64例合并HIV感染男男性行为者肛门直肠尖锐湿疣临床特征及心理评估

目的探讨合并人类免疫缺陷病毒（HIV）感染的男男性行为（MSM）人群发生肛门直肠尖锐湿疣的临床特征及心理状态。 方法分析2015年7月至2017年6月于四川洲际胃肠肛门病医院住院治疗的64例合并HIV感染的男男性行为人群中发生肛门直肠尖锐湿疣患者临床特征以及90项症状清单（SCL-90）量表心理评估情况。 结果合并HIV感染的MSM人群中，肛周直肠尖锐湿疣主要见于18～45岁男性（61例，84.72%），其中大学学历患者47例（73.44%）；经典型尖锐湿疣患者56例（87.50%），扁平型尖锐湿疣患者8例（12.50%）。人乳头状瘤病毒（HPV）阳性率为81.25%（52例，52/64），以HPV11型为主（占50.00%，26/52）。SCL-90量表心理评估显示，负面心理情绪患者59例（92.19%），主要表现为抑郁（48例、75.0%）和焦虑（7例、10.94%）。 结论合并HIV感染的MSM人群中，肛周直肠尖锐湿疣主要见于青壮年，临床表现以经典型为主，心理状态以抑郁、焦虑为主。     

男男性行为者肛门与生殖器人乳头瘤病毒感染的分子流行病学差异表达研究

目的了解男男性行为者(MSM)肛门生殖器部位人乳头瘤病毒(Human papilloma virus,HPV)不同基因型别的流行情况及其临床意义。方法采取调查问卷方法收集2013年10月至2015年3月在上海市皮肤病医院性病科门诊就诊的301例男男性行为者的临床资料,同时检测其肛门生殖器HPV感染情况。结果在301患者中,有肛周及肛管内尖锐湿疣(condyloma acuminatum,CA)164例,同时伴有阴茎尖锐湿疣18例。301份肛周及肛管内脱落细胞标本中HPV阳性检出率为78.7%(237/301),其中高危型50.5%(152/301),以HPV16型(14.3%)和HPV52型(14.3%)最常见;低危型69.1%(208/301),其中HPV6型43.9%(132/301)和HPV11型21.6%(65/301)为常见型别。143例阴茎部脱落细胞标本中HPV阳性检出率为44.8%(64/143),高危型为20.3%(29/143),以HPV33型(4.9%)最常见;低危型33.6%(48/143),以HPV11型17.5%(25/143)最常见。高危型HPV16、HPV33、HPV52、HPV53和HPV56在肛周及肛管的感染率比阴茎部位高(P0.05)。在16例肛周CA,36例肛管CA、112例肛周肛管CA和22份阴茎部CA标本中,肛周和阴茎部HPV均以单一型感染为主,其中HPV6/11为常见感染型别。肛管CA多重HPV感染为主(88.8%),以HPV16型、HPV52型、HPV56型常见。结论在男男性行为者中,肛周和肛管HPV感染率较高,且肛管CA以混合型HPV感染为主。高危型HPV在肛管感染率比生殖器部位高,筛查MSM肛管HPV感染可为早期防治肛管恶性肿瘤提供依据。     

上海地区男男性行为者肛门部位尖锐湿疣HPV型别特征及口腔部位HPV感染情况研究

目的调查上海地区男男性行为者(MSM)肛门部位[包括肛周和(或)肛管]尖锐湿疣(CA)与口腔部位人类乳头瘤病毒(HPV)的感染情况和亚型特征。方法对上海市皮肤病医院性病门诊2013年10月至2017年1月期间就诊的肛门尖锐湿疣的MSM人群进行入组,采集病史及相关部位的脱落细胞样本,进行HPV基因型别分析。结果入组的162例研究对象,肛门部位尖锐湿疣部位HPV以多重型别感染最为常见,占63.58%(103/162),绝大多数为二重感染(24.69%,40/162)和三重感染(32.10%,52/162)。肛门部位高危型别HPV的感染率为53.09%(86/162)。各高危型别HPV的检出率较高的依次为HPV52型(17.28%)、HPV33型(17.28%)和HPV16型(15.43%)。口腔部位HPV感染阳性检出率为36.42%(59/162),合并口腔尖锐湿疣患者10例(6.17%,10/162)。口腔部位与肛周肛管CA部位HPV检出率相比,单一型别、二重型别和三重型别HPV感染均有差异(P0.05)。与肛周、肛管尖锐湿疣部位HPV优势高危型相比,口腔部位阳性检出率较高的HPV感染型别除了16型、52型和33型,还有31型和58型,高危型分布较分散。结论上海地区MSM肛周或肛管尖锐湿疣者的口腔部位HPV感染率较高,且口腔部位HPV高危型别与肛门部位有差异,因此需加强对口腔HPV感染情况的重视。HPV感染的早期诊治和HPV疫苗的预防性接种,能有效的预防和控制HPV感染及其导致的性传播疾病及相关肿瘤的发生。     

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。     

丽水地区男性尖锐湿疣患者皮损HPV基因型别分析

目的:探讨丽水地区男性尖锐湿疣(CA)患者皮损人乳头瘤病毒(HPV)基因分型情况。方法:采用Hybri Max医用核酸分子快速杂交系统对丽水地区110例男性CA患者(年龄16~65岁)的疣体组织样本进行HPV基因分型检测。结果:110例患者中107例HPV检测阳性,HPV感染率97.27%,单一型感染76例(71.03%),多重感染31例(28.97%),感染高峰年龄段集中在21~40岁。检测出HPV基因型14种,高危型为HPV16、53、52、33、CP8304、58、51、45、66、68、59,感染率44.85%;低危型为HPV11、6、19(43),感染率为93.45%。结论:丽水地区男性CA患者HPV感染以低危型为主,高危型及多重感染率高。     

山东地区1225例男性尖锐湿疣患者HPV感染亚型分析

目的探讨山东地区男性尖锐湿疣患者人乳头状瘤病毒(HPV)不同亚型感染的分布情况。方法采用基因芯片技术,对1 225例男性尖锐湿疣皮损拭子或组织进行23 HPV基因型检测。结果 708例患者HPV检测阳性,总阳性率为57.8%,其中低危亚型以HPV6(40.8%)和HPV11(40.5%)最常见;高危亚型以HPV16(14.1%)最常见。在708例阳性患者中,单一亚型感染367例,占51.8%,其中未检测出HPV45和HPV73;在341例混合感染病例中,23种HPV型别均检测到,多重感染以低危和高危HPV混合感染为主(P0.05)。不同年龄组以21岁~年龄组感染率最高(48.5%),不同地区以鲁中(36.9%)和鲁东(36.6%)地区感染率较高。结论山东地区男性尖锐湿疣患者HPV感染主要以6、11型为主,HPV不同亚型的分布受到年龄、地域以及感染重数的影响。     

男子性交传染的乳头瘤病毒感染:解剖分布与临床特征

人乳头瘤病毒(HPV)是部位特异的DNA病毒,可产生表皮和粘膜的特征性增殖。传统认为HPV感染限于外阴、肛门、阴道下段,产生乳头瘤——尖锐湿疣,后又发现宫颈处可有病毒增殖,但无乳头瘤样生长——扁平湿疣。肉眼不能发现扁平湿疣,只有用3％乙酸涂浸后才能发现,故作者将其称为亚临床型乳头瘤病毒感染。作者报道154例外生殖器和肛门湿疣或亚临床     

100例男性尖锐湿疣皮损人乳头瘤病毒基因亚型的分布及意义

目的 了解无锡男性尖锐湿疣皮损HPV基因亚型的分布状况.方法 采用基因分型芯片方法检测23种基因亚型,高危型18种:HPV-16,18,31,33,35,39,45,51,52,53,56,58,59,66,68,73,83,MM4和低危型5种:HPV-6,11,42,43,44.结果 100例临床标本中阳性率为98%,检出率最高依次为11型、6型、16型.25%患者存在多重感染.结论 HPV11、6、16型感染是男性尖锐湿疣发病的主要型别,且HPV感染趋于多重化.     

波姆红外光治疗肛周尖锐湿疣11例体会

笔者采用大连波姆仪器设备有限公司生产波姆红外光治疗仪(POME-Ⅲ型)结合口服三氮唑核苷片治疗肛周尖锐湿疣11例,收到满意效果。现报告如下。 1 临床资料 本组11例均为男性患者。年龄21～48岁。病程21～90d。病变部位:尖锐湿疣疣体生长在肛口旁及肛周皮肤区。所有病人均在门诊治疗。     

男性人乳头瘤病毒感染及基因型的分布分析

正人乳头瘤病毒(human papillomavirus,HPV)属乳头瘤病毒科,具有多种基因型,截至目前已有180种HPV基因型被鉴定出来[1],通常依据HPV感染引起的病变性质不同将其分为低危型和高危型,高危型中已有15种亚型认为与皮肤粘膜恶性肿瘤相关;而低危型则常以男女外生殖道、肛周皮肤黏膜尖锐湿疣表现为主[2-3]。HPV感染与女性宫颈癌有着密切关系,因此国内外对女性HPV感染具有较高的     

Cancer of the anus arising within condylomata acuminata. Apropos of 2 cases. Review of the literature

Two cases of squamous carcinoma of the anus developing from condylomata acuminata are reported. The general characteristics of condylomata acuminata are reviewed: viral etiology due to HPV virus, histological appearance and role in the the genesis of certain cancers. The association of condylomata acuminata and cancer of the anus is more particularly studied in a review of the literature: etiology, anatomoclinical aspects, treatment and current state of knowledge concerning the oncogenic role of HPV virus at this site.     

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.     

Human papillomavirus (HPV) in condylomatous lesions of cervix

Ninety-seven cervical condylomata classified histologically as flat condyloma (planum), papillary condyloma (acuminatum), and endophytic condyloma were studied by transmission electron microscopy (TEM) and by immunoperoxidase technique (IPT) for the presence of human papillomavirus (HPV) particles and antigen, respectively. Both techniques localized HPV chiefly in nuclei of koilocytotic cells. HPV particles were found in 25% of the cases by TEM and HPV antigen was detected in 48% of the cases by IPT. All cases positive by TEM were also positive by IPT, thus confirming the specificity of the immunological staining. The viral antigen was detected in 56% of 68 flat condylomata, 35% of 26 papillary condylomata, and in none of 3 cases of endophytic condylomata. However, when histiotypes of virus-positive condylomata were controlled for the intraepithelial extent of koilcytotic cells, the prevalence of HPV correlated with the extent of koilocytosis rather than with the histiotype. The immunologic technique will be of value for the further characterization of cervical condylomata and of the relationship between HPV infection and cervical intraepithelial neoplasia.     

Podophyllin versus scissor excision in the treatment of perianal condylomata acuminata: a prospective study

Thirty-seven patients with previously untreated perianal condylomata acuminata were randomly treated by application of 25 per cent podophyllin or scissor excision. The result of treatment was assessed by an independent observer. At 6 weeks, scissor excision completely cleared the warts from 16 of 18 patients (89 per cent) compared with 15 of 19 patients (79 per cent) treated with podophyllin. Following complete clearance by surgery, two patients had recurrent warts at 18 weeks and a further single patient at 42 weeks, giving a cumulative recurrence rate of 19 per cent. In contrast, five of 15 patients whose warts were cleared by podophyllin had recurrent warts at 18 weeks and a further four at 42 weeks representing a cumulative recurrence rate of 60 per cent (X2 = 3.95, d.f. = 1, P = 0.05). At 42 weeks six patients (32 per cent) were free of disease in the podophyllin group compared with 13 (72 per cent) in the scissor excision group (X2 = 4.6, d.f. = 1, P = 0.03). Scissor excision is therefore preferable to podophyllin application in the treatment of perianal condylomata acuminata.     

Anal neoplasia — Epidemiological considerations

Background: Squamous cell carcinoma (SCC) of the anus appears to be associated with human papilloma virus (HPV) infection. Methods: Based on the literature epidemiological and biological evidence is reported, that corroborates the relation of anal SCC and presence of HPV. Results: The embryologically similar endocervical and anal transitional zones are predisposed to the development of certain precancerous and malignant lesions, associated with HPV infection in a number of cases. There is a strong relation between sexually transmitted condylomata acuminata, anal cancer and HPV, type 16 and 18 in particular. The epidemiological observations have been increasingly supported by investigations with electron microscopy and DNA hybridisation. The diagnosis of ano-genital HPV infection is based on histology. Particular attention is to be directed to the direction of subclinical lesions by inspection of the epithelial surfaces under magnification after soaking the suspected areas with acetic acid. Conclusions: There exist high risk groups for anal SCC linked with HPV infection: homosexual men; patients who are immunosuppressed, either for medical reasons or due to HIV infection. These groups of patients and the reliable detection of subclinical lesions will be the object of future research.     

Subclinical papilloma viral infection of male genitalia

One hundred male patients with a history of genital condylomata were evaluated by the use of 3% acetic acid staining of their external genitalia. In 36 per cent positive aceto-white areas were discovered on the shaft of the penis (flat condylomata), and a 35 per cent meatal-urethral involvement, suggesting that flat and exophytic condylomata of the shaft and urethra are the most logical reservoir for transmitting the HPV infection to the female genitourinary tract.     

A case of syphilitic anal condylomata lata mimicking malignancy

IntroductionCondylata lata in secondary syphilis is well known presentation and needs to be considered in differential diagnosis of perianal lesions. In England between 2013 and 2014 the overall incidence of infectious syphilis increased by 33% and is mainly seen in men who have sex with men.Presentation of caseWe report the management of a 49-years-old Caucasian homosexual man with perianal lesions that were suspicious of malignancy. After biopsies, colonoscopy, staging with computed tomography, magnetic resonance imaging and syphilis serology anal cancer was excluded and a diagnosis of syphilis was confirmed. He was referred to the sexual health clinic for the appropriate investigations and treatment.DiscussionThis case highlights the consideration of treatable infectious syphilis pathology. The main differential diagnosis of perianal growths to consider is condylomata acuminata (warts caused by human papillomavirus), anal cancer, syphilis, chancroid, haemorrhoids, tuberculosis and lymphogranuloma venereum. To differentiate a biopsy is needed for histopathological examination. A dense plasma cell infiltrate and numerous spirochetes visualised by immunostaining confirms condylomata lata.ConclusionIn UK, it is important for colorectal surgeons to be aware of syphilitic condylomata lata and consider this when dealing with perianal lesions. It is advisable to refer patients suspected of or diagnosed with syphilis to sexual health clinics to help improve outcome. In sexual health clinics additional investigations and treatment are available in addition to partner notification and follow-up can be offered.     

AIDS患者与HIV感染者合并肛周尖锐湿疣的临床特征分析

为研究艾滋病（AIDS）患者和人类免疫缺陷病毒（HIV）感染者免疫缺陷程度合并肛周尖锐湿疣的临床特征和治疗方法,对50例AIDS患者与HIV感染者合并肛周尖锐湿疣的临床资料进行回顾性分析。根据术前检测CD4T淋巴细胞水平的不同,分为AIDS患者组23例（CD4≤200／ul）和HIV感染组27例（CD4〉200ul）,比较两组的临床特征和治疗效果。结果显示,AIDS患者组的CD4T淋巴细胞数和CD4／CD8比值,明显低于HIV感染组（P〈0．05）;AIDS患者组15例合并其他感染（15／23,65．2％）,8例形成肛周巨型尖锐湿疣（8／23,34．8％）,其中2例发生癌变。AIDS患者组手术切除肛周尖锐湿疣后3个月内有8例复发（8／23,34．8％）;HIV感染组6例合并其他感染（6／27,22．2％）,1例巨型尖锐湿疣（1／27,3．7％）,术后3个月内4例复发（4／27,14．8％）。结果表明,AIDS患者容易形成巨型尖锐湿疣而且容易发生癌变,容易合并其他感染。电刀彻底切除病变结合应用抗逆转录病毒药物,可以取得较好的疗效,降低复发率。     

肛周Paget病的诊断与外科治疗

目的 探讨肛周Paget病的临床病理特点和诊治方法,提高对此病的认识.方法 回顾性分析17例经手术及病理证实的肛周Paget病患者的临床资料.结果 17例中男11例,女6例,平均年龄62.5岁.12例患者以肛门周围湿疹、瘙痒、糜烂及溃疡就诊;5例以痔疮、结肠炎、尖锐湿疣及慢性肛周感染就诊.术前误诊为湿疹、痔疮和直肠癌等疾病者6例.7例行局部广泛切除+植皮术,其中3例术后辅以放射治疗.10例行Miles术,其中6例行局部淋巴结清扫,并辅以术后化疗.除2例失访外,15例获得随访,随访时间8个月至6年,15例中8例复发,7例死于该病.结论 肛周Paget病缺乏特征性的临床表现,误诊率高;一旦确诊应及早手术,术后应采取放疗及化疗等综合治疗.