation of genital sniffing and mounting. Preputial extract stimulated aggression. Urogenital substances from ovariectomized females were ineffective in reducing attacks and stimulating genital sniffs and mounts. It was concluded that the ovarian-dependent chemosignals in the urine voided by estrous females are contributed by the urethra, vagina, and preputial gland, perhaps in part through the excretion of unconjugated estrogens.

Agonistic Behavior↗
PubMed1985

Genital Paget's disease and urinary tract malignancy.

Eight cases of Paget's disease of genital mucosa with malignancy of the lower urinary tract are described. In five it was apparent that there was concurrence of two separate malignancies. In one patient with long-standing Paget's disease of the genital mucosa, carcinoma of the urethra and bladder developed subsequently in continuity with the genital lesion; the two lesions were indistinguishable histologically, suggesting extension of the Paget's disease into urothelium. In two patients with bladder malignancy, there was histologic evidence of outward pagetoid extension of this process along urothelium and onto the genital mucosa. The significance of genital Paget's disease is discussed in the light of these findings, and the possible origins of Paget cells within the epidermis are reviewed.

Aged↗
PubMed1999

What predisposes young women to genital prolapse?

OBJECTIVE: To determine the predictive factors for genital prolapse. STUDY DESIGN: We studied 85 young (< or = 45 year old) women who had been operated on for genital prolapse. The control group consisted of women of the same age operated on for benign ovarian tumor. RESULTS: In the study group the number of deliveries was higher and the babies were heavier than in the control group. However, the study group had not had more instrumental deliveries. In addition, the women with prolapses more often had operations of abdominal hernias and also had more chronic pulmonary disease, e.g. asthma. The incidence of preterm delivery was the same in the women with genital prolapse as in the controls. Familial incidence of genital prolapse was about 30%. CONCLUSION: Our study confirms that there are both acquired and congenital factors that predispose women to genital prolapse.

Adult↗
PubMed2002

High prevalence of mycoplasmas in the genital tract of asymptomatic stallions in Austria.

Mycoplasma equigenitalium and M. subdolum have been implicated in genital disorders and infertility of horses. The reported cytopathic effects of M. equigenitalium observed in vitro underscore its potential pathogenic role in reproductive dysfunction in mares. This study was initiated to determine the prevalence of mycoplasmas in the genital tract of stallions in relationship to age, clinical signs, geographic location and semen quality. For this purpose the mycoplasma flora of the genital tract of 116 stallions of the Noric breed was determined by isolation and colony immunoblotting and by polymerase chain reaction (PCR) assays. Of 438 swabs from the genital tract, pre-ejaculatory fluid and semen samples, 352 (80%) samples were positive by PCR and 125 (29%) were positive by culture. Mycoplasmas were isolated predominantly from the fossa glandis and urethra and less frequently from the penis shaft and from semen. M. equigenitalium (89 isolates) and M. subdolum (70 isolates) were the predominant species identified. M. equirhinis and M. felis were detected in 27 and 8 samples, respectively. Comparison of these isolations with clinical signs, semen quality, and age of the stallions revealed no significant correlation. However, geographical location of the stallion significantly correlated with mycoplasma detection. These results suggest that mycoplasmas are present as commensals in the genital tract of stallions. Thus, clinically healthy stallions may present a permanent reservoir for infection of mares via venereal transmission.

Animals↗
PubMed1998

Can a multimedia educational computer-based program on genital herpes teach patients about their disease?

Objective: Education of patients with genital herpes about their disease is time consuming. To evaluate the effectiveness of an educational computer program, we developed a multimedia interactive presentation to teach patients about genital herpes. Such programs can supplement clinician visits for patients with genital herpes, or those at risk for HSV acquisition.Methods: Patients seeking care for genital herpes, or those at risk for HSV acquisition, were asked to participate in the program during routine clinic visits at 5 physician's offices nationwide. A self-administered 7 item herpes knowledge questionnaire was given before and after participation. An additional questionnaire evaluating the satisfaction with the program was also self-administered at completion.Results: 428 patients were enrolled and completed the pre- and post-knowledge questionnaire and 332 patients completed the satisfaction survey. On the pre-test, 20.1% of patients answered all questions correctly, 65.4% answered correctly 4 to 6 questions, and 14.5% 3 or less. On the post-test, 32.9% of patients answered all questions correctly, 61.5% answered correctly 4 to 6 questions, and 5.6% 3 or less (P <.001 for pre- and post-test comparison). A positive change in knowledge between pre- and post-test was seen on 6 of 7 items (P <.001 for all 6). The overall satisfaction with the program was high: the mean rating was 6.2 on a scale 1 (poor) to 7 (excellent).Conclusion: Computer-based education programs about genital herpes may provide a useful adjunct to teaching in physician offices and result in knowledge gain about the disease, at least short-term. Such programs may assist in management of chronic sexually transmitted infections.

Journal Article↗
PubMed1997

Rectal immunization for induction of specific antibody in the genital tract of women.

The purpose of the current study was to examine potential routes of vaccine administration for the induction of antigen-specific responses in the genital tract of women. Sixteen women were enrolled in this study, and the level of influenza-specific antibodies induced in the genital tract was measured after rectal or intramuscular immunizations. Both methods of administration induced significant increases in the concentration of flu-specific IgA found in cervical secretions within 28 days after vaccination. Initially flu-specific IgG antibodies were not induced in the genital tract by either route. As expected both IgA and IgG flu-specific antibodies were dramatically increased in serum after intramuscular vaccination. In contrast, rectal administration did not induce significant IgA responses, and only small flu-specific IgG increases in serum. Six months after administration, IgA flu-specific antibody concentrations were significantly higher than baseline levels in vaginal secretions and saliva isolated from both subject groups and flu-specific IgG concentrations in cervical secretions were high in the rectal immunization group. The long-term presence of both IgG and IgA antibody in genital secretions suggests that rectal immunization may be an effective method for induction of immune protection in the genital tract of women.

Administration, Rectal↗
PubMed2006

Relationship between plasma selenium concentrations and lower genital tract levels of HIV-1 RNA and interleukin type 1beta.

OBJECTIVE: To examine the relationship between selenium nutritional status and intermediates of human immunodeficiency virus (HIV)-1 transmission. DESIGN: Prospective cohort study. SETTING: A study clinic at Muhimbili National Hospital, Dar es Salaam, Tanzania. SUBJECTS: A total of 340 HIV-1-infected pregnant women with gestational ages 12-27 weeks. METHODS: Women's plasma selenium concentrations were determined at enrollment and modeled as tertiles (tertile 1: <114 microg/l (reference); tertile 2: 114-131 microg/l; tertile 3: >131 microg/l). Cervicovaginal lavage specimens were obtained at 36 weeks of gestation to determine HIV-1 RNA and interleukin-1beta (IL-1beta) levels. In subgroup analyses, 123 women with genital tract infections at enrollment were excluded. RESULTS: Plasma selenium concentrations >or=114 microg/l were related to increased risk of lower-genital shedding of HIV-1 RNA. Excluding women with genital tract infections strengthened the associations (relative risk (RR) tertile 2: 1.46, 95% confidence interval (CI)=1.10, 1.92; RR tertile 3: 1.39, 95% CI=1.05, 1.84). There was evidence for an association between plasma selenium concentrations >or=114 microg/l and increased HIV-1 RNA levels among the entire cohort and after excluding women with genital tract infections. There was no association between plasma selenium and IL-1beta concentrations. CONCLUSIONS: High selenium status may lead to increased risk of genital HIV-1 shedding, but data from other studies indicate that the evidence is mixed. Results from ongoing selenium trials are awaited to clarify the impact of selenium on HIV-1-related transmission endpoints. SPONSORSHIP: National Institute of Child Health and Human Development (NICHD R01 32257) and the Fogarty International Center (NIH D43 TW00004).

Adult↗
PubMed1996

Local intravaginal vaccination of the female genital tract.

In a clinical trial the authors tested whether local intravaginal or oral vaccination would stimulate a mucosal immune response in the female genital tract. The whole cell/B subunit (CTB) oral cholera vaccine was used. Two groups of previously unimmunized volunteers were given three doses of vaccine at 2-week intervals: a first group of seven women received oral immunizations and a second group of seven women were immunized locally in the genital tract by mixing the vaccine with a well defined gel, eldexomer, and applying it directly in the fornix of the vagina. The women were given the first vaccination on day 10 of the menstrual cycle. Sampling of peripheral blood and of cervical mucus (CM) using an Aspiglaire syringe was performed immediately prior to the first dose and at 8-10 days following the last immunization. The study showed that while only three of the seven orally immunized women responded with detectable IgA and IgG anti-CTB antibodies in the genital tract, six out of the seven women in the locally vaccinated group responded with genital tract antibodies. The responses were also generally stronger and CM contained higher specific IgA and secretory component containing anti-CTB titres in the locally vaccinated group. Of the orally vaccinated individuals all responded with increases in serum anti-CTB IgG and 4,7 also exhibited specific IgA serum titres. By contrast, only 3/7 in the intravaginal group responded with increases in serum IgG and IgA anti-CTB titers following immunization. The authors conclude that local intravaginal vaccination using a well-defined gel appears to be the route of choice to stimulate immunity in the female genital tract.

Administration, Intravaginal↗
PubMed2000

Occurrence of chlamydiae in the genital tracts of sows at slaughter and their possible significance for reproductive failure.

The aim of this study was to investigate further the role of chlamydiae as pathogens in the genital tracts of sows at slaughter. Genital tracts of 101 randomly selected sows were collected and specimens of genital tract localizations were systematically examined for chlamydiae using immunohistochemistry and PCR. In the genital tracts of 10 sows, Chlamydia psittaci DNA was detected by PCR, and was further typed as 'serotype 1' in nine cases and as avian strain 6 BC in one animal. However, all specimens examined by immunohistochemistry were negative for chlamydiae. Pooled samples of scalding tank water were additionally investigated for 95 animals. Of these samples, 63.2% contained chlamydial DNA, mostly C. trachomatis, and in one sample C. psittaci 'serotype 1'. Although in most cases contamination through influx of faecally contaminated scalding water is a possible reason for the positive PCR results in the genital tract, latent infection cannot be excluded. In conclusion, the results obtained suggest that chlamydiae are of no or only minor importance in the examined group of Swiss breeding sows. Nevertheless, the role and significance of chlamydiae as pathogens in porcine reproductive disorders remain unresolved and require further investigation.

Animals↗
PubMed2005

Genital herpes in adolescents.

Herpes simplex virus (HSV) infections occur commonly among adolescents. Most HSV-2 infections are genital, but genital herpes can be caused by either HSV-1 or HSV-2. Weighted means were calculated based on published seroprevalence data on adolescents from the United States and found HSV-1 rates of 53.1 percent for adolescent males and 49.4 percent for adolescent females. The weighted means for HSV-2 was 15 percent for adolescent females and 12 percent for adolescent males. Most individuals who are infected with HSV-2 are unaware of their infection. Healthcare providers of adolescents should consider genital herpes even when an adolescent presents with nonspecific genital symptoms. In this article, we review current recommendations for diagnosis and management and review the psychological sequelae that can be associated with having genital herpes. Finally, we discuss biomedical interventions that are being developed to help reduce the epidemic of HSV and the challenges that these interventions face with regard to implementation.

Adolescent↗
PubMed2002

Genital and perineal burns in children: 10 years of experience at a major burn center.

PURPOSE: The aim of this report is to review a decade of experience in the management of perineal and genital burns at a major burn center. METHODS: Seventy-eight children who sustained perineal or genital burns admitted to the Shriners Hospitals for Children in Galveston are discussed. RESULTS: Genital and perineal burns occurred in the context of major burns and were rarely isolated. A total of 64.1% were caused by hot liquids (scalds), 29.5% were flame burns, 3.8% contact burns, and 2.6% electrical burns. A total of 61% of the burns could be treated conservatively with loose debridement, topical, and parenteral antibiotics with satisfactory outcomes. Foley catheterization did not increase the morbidity in these patients except in children less than 1 year of age. Testicular involvement was associated with the most severe burns. Child abuse was found in 46% and 48% of boys and girls, respectively, younger than 2 years that had sustained scald burns to the perineum and, or genitals. CONCLUSIONS: Most perineal and genital burns in children can be treated successfully with a conservative approach. Child abuse should be vigorously investigated.

Burns↗
PubMed1987

Effects on infants of a first episode of genital herpes during pregnancy.

Although genital herpes simplex virus (HSV) infections occurring during pregnancy are known to be associated with neonatal and maternal complications, their frequency and contributing risk factors are not well understood. We prospectively followed 29 patients who acquired genital herpes during pregnancy, to evaluate the perinatal effects of the infection. The patients were classified on the basis of clinical or serologic criteria. Fifteen patients had a primary first episode of genital HSV Type 2 (HSV-2), and 14 had a nonprimary first episode. Although no patient had disseminated disease, 6 of the 15 with primary genital herpes but none of 14 with nonprimary first-episode infection had infants with serious perinatal morbidity (P less than 0.01). Four of the five infants whose mothers acquired primary HSV-2 in the third trimester had perinatal morbidity such as prematurity, intrauterine growth retardation, and neonatal infection with HSV-2. Perinatal complications occurred in one of five infants whose mothers acquired primary HSV-2 during the first trimester, as well as in one of five infants whose mothers had primary HSV-2 during the second trimester. Asymptomatic cervical shedding of HSV-2 was detected at 10.6 percent of weekly visits made after a primary first episode, as compared with 0.5 percent of visits after a nonprimary first episode (P less than 0.01). We conclude that infants born to women who acquire primary genital herpes during pregnancy are at high risk of exposure to HSV, either during premature labor at the time of the primary episode or subsequently because of asymptomatic cervical shedding of the virus. The 40 percent incidence of serious perinatal morbidity in such women suggests that studies of preventive measures such as the use of antiviral chemotherapy are warranted.

Cervix Uteri↗
PubMed2006

Monitoring the T cell response to genital tract infection.

To date, it has not been possible to study antigen-specific T cell responses during primary infection of the genital tract. The low frequency of pathogen-specific T cells in a naïve mouse makes it difficult to monitor the initial events after antigen encounter. We developed a system to examine the response of pathogen-specific T cells in the genital mucosa after intrauterine infection. We identified the protective CD4(+) T cell antigen Cta1 from Chlamydia trachomatis and generated T cell receptor (TCR) transgenic (tg) mice with specificity for this protein. By transferring TCR tg T cells into naïve animals, we determined that Chlamydia-specific T cells were activated and proliferated in the lymph nodes draining the genital tract after primary intrauterine infection. Activated T cells migrated into the genital mucosa and secreted IFN-gamma. The development of Chlamydia-specific TCR tg mice provides an approach for dissecting how pathogen-specific T cells function in the genital tract.

Animals↗
PubMed2006

Prevalence of genital human papillomavirus infections established using different diagnostic techniques among males attending a urological clinic.

OBJECTIVE: To compare the accuracy of different diagnostic methods and their use in estimating the prevalence of genital human papillomavirus (HPV) infections in males attending a urological clinic. MATERIAL AND METHODS: The study population was derived from a series of 1,153 consecutive males attending a urological clinic in São Paulo between January 1996 and November 1998. Of these 1,153 males, 334 had clinically suspected genital HPV infection and comprised the study cohort. The diagnostic methods used included peniscopy, directed biopsy and HPV detection by means of the Hybrid Capture 2 (HC) assay for both oncogenic and non-oncogenic HPV types. RESULTS: Peniscopy was performed for 297 males, positive results being reported in 237 cases (79.8%). Directed biopsy was performed in 188 males, and histology suggested HPV in 140 of these cases (74.5%). HC confirmed the presence of HPV in only 35.2% of the histologically HPV-suggestive cases. Peniscopy has good sensitivity for identifying male carriers of genital HPV. However, the technique has an inherent low specificity, limiting its usefulness to the correct identification of those who never present with HPV infection. Characteristic histological alterations are useful in suggesting HPV infection, but their correlation with HPV detection using HC is not particularly good. CONCLUSIONS: These data suggest that both histology and peniscopy have low specificity in detecting male genital HPV. Accurate diagnosis of HPV infection can be confirmed by molecular detection methods only. Histology, however, plays an important role in the differential diagnosis. An appropriate diagnostic protocol for male genital HPV infections in a urological clinic should include peniscopy, histology and molecular diagnostic tools (HC or polymerase chain reaction).

Biopsy↗
PubMed1998

Immediate effects of extracorporeal shock waves on the male genital system of rabbit. Preliminary report.

Hemospermia was reported to occur following extracorporeal shock wave lithotripsy of lower ureteric stones. Because no studies showed clearly the possible effect of extracorporeal shock waves (ESW) on the male genital system, we were prompted to study this effect. Eighteen male white New Zealand rabbits were divided into three groups (six in each) and subjected to different doses of ESW (2000, 3000 and 4000) using a Dornier MFL 5000. Shocks were focused on the lower parts of the bladder. Four animals were used as controls. Two hours later, the animals were dissected. Gross examination of the genital systems showed bleeding in the testicles and prostates of only some animals, whereas microscopic examination revealed bloody spots in the genital structures of all animals. The amount of bleeding was ESW dose-independent. In conclusion, ESW showed evident immediate effects on the male genital system. Application of shock waves in treating lower ureteric or vesical stones in doses between 2000 and 4000 may cause bleeding in the structures of this system, which can lead to hemospermia. More studies will be needed to show the long-term sequelae of these changes on the male genital system.

Animals↗
PubMedDate not supplied

Human papillomavirus, genital warts, Pap smears, and cervical cancer: knowledge and beliefs of adolescent and adult women.

The high prevalence of genital warts, human papillomavirus (HPV), and the virus's cancer-causing potential warrant that women be well informed about these conditions and measures to prevent them. The purpose of this descriptive study was to examine women's knowledge and beliefs about genital warts, HPV, cervical cancer, and Pap tests. We interviewed 40 women recruited from health clinics in Chicago (20 adults) and Indianapolis (20 adolescents) about these issues. Audiotapes of the interviews were transcribed and analyzed. Among both the adults and adolescents there was a good deal of misunderstanding about symptoms associated with genital warts, about the purpose of Pap smears, and about the association of genital HPV with abnormal Pap smears and cervical cancer. The gaps in women's understanding about this potentially deadly infection suggest the need for more comprehensive education about preventing genital HPV, the infection's possible sequelae, and the significance of Pap screening for cancer detection and prevention.

Adolescent↗
PubMed2002

Applied anatomy of the genital branch of the genitofemoral nerve in open inguinal herniorrhaphy.

OBJECTIVE: To record the anatomical variations and clinical importance of the genital branch of the genitofemoral nerve in the inguinal canal. DESIGN: Neuropathology study. SETTING: General hospital, Taiwan. SUBJECTS: 58 cadavers. INTERVENTIONS: 116 dissections findings of the genitofemoral nerve in the inguinal canal. MAIN OUTCOME MEASURES: Anatomical variations. RESULTS: All the genital branches passed through the ventral aspect of the internal ring. Almost all these branches entered the ring and continued within the spermatic cord between the fibres of the cremaster and the internal spermatic fascia. In 59% the nerve was related to the inferior fibres and in 38% it was in relation to the lateral or medial fibres. In only 3% did the genital branch run outside the spermatic cord. CONCLUSION: To avoid damage to the genital branch of the genitofemoral nerve, suturing should be done over the dorsal aspect of the internal ring. The cremaster should be incised longitudinal rather than transversely and the genital branch of the genitofemoral nerve should be identified before repair of the posterior wall.

Cadaver↗