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PubMed1988

Interferons in the treatment of genital human papillomavirus infections.

Three major classes of interferons have been identified (alpha, beta, and gamma). All three have been tested in clinical trials in condylomata acuminata, or genital warts, with positive results. Administration by topical, intralesional, intramuscular, and subcutaneous routes results in regression of human papillomavirus genital disease. Significant reduction in measurable lesions occurs in some patients within days of initiation of therapy. Responses appear to be both time and dose dependent. Although disease resolution is highly variable from patient to patient, approximately 75 to 80 percent of all persons show clear clinical benefit at low doses. Biologic side effects of interferons are tolerated well at these doses and occur following systemic or local administration of interferon. In general, the interferons are emerging as active and safe therapeutic agents for genital human papillomavirus infections. This study reviews in detail the series of clinical trials conducted with one of these agents, interferon alpha n1. Results of four small and two major controlled trials in refractory genital warts have proved that this interferon provides significant clinical benefit for the majority of subjects with severe disease. Current studies show that it can be combined safely and effectively with other conventional treatment modalities, such as laser or podophyllin.

Clinical Trials as Topic↗
PubMed1994

[Genital skin manifestations in sexually transmissible diseases].

When diseases of the genital skin are treated with topically applied drugs, it must be borne in mind that resorption through the genital skin is facilitated compared with other skin regions, so that toxic reactions can result even with low doses, and that it is not permissible to prescribe antibiotic treatment on the suspicion of ulcers without skillful diagnosis, because a primary syphilis might be overlooked in this way. Important diseases of the genital skin are: Condylomata acuminata. The prevalence has increased in recent years, to the point where genital warts are now one of the commonest sexually transmitted diseases. As they are contagious and involve the risk of malignant transformation, treatment is necessary in every case. Herpes genitalis. The typical blisters occur on the glans penis or the labia minora. At the time of presentation the physician often observes only excoriations and crusts. Herpes genitalis recidivans is particularly problematic, the only effective treatment being long-term acyclovir. Lymphopathia venerea is caused by Chlamydia trachomatis and is rare in central Europe. Treatment with quinolones is effective. Molluca contagiosa is a group of self-limiting viral diseases that occur in children; they are harmless in themselves, but sexual abuse should be considered. Parasitic diseases are caused by Phthirius pubis and Sarcoptes scabiei. The main symptom is severe itching. The diseases can be easily treated with suitable insecticides. Syphilis. The first sign of the disease is chancre, which can be described as a flat, indurated, nontender ulceration.(ABSTRACT TRUNCATED AT 250 WORDS)

Condylomata Acuminata↗
PubMedDate not supplied

[Epidemiologic analysis of genital diseases associated to papillomavirus].

UNLABELLED: In order to investigate genital papillomavirus infection in a university hospital, we verified that condyloma acuminata and epidermoid carcinoma were the most common diseases associated to this virus. PURPOSE: This study was undertaken to verify the prevalence of genital lesions associated to papillomavirus and sex, age and race distribution. METHODS: We have reported 223 patients who were treated at Hospital Universitario Antonio Pedro, Rio de Janeiro State, during the period 1988-1992. After clinical diagnosis, biopsies were submitted to histological analysis. RESULTS: Results showed that condyloma acuminata and epidermoid carcinoma were the most frequent lesions among genital lesions. Carcinoma cases had a stable prevalence along the period while condyloma cases had a significant increase. Both lesions were more frequently found in Caucasian (white) patients. There were no differences between sexes and condyloma evidence. The media age in the epidermoid carcinoma cases did not change in the years, but it has decreased regarding condyloma acuminata. CONCLUSION: Genital diseases associated to papillomavirus increased during five years. Attention must be paid to control and early diagnosis to prevent neoplasic evolution.

Adolescent↗
PubMed1996

Combating female genital mutilation: an agenda for the next decade.

Female genital mutilation (FGM)-sometimes locally referred to as "female circumcision"-is a deeply rooted traditional practice that adversely affects the health of girls and women. At present it is estimated that over 120 million girls and women have undergone some form of genital mutilation and that 2 million girls per year are at risk. Most of the girls and women affected live in 28 African countries where the prevalence of female genital mutilation is estimated to range from 5% to 98%. The elimination of female genital mutilation will not only improve women's and children's health; it will also promote gender equity and women's empowerment in the communities where the practice persists. To achieve change will require more planning, and more sustained programmes for its elimination. The political will of governments is essential in order to eliminate this harmful traditional practice and concerted efforts from all concerned are required.

Adolescent↗
PubMed1997

Issues in the management of human papillomavirus genital disease.

Human papillomavirus (HPV) infects epithelial cells at a variety of anatomic sites. Of the more than 80 types of this virus, approximately one third infect genital tissue. Genital infection can be clinical (warts), subclinical (abnormal Papanicolaou [Pap] smears or lesions visible only with magnification and application of acetic acid) or latent (infection with apparently normal tissue). Recent research has revealed a clear association between genital warts and HPV types 6 and 11, and between cervical cancer and HPV types 16, 18 and others. Women with genital warts who have normal Pap smears do not need colposcopy. All available therapies are suboptimal because HPV is not eradicated by treatment. However, the active disease expression can be eliminated by treatment. The approach to treatment will depend on each patient's personal characteristics and preferences.

Condylomata Acuminata↗
PubMed1997

A comparison of prevalence rates of genital ulcers among persons attending a sexually transmitted disease clinic in Jamaica.

Two cross-sectional surveys were undertaken, from December 1982 to August 1983 and from November 1990 to January 1991, to estimate the prevalence rates of genital ulcer disease (GUD) in all patients presenting with a new sexually transmitted disease (STD) complaint to the STD clinic at the Comprehensive Health Centre in Kingston, Jamaica. Diagnosis of syphilis and human immunodeficiency virus (HIV) infection was based on results of laboratory tests, but diagnosis of the other STDs was based on clinical features. Data from these two surveys were compared, and reported national annual incidence data for GUD reviewed. In 1982/83 6.8% of 23,050 patients had GUD, men (9.3%) more often than women (4.2%; p < 0.001). In 1990/91 the prevalence rate was 12.8%, with increased rates for both men (18.2%) and women (6.8%; p < 0.001). In patients with GUD, a clinical diagnosis of genital herpes was made, in 1982/83 and 1990/91, respectively, in 16.8% and 7.8% of the patients; syphilis, in 12.9% and 18.8%; chancroid, in 12.4% and 13.3%; viral warts, in 5.7% and 6.3%; lymphogranuloma venereum, in 4.1% and 3.9%; and granuloma inguinale, in 3.6% and 2.3%. In men the rate for syphilis was 19% in 1990/91 and 8% in 1982/83 (p = 0.001); and for genital herpes it was 7% in 1990/91 and 17% in 1982/83 (p = 0.025). These reversals were attributed to intense media coverage of herpes in 1982/83. There was no difference in prevalence rates between the two surveys for these diseases in women, or for lymphogranuloma venereum, granuloma inguinale and genital warts in men and women. A clinical diagnosis could not be made in 44.4% of cases in 1982/83 (particularly in men), and in 47.6% of cases in 1990/91. GUDs facilitate transmission and adversely affect the prognosis of HIV. The increase in their prevalence has implications for the evolution of the local HIV epidemic, and should be addressed effectively by strengthening the STD/HIV control programme.

Chancroid↗
PubMed1999

Ultrapotent topical corticosteroid treatment of childhood genital lichen sclerosus.

OBJECTIVE: To observe the clinical effects of short-term application of ultrapotent topical corticosteroid on symptomatic genital lesions of lichen sclerosus in pediatric patients. DESIGN: Case series of 10 prepubertal girls with genital lichen sclerosus. Ultrapotent topical corticosteroids were applied twice daily for 6 to 8 weeks and patients were reexamined at completion of treatment. Long-term follow-up over 6 months to 3 years. SETTING: Pediatric dermatology clinic (referral center). PATIENTS: Ten prepubertal girls with typical clinical features of genital and/or perianal lichen sclerosus. INTERVENTION: Topical ultrapotent corticosteroid ointment was applied sparingly to affected areas for 6 to 8 weeks. MAIN OUTCOME MEASURE: Improvement of erythema, whitening erosions, and atrophy. Subjective improvement of symptoms. RESULTS: All patients showed partial or total subsistence of signs and symptoms of lichen sclerosus. Frequency and severity of recurrences varied, but patients responded within a few days to reapplication of ultrapotent topical corticosteroid. No significant adverse effects were noted after the initial 6- to 8-week course of therapy or during the 6-month to 3-year follow-up period. CONCLUSION: A 6- to 8-week course of ultrapotent topical corticosteroid is a safe and effective treatment for genital lichen sclerosus in pediatric patients.

Administration, Topical↗
PubMed1984

Metastases to the female genital tract. Analysis of 325 cases.

In order to better define the frequency and patterns of metastasis to the female genital tract, all cases of nonhematopoietic metastases to the adnexa, uterus, vagina, and vulva encountered in patients treated at Barnes Hospital between 1950 and 1981 were reviewed. Three hundred twenty-five metastatic cancers from 269 patients were recovered. One hundred forty-nine cases were from extragenital primaries; the remaining tumors were intragenital metastases. Ovary and vagina were the most frequent metastatic sites for both extragenital and genital primaries. The majority of the extragenital metastases were adenocarcinomas from the gastrointestinal tract, but a variety of other primaries did spread, on occasion, to the genital tract. Twenty-seven percent of the metastases presented as possible primary gynecologic lesions, and 75% of these tumors had an extragenital origin. It is shown that despite certain trends in the distribution of metastases, all sites in the female genital tract are at risk for the occurrence of metastases.

Adenocarcinoma↗
PubMed1995

Male genital cancers.

BACKGROUND: The estimated 165,000 cancers of the male genital system that will occur in the United States during 1993 represent one fourth of the expected 600,000 newly diagnosed cancers in American males for the year. METHODS: Data were collected by the Surveillance, Epidemiology, and End Results (SEER) program. This paper examines histologic data collected by the SEER program from 1973-1987 and focuses on incidence, stage at diagnosis, and survival for the dominant histologic types of cancer that occur in the four major topographic divisions of the male genital system: prostate gland, testis, penis, and scrotum. Some less common histologic types within each organ are also discussed. RESULTS: The incidence of male genital cancer has increased rapidly over the period of study. Cancers of the prostate, most of which are adenocarcinomas, represent more than 92% of all male genital cancers. Among adolescents and young men, germ cell cancers of the testis predominate, but decline rapidly in occurrence after 40 years of age. Blacks had higher incidence rates for prostate cancer than whites; however, the situation was reversed for testicular cancer. Survival increased dramatically for testicular cancer. Cancers of the penis and scrotum of any histologic type are uncommon in the United States. CONCLUSIONS: The increased incidence of prostate adenocarcinomas and testis germ cell tumors indicates the need for further etiologic studies as a basis for prevention efforts.

Adolescent↗
PubMed1987

Simultaneous presence of herpes simplex and human papilloma virus sequences in human genital tumors.

Herpes simplex virus (HSV) and human papillomavirus (HPV) sequences were analyzed in tumors of the female lower genital tract, by probing DNA from 13 intraepithelial and 30 invasive neoplastic lesions with radiolabelled HPV-16 and HPV-18 DNA as well as cloned fragments of HSV-2 DNA. Careful removal of stromal tissue from the pathological specimens allowed authentic tumor DNA to be processed. Normal genital tissue obtained from the patients and genital condylomata were included as internal controls. The presence of HPV-16 or 18 DNA was detected in 12/13 (92.3%) intraepithelial neoplasms and in 16/30 (53.3%) invasive carcinomas. No significant difference was detected in titer or frequency of antibodies to HPV group-specific antigen in sera from patients and controls. Hybridization to BgIII N fragment of HSV-2 DNA was detected in 4/13 (30.8%) intraepithelial neoplasms and 4/30 (13.3%) invasive carcinomas but in none of the control tissues. All the 8 samples harboring HSV-2 homologous sequences were also positive for HPV, supporting the hypothesis of a synergistic association between the 2 viruses. The hybridization analyses performed to study c-myc involvement in genital oncogenesis did not reveal c-myc amplification in either invasive or pre-invasive lesions.

Antibodies, Viral↗
PubMedDate not supplied

Male genital tract inflammation: The role of selected interleukins in regulation of pro-oxidant and antioxidant enzymatic substances in seminal plasma.

Human semen contains spermatozoa as well as populations of round nonspermatozoal cells primarily consisting of leukocytes. Activation of white blood cells present in the seminal plasma during genital tract inflammation and cellular reactions against microbial agents may provoke a release of a variety of products such as cytokines and reactive oxygen species. The aim of this study was to evaluate whether a panel of selected cytokines (interleukin [IL]-1 beta, IL-6, IL-8, and tumor necrosis factor-alpha [TNF alpha]) detectable in seminal plasma during male genital tract inflammation could be considered as mediators between altered semen parameters and changed levels of pro-oxidant and antioxidant substances. Studies using chemiluminometric, spectrophotometric, and enzyme-linked immunosorbent assay methods indicate that proinflammatory cytokines such as IL-1 beta, IL-6, IL-8, and TNF alpha may modulate pro-oxidant and antioxidant activities in the male genital tract. The data also suggest that the function of pro-oxidant and antioxidant systems in semen may directly influence basic semen parameters. The elevated numbers of leukocytes present in semen during male genital tract inflammation without an associated contribution of cytokines and semen antioxidant capacity appear to be of little prognostic value in evaluating male fertilization potential.

Antioxidants↗
PubMed2006

Male genital tuberculosis in Siberians.

To study the epidemiology and the clinical picture of male genital tuberculosis in Siberia, Russia. Five hundred and fourteen patients with genitourinary tuberculosis were enrolled in the study: 414 had kidney tuberculosis only, 100 had genital involvement. The clinical picture and structure of genital tuberculosis were investigated: 42 had tuberculosis of scrotal organs and 58 had tuberculosis of the prostate. Urinary cultures, urinalysis, three-glass test, and investigation of the prostate secretion, Mycobacteria culture, and susceptibility testing were performed in all 514 patients. 33.6% of all patients earlier suffered from pulmonary or extrapulmonary tuberculosis and were successfully cured. In 61.9% nephrotuberculosis was diagnosed alongside with an orchiepididymitis. In 30.9% of patients bilateral epididymorchitis was diagnosed. Mycobacteriuria was present in 38.1%. Scrotal fistula was found in 11.9%. In 66.7% the symptoms appeared acutely. Half of the patients with prostate tuberculosis complained of dysuria, 23 (39.6%) had perineal pain, 34 (58.6%) had flank pain. Leucocytes in urine were present in 49 (84.5%) patients, and in prostatic secretion in 45 (77.6%) patients. Erythrocytes in urine were present in 31 (53.4%) patients, and in prostatic secretions in 17 (29.3%) patients. Male genital tuberculosis has no specific pathognomonic signs. Using a special algorithm for the management of patients with prostatitis or epididymitis is recommended.

Adult↗
PubMed2004

Observations on aetiology and management of genital fistulas.

METHODS: We evaluated the aetiological factors and outcome of the management of genital fistulas. A review of patients who presented with genital fistulas between January 1998 and June 2002 was performed. RESULTS: There were 34 cases of various genital fistulas, including 29 urinary and 5 intestinal fistulas. Among them 14 (41.2%) were attributed to obstetrical causes, 11 (32.3%) to gynaecological surgery, and 9 (26.3%) to other factors like vaginal procedure, coitus, trauma, etc. We had an operation success rate of 85.7% (30 out of 35 repairs). The success rate was 85.71% (24 out of 28) after primary and 83.3% (5 out of 6) after secondary repair (p=1.00). Vaginal repair was done in 28 cases whereas abdominal repair was carried out in 7 cases. The failure rate was 7.14% (2 out of 28) using the vaginal route and 42.8% (3 out of 7) using the abdominal route (p=0.05). The average duration of disease was 11.8+/-4.9 months vs. 30+/-10.3 months (p=0.5), the mean size of the fistulas was 1.5+/-1.0 x 1.3+/-0.9 cm vs. 2.4+/-1.9 x 2.2+/-1.8 cm (p=0.02) in successful and failed cases respectively. CONCLUSION: The vaginal repair of fistulas is associated with a higher success rate. Fistulas due to other etiological factors specifically associated with genital malformation, like vaginal procedures and coitus, have the worst prognosis. Larger or longer duration fistulas are associated with poorer prognosis.

Adolescent↗
PubMed1981

Genital manifestation of pulmonary tuberculosis.

We studied 200 women with pulmonary tuberculosis to check for genital lesions: 13% of these women had genital tuberculosis. As clinical diagnosis was not possible, we relied on meticulous and repeated histopathologic studies. The occurrence of genital tuberculosis was more frequent in women who had pulmonary tuberculosis of shorter duration, but was not related to the severity of the disease. Pulmonary tuberculosis indirectly affects the female genital tract in almost all cases, giving rise to various gynecologic symptoms and signs. A review of the literature and further discussion about this subject are presented.

Adolescent↗
PubMed1992

Human papillomavirus detection from the female genital tract: combined vs. separate scrape methods.

Because genital human papillomavirus (HPV) infections tend to be multifocal, it was studied how effective one combined specimen is in detecting HPV-DNA from the lower female genital tract. The study population consisted of 50 patients referred to a colposcopy clinic for a suspected condylomatous and/or dysplastic lesion. From half of the patients, a separate scrape from the cervix, vagina and vulva was taken first followed by a combined scrape representing all the genital sites, and from the other half, vice versa. HPV-DNA (types 6, 11, 16 and 18) was identified using the AffiProbe hybridisation test. Thirty-six specimens collected from 17 patients were positive for HPV-DNA. A multifocal infection was demonstrated in at least 11/17 (65%) HPV-DNA positive patients. The combined scrape was the most informative specimen, revealing 75% of all HPV-DNA-positive patients. It was concluded that HPV-DNA can reliably be detected from the female genital tract in a simple way from one combined specimen.

Adolescent↗
PubMed1994

Treatment with interferon for genital HPV in HIV-positive and HIV-negative women.

The administration of interferons can be resorted to, either on its own or in combination with physical destruction methods, when the extent of genital HPV is widespread. Extensive genital HPV involvement is often seen in HIV-positive patients as a consequence of their immunodeficiency. The extension of these lesions may invalidate treatment by physical destruction, while an underlying immunodeficiency renders interferon therapy less efficacious. We studied HIV-positive and HIV-negative patients with a similar HPV involvement of their genital tract and compared the effectiveness of systemically administered alpha 2b and beta interferons in clearing HPV. Our results confirm that interferon therapy will cure most patients with extensive genital HPV when they are HIV-negative. HIV-positive patients with CD4 counts over 400 lymphocytes/mm3 may expect a similar cure rate, but this halves when this critical threshold is crossed. In these severely immunodeficient patients repeated courses of interferon therapy alone or in combination with physical destruction methods may be required to cure HPV infection.

CD4-Positive T-Lymphocytes↗
PubMed2005

Genital automatisms in childhood partial seizures.

PURPOSE: To describe frequency and electroclinical characteristics as well as localizing and lateralizing value of childhood periictal genital automatisms (GAs). METHODS: Five-hundred-forty-one videotaped seizures of 109 consecutive patients <12 years with refractory partial epilepsy and postoperatively seizure-free outcome were analyzed. Genital automatisms (scratching, fondling or grabbing of the genitals) were monitored by two independent investigators. RESULTS: Eight (four temporal, four extratemporal) patients (7%) showed GA at least once during 20 (3.7%) seizures. Age of patients with GA was between 4.5 and 11.9 (mean 9.5+/-2.4) years and was significantly higher than the age of children without GA (p=0.006). Boys showed GAs more frequently than girls (p=0.026). Genital automatisms appeared both ictally and postictally with a mean duration of 51s. They were unilateral (completed by one hand) in 18/20 seizures and were done by the hand ipsilateral to the seizure onset zone in 16/18 cases (p=0.001). Although consciousness was preserved during GA in 3/8 patients, neither periictal urinary urge nor penile erection was associated with it. CONCLUSIONS: Periictal GAs appear in school-age patients with a similar frequency to that in adults but almost lack in preschool children. Although the presence of childhood GA has neither localizing nor lateralizing value per se, the hand used for GA is more frequently ipsilateral to the seizure onset zone. The mechanisms for childhood GAs are not clear but probably different from those of adults.

Automatism↗
PubMed2003

[Genital mycoplasmas].

The mycoplasmas frequently isolated in genital tract, and potentially pathogenic, are M. hominis, U. urealyticum and M. genitalium. M. hominis and U. urealyticum are very frequent in the vaginal tract and they can be, according to circumstances, either commensal or pathogenic. M. hominis and/or U. urealyticum, have been considered as responsible for many types of genital infectious diseases (such as cervicitis, pelvis inflammatory disease), for infertility, obstetrical pathologies (premature delivery, premature rupture of membranes, chorio-amniotitis) and neonatal infections. Yet, most of the time, their actual responsibility has not been conclusively proven. Published data lack indisputable conclusions and in many fields, doubts still exist whether these mycoplasmas are pathogens or mere co-factors associated with genital infections. On the other hand, M. genitalium has been much less studied but it seems to be an unquestionable pathogen of genital tract; new studies will be necessary so that one has a better understanding of the pathologies it can induce.

Female↗