Verruca vulgaris of the vulva in children and adults: a nonvenereal type of vulvar wart

Condyloma acuminata are common lesions of the vulva in adults, and associated with infection by human papillomavirus (HPV) types 6 and 11, which are acquired via sexual contact. The detection of an HPV 6/11 condyloma in the genital tract of a child, therefore, raises the question of sexual abuse. In this study, 29 genital warts in girls less than 5 years of age were examined for nongenital and genital tract HPVs by in situ hybridization. These results were compared with 275 vulvar lesions clinically suspicious for condyloma from adults. Of the 27 HPV-related lesions in young girls, 11 (41%) were due to HPV 2 whereas the other 16 (59%) were associated with HPV 6/11 infection. Of the 214/275 (78%) HPV positive vulvar lesions in adults, 6 (3%) were due to HPV 2 whereas 202/214 (94%) contained HPVs 6/11; 1 lesion contained HPV 16 and the 5 other lesions contained HPV 42, 43, or 44. Histologic correlation documented that the vulvar lesions positive for HPV 2 commonly showed the marked hyperkeratosis typical of verruca vulgaris. However, the verrucous pattern was present in lesions HPV 6/11 positive. It is concluded that verruca vulgaris of the vulva, which is likely not transmitted sexually, can occur, albeit rarely, in the genital tract of women and is common in the genital tracts of young girls. This highlights the value of HPV testing in such cases, especially if the histologic changes are consistent with verruca vulgaris.     

Rapidly Enlarging Growth of the Proximal Nail Fold

BACKGROUND: Squamous cell carcinoma (SCC) of the nail unit is a rare but often underappreciated neoplasm. Treatment can be delayed due to confusion with paronychia and verruca. Infection with human papilloma virus (HPV) has been associated with this malignancy. OBJECTIVE: To describe the development of a superficially invasive SCC of the proximal nail fold in a patient infected with HIV, to report the association of a previously unrecognized HPV genotype, and to review key etiologic, diagnostic, and therapeutic points as related to SCC of the proximal nail fold. RESULTS: This is the first report of HPV 26 coinfection in monogamous sexual partners, both of whom are HIV infected and have demonstrated lesions of malignant degeneration consistent with SCC. CONCLUSION: SCC must be considered in the differential diagnosis of nail fold neoplasm. An immunocompromised condition such as HIV/AIDS may predispose to malignant degeneration of lesions caused by infection with HPV.     

Cosmetic Warts: Pseudo-Koebnerization of Warts after Cosmetic Procedures for Hair Removal

Objective: To sensitize patients, physicians, and aestheticians about the possibility of spread of cutaneous warts during cosmetic procedures, especially following temporary hair removal methods, such as shaving, waxing, threading, and using depilatory creams, so they practice the requisite safety measures. Cutaneous warts caused by human papilloma virus are highly contagious. They tend to spread locally with even the trivial trauma of scratching, resulting in autoinoculation or “pseudo-Koebnerization.” Other than isolated case reports, there is a paucity of literature on pseudo-Koebnerization of warts by temporary hair removal methods. Design, setting, and participants: The authors present their observations from five patients—two men and three women (Cases 1 to 5)—in whom, after a single or a few episodes of a specific temporary hair removal method, either pre-existent warts spread locally at a rapid pace or surfaced clinically for the first time and then started spreading locally. An attempt was made to study the temporal relationship between the cosmetic procedure and the eruption or exacerbation of warts. Results: All five cases showed warts in a linear or local distribution, suggesting pseudo-Koebnerization and the possible use of unclean material used for temporary hair removal methods. One male (Case 1) and two female (Cases 3 and 4) patients already had pre-existent warts, which spread locally following the temporary hair removal procedures. The clinically naive other two patients may have acquired human papilloma virus due to cross-infection from unsterilized razor blades (possibly in Case 2) or from a spouse’s infected towel pressing against freshly waxed skin (Case 5). Treatment with radiofrequency ablation or topical tretinoin was successful in all patients. Conclusion: Despite the widely prevalent practice of temporary hair removal cosmetic procedures around the globe, such pseudo-Koebnerization-induced “cosmetic warts” remain under-reported. Through this case series, the authors wish to inculcate the practice of more hygienic measures by patients, barbers, aestheticians, and beauticians to prevent such cosmetic mishaps.Cutaneous warts caused by human papilloma virus (HPV) constitute one of the most common viral infections of the skin and mucosae. There are more than 100 distinct HPV subtypes, with certain types having a predilection for specific body sites to produce characteristic proliferative lesions. For example, verruca vulgaris (common warts with verrucous surface) caused by serotypes 2 and 4; verruca plana (flat warts) caused most often by HPV type 3 and less often by types 10, 27, and 41; filiform warts (firm thread-like projections) caused by types 2 and 4; and condyloma acuminata (genital warts) commonly caused by HPV types 6 and 11 and less often by the oncogenic types 16 and 18. Once acquired, the virus remains in the skin indefinitely and may give rise to recurrent lesions, the frequency of which depends upon the HPV serotype and host immunity against the virus.1 Warts also tend to spread locally around the site of original lesion by autoinoculation induced by trauma-like scratching. This phenomenon is akin to the occurrence of lesions of psoriasis at sites of trauma. However, the pathogenesis of this phenomenon, called Koebner phenomenon is different in the two conditions. While the former is speculated to involve various pathogenetic factors, primarily immunologic with others being vascular, dermal, enzymatic, genetic, and hormonal, the latter is believed to be due to autoinoculation of the infective viral material (hence, called “pseudo-Koebner” rather than true Koebner phenomenon).2 Lesions of molluscum contagiosum, another common cutaneous viral infection, also spread through a similar mechanism. All procedures employed for temporary hair removal (THR) result in trivial unnoticeable trauma to the skin, such as shaving, threading, waxing, or using depilatory creams. In a patient with pre-existent viral warts, these may seed and spread, whereas in patients not yet exposed to HPV, THR procedures breach the protection of the epidermis and allow viral inoculation from an external infected source, such as a non-sterile razor blade or an infected thread or towel, resulting in a fresh eruption.     

The histologic spectrum of epidermodysplasia verruciformis

The classic histologic presentation of epidermodysplasia verruciformis is a verruca plana-type lesion with minimal hyperkeratosis and acanthotic areas where the cells contain perinuclear halos and blue-gray pallor. Whereas these lesions have a high malignant potential, it is important to elucidate the histologic spectrum of this entity and to differentiate it from its mimics. Fifteen skin biopsies from people with multiple cutaneous warts clinically suspicious for epidermodysplasia verruciformis were analyzed both histologically and for human papillomavirus (HPV) deoxyribonucleic acid (DNA) by in situ hybridization. Ten of the lesions contained HPV DNA, either type 5 (n = 6), type 8 (n = 3), or type 51 (n = 1). Only three of these lesions showed typical verruca plana. The histologic marker of HPV DNA in the other seven viral-positive cases was rare perinuclear halos in association with an irregular granular layer. The other five cases, which were also negative for viral DNA after polymerase chain reaction in situ hybridization, rarely demonstrated the abrupt variation in keratohyaline granules and concomitant perinuclear halos. The authors conclude that there is a wide spectrum of histologic changes in epidermodysplasia verruciformis and that viral testing in conjunction with the histologic and clinical findings can differentiate this premalignant entity from its mimics.     

Cutaneous verrucous carcinoma.

Verrucous carcinoma is a rare, low-grade, well-differentiated squamous cell carcinoma most commonly seen on mucosa. It has been infrequently reported to occur on the skin, where it is a slow-growing and locally aggressive tumour. It is not uncommon for cutaneous verrucous carcinomas to be mistaken for the more frequent verruca vulgaris and treated accordingly. Three cases of cutaneous verrucous carcinoma are presented with the medical history and follow-up data. Surgery is the treatment of choice; these lesions may sustain a potentially anaplastic transformation after radiation therapy.     

Common skin disorders of the penis

Diseases of the male genitalia range from infectious lesions to inflammatory and neoplastic conditions, including many genital manifestations of more general skin diseases. This review highlights the clinical features, diagnosis and treatment of the most common dermatoses of the male genitalia. Herpes genitalis and infections caused by human papillomavirus (HPV) are increasing, particularly in young sexually active people. Herpes simplex virus infection is the commonest infectious cause of genital ulceration, with evidence that many infections are asymptomatic. HPV infection may be latent, subclinical and clinical. The most common causal agents for condyloma acuminatum are low-risk HPV 6 and 11; high-risk HPV types 16 and 18 are associated with premalignant and malignant lesions. Treatment for genital warts remains unsatisfactory; recurrences are common. Imiquimod, a new topical immunotherapeutic agent, which induces interferon and other cytokines, has the potential to be a first-line therapy for genital warts. Scabies and pediculosis are transmitted by skin-to-skin contact and sexual transmission is common, with the penis and scrotum favourite locations for scabious lesions. Oral ivermectin, a highly active antiparasitic drug, is likely to be the treatment of choice, but until approval is granted it should be reserved for special forms of scabies. Common skin diseases, e.g. psoriasis and lichen planus, may have an atypical appearance in the genital area. The typical psoriatic scale is usually not apparent because of moisture and maceration. Allergic contact dermatitis of the genital area may result from condoms, lubricants, feminine hygiene deodorant spray and spermicides. More often, contact dermatitis is irritant, resulting from persistent moisture and maceration. Lichen sclerosus is a chronic inflammatory disease that occurs as atrophic white patches on the glans penis and foreskin. The penile form is a common cause of phimosis in uncircumcised men; involvement of the urethral meatus may lead to progressive meatal stenosis. Plasma cell balanitis is a benign, idiopathic condition presenting as a solitary, smooth, shiny, red-orange plaque of the glans and prepuce of a middle-aged to older man. Squamous cell carcinoma (SCC) in situ, e.g. erythroplasia of Queyrat and Bowen's disease, cannot be excluded clinically; their apparent clinical benignity may lead to lengthy periods of misdiagnosis and biopsy is required to confirm the diagnosis. SCC is the most common malignancy of the penis and the role of oncogenic HPV-types has been also established in SCC of the penis. Prevention of SCC of the penis presupposes an identification of risk factors, early detection of all pre-cancerous lesions and treatment of phimosis.     

Anti-papillomavirus vaccines and prevention of cervical cancer: progress and prospects

Human papillomaviruses (HPV) cause the development of various cutaneous and mucosal lesions. Some genotypes play a role in the genesis of cervical cancer, which is the second most common cancer in women. HPV types 16 and 18 account for 60 to 72% of all HPV-associated cervical cancers, while types 6 and 11 cause genital warts. Despite the various escape strategies viruses use to fight the natural immune system, more than 90% of the infections clear spontaneously. It should therefore be possible to prepare prophylactic vaccines. The HPV major capsid protein L1 self-assembles into virus-like particles (VLP). Immunization after parenteral vaccination with it provided very good protection against experimental infection in different animal models. The first clinical trials revealed the satisfactory tolerance and excellent immunogenicity of these vaccines. Two vaccine approaches were selected: one based on protection against cervical cancer from a bivalent VLP L1 vaccine containing the two genotypes most frequently involved in cervical cancer (type 16 and 18) and the other, protecting against warts as well as cervical cancer, with a quadrivalent HPV VLP L1 vaccine containing genotypes 6, 11, 16 and 18. Initial results with these vaccines show an efficacy of more than 90% against infection and 100% against the onset of dysplastic lesions. Despite these hopeful results, a vaccined strategy sould still be defined. Meanwhile, the cytology screening program should be carried on until the beginning of the vaccination.     

72例男性肛周尖锐湿疣的临床特征及流行病学调查

目的:了解男性肛周尖锐湿疣的临床特征及流行病学资料。方法:观察并总结了2004年6月~2006年4月我院皮肤性病科门诊72例男性肛周尖锐湿疣临床特征及流行病学资料。结果:肛周尖锐湿疣主要见于18~45岁的中青年男性(61例,占84.72%),有同性性行为占12.50%,有桑拿习惯的男性更容易患肛周尖锐湿疣。肛门直肠疾病如肛门瘙痒症、肛门湿疹、肛裂及痔疮等均可出现局部皮肤黏膜的破损而为人乳头瘤病毒(HPV)感染创造条件。经典尖锐湿疣61例(84.72%),扁平型尖锐湿疣11例(15.28%),前者多与6、11型HPV感染有关,后者与16、18型HPV感染有关。肛周扁平型尖锐湿疣适合冷冻术治疗。通过与健康对照组比较外周血T细胞亚群发现肛周尖锐湿疣患者细胞免疫功能下降。结论:肛周尖锐湿疣的传染途径中肛交不是主要因素,有桑拿习惯的男性更容易患肛周尖锐湿疣(χ2=5.03,P<0.05)。肛周尖锐湿疣以经典尖锐湿疣为主,扁平型其次。本研究对于了解我国男性肛周尖锐湿疣临床和流行病学特点和积极防治该病提供参考。     

Off-label photodynamic therapy for recalcitrant facial flat warts using topical 5-aminolevulinic acid

The facial flat wart (verruca plana) is one of the most common reasons for dermatology and primary care visits. Although there are many therapeutic modalities, no single therapy has been proven to be completely curative. Case reports and uncontrolled studies suggested that photodynamic therapy (PDT) with topical 5-aminolevulinic acid (ALA) can effectively treat recalcitrant facial flat warts. A total of 12 patients with recalcitrant facial flat warts were enrolled in the study. ALA gel (10 %) was applied topically to lesions and incubated for 3 h. The lesions were irradiated by an LED light of 630?±?10 nm at dose levels of 60–100 mW/cm. Clinical assessment was conducted before and after every treatment for up to 24 weeks. Among the ten patients completing three sessions of ALA-PDT, five had complete lesions clearance, and the other five patients were significantly improved. At the 24-week follow-up, the average effective rate was 88.8 %, with no recurrences. No significant side effects were reported. A low-dose topical ALA-PDT regimen using 10 % ALA, 3 h incubation, and a red light source for three treatment sessions are suggested as the optimal scheme for the treatment of recalcitrant flat warts on the face in Chinese patients. Superior efficacy is found in elevated or active period lesions with mild side effects.     

Human papillomavirus infection in solid organ transplant recipients: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice

These guidelines from the American Society of Transplantation Infectious Diseases Community of Practice update the epidemiology and management of human papillomavirus (HPV) infections in organ transplant recipients. HPV is one of the most common sexually transmitted infections and is associated with cancers of the anogenital region. Increasing evidence suggests an association with head and neck cancers as well. Solid organ transplant recipients have a higher risk of HPV infection than the general population. Infection manifests as premalignant lesions, warts, or cancer of the cervix, penis, vulva, scrotum, and anal canal. Most are asymptomatic initially, so diagnosis can be difficult without screening. A vaccine is available though not effective in preventing all cancer‐causing strains. Organ transplant recipients should be screened for HPV‐associated cancers and appropriate therapy initiated in a timely manner. Further studies are warranted to delineate the most effective screening methods and therapeutic modalities, including whether changes in immunosuppression are effective in attenuating disease.     

Human papillomavirus in the oral cavity of patients with and without renal transplantation

This study investigates human papillomavirus (HPV) infection in the oral cavities of 88 Australian renal transplant recipients and 88 immunocompetent controls. Oral cavities were examined for lesions and brushings collected for HPV analysis by consensus PCR. No warts were identified; HPV DNA was detected in 18% of transplant versus 1% control samples (P<0.001). Cutaneous HPVs predominated. One patient had HPV16 in samples taken four years apart without evidence of associated lesions or malignancy. Transplant recipients were more likely than controls to have current cutaneous warts (P<0.001), fewer sexual partners (P=0.001), and to have never consumed alcohol (P=0.01). Among the transplant group, the risk of an HPV-positive sample was higher among older patients (P=0.05), and those with past cutaneous warts (P=0.04). This study extends previous surveys by encompassing overt and asymptomatic infection, a broad spectrum of cutaneous and genital HPVs, and by providing new data on risk factors for oral HPV infection.     

Warts of the Nail Unit: Surgical and Nonsurgical Approaches

BACKGROUND: Warts are the most common nail tumor and mostly affect children and young adults. Periungual warts are usually due to HPV-1, 2, and 4. Development of periungual warts is favored by maceration and trauma, especially nail biting. OBJECTIVE: To discuss the biology, clinical features, and medical and surgical treatment of periungual warts. METHODS: Review of the literature and personal experience. RESULTS: The natural course of warts makes aggressive approaches restricted to selected cases. Medical treatments, usually topical, include keratolytic agents, virucidal agents, and immunomodulators. All choices have been utilized successfully, but keratolytic agents are the best first-line approach. Surgical treatments include cryotherapy, surgical excision, electrosurgery, infrared coagulation, localized heating with a radio-frequency heat generator and laser therapy, especially the Er:YAG laser, which has an excellent safety profile. CONCLUSIONS: Definitive cure is not guaranteed by any therapy and periungual warts can recur and become larger after correct treatment.     

Treatment of Common Warts with an Intralesional Mixture of 5-Fluorouracil, Lidocaine, and Epinephrine: A Prospective Placebo-Controlled, Double-Blind Randomized Trial

BACKGROUND 5-Fluorouracil is an antimetabolite that has been known to be effective for the treatment of common warts.
OBJECTIVE The objective was to evaluate the efficacy of a combination of 5-fluorouracil, lidocaine, and epinephrine (5-FU+LE) for the treatment of common warts.
MATERIALS AND METHODS Of the 40 patients initially enrolled, 34 patients with at least 68 verruca vulgaris (one pair for each subject) completed the study. The selected warts were randomized into two treatment groups, with one wart on each patient receiving intralesional 5-FU+LE (4 mL of 50 mg/mL 5-fluorouracil and 1 mL of a mixture of 20 mg/mL [2%] lidocaine and 0.0125 mg/mL epinephrine) and the other receiving intralesional normal saline placebo using a Mantoux needle. Patients received up to four injections at weekly intervals and were followed at 1 and 6 months after the initial injection.
RESULTS Complete response was observed in 64.7% of the warts treated with 5-FU+LE compared to 35.3% in the warts treated with placebo ( p <.05). Systemic reaction or treatment-related adverse medical events and recurrence rate did not differ significantly between two groups.
CONCLUSION The results show that intralesional 5-FU+LE is a safe and effective approach for common warts with high success rate.     

Gesichertes und Neues bei der Therapie von Condylomata

Anogenital warts are the most common clinical manifestation of human papillomavirus (HPV) infections. Although easy to recognize, asymptomatic anogenital warts (condylomata acuminata) may be overlooked, leading to unaware transmission to the sexual partner. On the other hand awareness of this sexually transmitted disease (STD) is largely associated with a great psychological and social burden, in men as well as women. Spontaneous regression of genital warts has been observed mostly within 2-5 years; however, persisting condylomata may prove refractory to all current treatment options. Because removal of the warts does not totally eliminate the underlying viral infection, treatment of genital warts can often be of long duration, of varying effectiveness and with high recurrence rates. Without a doubt only the patient’s own immune system is capable of clearing HPV infections. Therefore, the solution to one of mankind’s oldest health problems will depend on the future acceptability of HPV vaccines.     

Glycolic acid 15% plus salicylic acid 2%: a new therapeutic pearl for facial flat warts

Background: Facial flat warts are a contagious viral disease that can cause disturbing cosmetic problems. Topical glycolic acid has been reported to be effective in dermatological treatment depending on the exfoliant capacity, but has not often been reported to be effective in the treatment of facial flat warts. Objective: The aim of this paper was to evaluate the efficacy and safety of glycolic acid 15% topical gel plus salicylic acid 2% in the treatment of recalcitrant facial flat warts. Methods: A total of 20 consecutive patients 7 to 16 years of age with recalcitrant facial flat warts were enrolled in this study. Patients having warts by the eye and lip regions were excluded from the study. A fine layer of face gel was applied to the treatment area once daily. Most of the participants had tried different treatments with no success. Assessments for the response and the occurrence of side effects were performed every two weeks at Weeks 2, 4, 6, and 8. Results: All the patients were clinically cured within eight weeks. Seven patients cleared in four weeks, and 13 patients cleared in eight weeks. No noticeable adverse events were related to the skin. Conclusion: Topical gel of glycolic acid 15% plus salicylic acid 2% is safe and effective when applied to facial flat warts once daily until clearance and may be considered as first-line treatment.Flat viral warts are circumscribed papules with hyperkeratotic surfaces that can occur singly or in groups. In these types of warts, the human papilloma virus (HPV) has been shown to infect the koilocytes. Although no viral subtype is absolute, typically the infection is with HPV types 3, 10, 28, and 41. These warts are small in size (1–5mm), flat, or slightly elevated lesions. Flat viral warts typically present as skin-colored or light brownish, flat-topped papules on the face, beard area, or on the back of the hands, and primarily affect children and young adults.1 Their evolution is variable, and although two thirds of cases regress spontaneously in the course of two years due to immunological mechanisms, they occasionally are long lasting.1 Flat viral warts can greatly affect a patient''s quality of life, and their persistence and/or recurrence can cause frustration. Moderate-to-extreme discomfort is reported in 51.7 percent of patients, and social or leisure activities are affected to a moderate-to-extreme degree in 38.8 percent of patients.2     

595 nm脉冲染料激光单独或联合剥脱性激光治疗寻常疣的临床观察

目的 探讨595 nm脉冲染料激光单独或联合剥脱性激光(CO2激光或Er:YAG激光)治疗寻常疣的临床效果.方法 自2016年9月至2018年9月,中国医学科学院整形外科医院激光中心收治10例寻常疣患者(21个疣体),采用595 nm脉冲染料激光单独或联合剥脱性激光治疗1～3次,记录每次治疗结束后2～4周疣体面积变化,...     

男性健康人群和尖锐湿疣患者阴毛毛囊中人乳头瘤病毒的调查分析

目的:人乳头瘤病毒(human papillomavirus,HPV)在健康人群中广泛存在,但其在阴毛毛囊中的感染率目前尚不清楚,阴毛毛囊感染与尖锐湿疣的复发关系更不清楚,本课题旨在研究HPV在健康男性和尖锐湿疣患者阴毛毛囊中的感染情况,了解毛囊感染与尖锐湿疣复发的关系。方法:尖锐湿疣患者86例,年龄24~61岁,健康男性122例,年龄22~80岁,采用PCR技术对耻骨部阴毛毛囊中的HPV进行检测,并对两组资料进行分析。结果:男性尖锐湿疣患者的阴毛毛囊中HPV阳性率为32.55%(28/86),其中17例为HPV6(19.77%),7例为HPV11(8.14%),2例为其他亚型,混合感染2例(同时检测到HPV6和HPV11,以下同)。健康人群阴毛毛囊中的HPV检出率为17.21%(21/122),其中15例HPV6(12.30%),4例为HPV11(3.28%),1例其他亚型,1例为混合感染。结论:尖锐湿疣患者的阴毛毛囊中HPV感染率高于健康男性人群。尖锐湿疣患者与健康人群感染HPV的亚型基本相似,主要为HPV6和HPV11。     

Hemorrhagic Bullae After Cryosurgery in a Patient With Hemophilia A

BACKGROUND: A case of hemorrhagic bullae and blisters on the hand of a patient with hemophilia A after cryosurgery for verruca vulgaris is reported. OBJECTIVE: To discuss a hemorrhagic complication in a patient with hemophilia A after cutaneous cryosurgery. METHODS: This is an observatory case report. RESULTS: Even minimal cryosurgery can induce hemorrhagic bullae in patients with hemophilia A. CONCLUSION: The risks and benefits of cryosurgery should be weighed carefully in patients with bleeding disorders such as hemophilia.     

Association of human papillomavirus infections with cutaneous tumors in immunosuppressed patients

Besides immunosuppression and UV radiation, human papillomavirus (HPV) infection was also suggested to be involved in the development of non-melanoma skin cancer, the most common malignancy after transplantation. In this study we used a comprehensive PCR assay to analyze the prevalence of individual HPV types in different skin lesions from transplant and non-transplant patients. HPV DNA was detected more frequently in squamous cell carcinomas (SCCs) of transplant recipients (75%) than the same lesion was in non-immunosuppressed patients (47%). Similar HPV prevalences were found in cutaneous warts (91% vs 94%), pre-malignant skin tumors (38% vs 36%), and normal skin specimens (17% vs 16%) of both patient populations. Overall, more than 40 different HPV types were identified. HPV types 5 and 8 were found more frequently in SCCs (26%) than in pre-cancerous (5%) or benign lesions (1%). All HPV 5- and HPV 8-positive SCCs were from immunosuppressed patients, indicating that infection with HPV 5 and HPV 8 may present an increased risk of SCC development in these patients.     

Genital human papillomavirus infections in the male sexual partners of 45 female patients with papillomavirus infection

Forty-five women with a confirmed genital human papillomavirus (HPV) infection and their regular male sexual partners were examined. The diagnosis of the women was based on the colposcopic examination with cytological and histological samples. The men were studied by using a similar microscopic technique. Penisscopic and histological examinations showed that 22 out of the 45 men had genital HPV infection although only 7 men showed visible condylomatous warts. In addition, nine men had clinical lesions highly suggestive to HPV infection in penisscopy but they had unspecific histological samples. 23 of these 31 men were symptom-free. These results further emphasize the importance of regular examinations of the male sexual partners of women with genital HPV infection in order to prevent recurrences and spreading of the infection.