Cryotherapy versus electrocautery in the treatment of genital warts.

Forty-two male patients with ano-genital warts were randomly allocated to a single-blind study of cryotherapy versus electrocautery. There was no significant difference in the success rates of these two forms of treatment in patients followed for three months. Cryotherapy was qualitatively much more acceptable to the patients than electrocautery. It seems particularly suited to patients with widely scattered warts who are unable to attend for regular treatment.     

Therapy for genital warts.

This article presents the spectrum of genital wart infection, including possible subclinical infection and reinfection from partners. Present therapy is effective in warts of recent onset but usually requires multiple treatments and is painful, and warts are frequently recurrent. Trials of combination therapy appear to have greater efficacy than does single-agent treatment. Problems for the future include the best management of warts in the sexually abused child, the immunocompromised host, and the pregnant patient. Genital warts are increasingly linked with the potential development of carcinoma, mandating more effective treatment regimens in the future.     

Pivampicillin compared with erythromycin for treating women with genital Chlamydia trachomatis infection.

In a randomised single blind study, pivampicillin was compared with erythromycin in women with urogenital Chlamydia trachomatis infections. The pivampicillin dosage was 700 mg twice a day and the erythromycin dosage 500 mg twice a day for seven days. Follow up took place on days 7 and 14 after the start of treatment. All 26 women treated with pivampicillin were culture negative for chlamydiae at the first and second follow up visits. All 23 women who received erythromycin were culture negative at the first follow up visit, but one was culture positive at the second follow up visit. Gastrointestinal side effects were recorded in five patients receiving pivampicillin and in nine receiving erythromycin. Two patients receiving erythromycin were withdrawn from treatment because of gastrointestinal disturbances, compared with none receiving pivampicillin.     

Condylomata acuminata (genital warts): patient demographics and treating physicians.

BACKGROUND: Condylomata acuminata (genital warts), caused by the human papillomavirus, are common and sexually transmitted. However, the use of healthcare services for condylomata has never been characterized from a national probability sample study. GOAL: To understand better the demographics of patients seen by physicians for this disorder. STUDY DESIGN: Data from office visits for warts, both condylomata and noncondylomatous types, were obtained from the 1994 to 1998 National Ambulatory Medical Care Survey. RESULTS: The age distribution of those treated for condylomata peaked in 20- to 39-year-olds, with more than 70% of patients in this age category. A younger and wider age distribution was seen in patients with noncondylomatous warts. Women accounted for 67% of the population seen for condylomata, whereas a more equal number of women and men were seen for noncondylomatous warts. Per capita healthcare use for condylomata was equal between blacks and whites, and whites had almost five times more per capita healthcare use than blacks for noncondylomatous warts. Obstetrician/gynecologists were the most commonly consulted physicians for condylomata. Per capita condylomata visits per physician were highest for obstetrician/gynecologists, dermatologists, and urologists, and lower for all other physicians. CONCLUSIONS: The difference in age distribution between condylomata and noncondylomatous visits likely results from differing modes of transmission and age at first sexual contact. Females are more likely than males to use health care for condylomata, which may be attributable to increased prevalence, differences in treatment efficacy, differences in the gender frequency of genital health screenings, or psychosocial causes. Healthcare use for condylomata appears equal between blacks and whites. Patients with condylomata acuminata were most often seen by obstetrician/gynecologists, whereas patients with noncondylomatous warts most often consulted dermatologists. The fact that per capita condylomata visits per physician were highest for obstetrician/gynecologists, dermatologists, and urologists may imply that specialists in these fields have expertise in treating these patients.     

二氧化碳激光术结合干扰素局部封闭治疗尖锐湿疣的临床研究

目的:探究分析激光术后结合干扰素局部封闭治疗尖锐湿疣患者的临床疗效。方法:选择2011年3月至2013年7月来我院诊治的80例尖锐湿疣患者,按照随机数字表法分为实验组和对照组,每组患者40例。对照组患者只采取CO2激光治疗,实验组患者在对照组治疗基础之上结合利分能干扰素治疗。观察两组患者治疗前后IL-2、IL-10以及IL-4等炎症因子水平的变化;比较两组患者的临床治疗效果。结果:治疗前,实验组患者IL-2、IL-10以及IL-4的水平与对照组患者比较无显著性差异(P0.05);经过治疗,实验组患者的IL-2水平显著升高,IL-10以及IL-4的水平显著降低,均较对照组患者变化大,具有统计学意义(P0.05),且实验组患者的三项指标的治疗前后的差值均较对照组患者大,具有显著性差异(P0.05);经过治疗,实验组患者的总有效率为97.5%,较对照组患者高,差异性比较明显(P0.05)。结论:激光术后结合干扰素局部封闭治疗尖锐湿疣患者,能够显著改变患者外周血清炎症因子的水平,明显提高临床疗效,是一种值得推广的治疗方法。     

Topical treatment of genital warts in men, an open study of podophyllotoxin cream compared with solution.

OBJECTIVE--To evaluate the clinical efficacy of a 0.15% and a 0.3% cream formulation of podophyllotoxin in comparison with the 0.5% solution in the treatment of condylomata acuminata and to compare the treatment modalities regarding side effects. DESIGN--The study was designed as an open randomised trial. Ninety male patients with signs of penile HPV infection, with either acuminate or papular lesions, were randomised into three parallel treatment groups. The study medication comprised 0.15% and 0.3% cream and 0.5% solution of podophyllotoxin. The patients treated themselves twice daily for three consecutive days and if total regression of the warts was not achieved after this first treatment cycle, further treatment cycles at 7-day intervals were to be repeated up to a maximum of four treatments. SETTING--The study was carried out in three outpatient clinics: two STD clinics, Department of Dermatology and Venereology, University Hospital (45 patients) and Institut Antoine Fournier, Paris (30 patients), and one military hospital, S1/FO 47/48, Sjukhusenheten, Enköping (15 patients). RESULTS--Statistical evaluation of the treatment effect was based on a "Response rate" calculation at each visit. The number of completely responding patients after the first, second, third and fourth cycle were 40 (44%), 61 (68%), 67 (74%) and 70 (78%), respectively. There was no statistically significant difference between the three treatments after four treatment cycles. However, the 0.15% cream had a significantly slower onset of efficacy as compared with the 0.3% cream and 0.5% solution. Adverse effects were less severe and less frequent with the 0.15% cream than with the other treatment modalities. Severe adverse effects were reported by 12 patients, of whom two were treated with 0.15% cream, five with 0.3% cream and five with 0.5% solution. Thirty-one patients were completely free from adverse effects. CONCLUSION--In this open randomised study with three parallel treatment groups, two cream formulations of 0.15% and 0.3% podophyllotoxin and a 0.5% solution of the same drug all showed an equally good response rate after four treatment cycles. Reported adverse effects were few and mild. The convenience of having different formulations to offer when prescribing treatment for condylomata must be considered.     

Hunan wart-virus antibodies in patients with genital and skin warts.

A comparative follow-up study of the antibody response against human wart-virus was performed, using the immunodiffusion and complement fixation methods on patients with condylomas and skin warts. By the immunodiffusion method, 13% of the patients with skin warts and 3% of the patients with condylomas showed greater than or equal to fourfold increase of antibody titre during the follow-up of 2--35 months. The findings show some typical features of the weak antibody response of a chronic virus infection and suggest a serological overlapping between condyloma viruses and certain group of skin wart-viruses. The antibody prevalence in age-matched controls is shown to be significantly higher than that in the wart or condyloma patients' initial serum samples. This is indicative of the protective function of antibodies against warts and condylomas. Also the analysis of the history of warts in patients with condylomas suggests that protection against condylomas can be acquired from previous warts, evidently by immunological mechanisms. In a control group of medical students, human wart-virus antibodies were frequently (52%) found in subjects without any history of warts. This finding supports the view that human wart-virus can frequently induce latent or subclinical infections in human beings.     

Colposcopic evaluation of men with genital warts

Colposcopy, which is the examination of the female genital tract that generally is performed after the application of acetic acid, has been an effective tool in the diagnosis of genital warts (condyloma acuminatum) in women for years. With the help of colposcopy, both microscopic and flat warts that cannot be visualized with traditional, noncolposcopic methods can be seen and, hence, treated. Recently, studies reported in the gynecologic and urologic literature have evaluated the usefulness of colposcopy in male patients. We present a patient whose genital warts were recalcitrant to treatment. When examined with colposcopy he was noted to have multiple additional areas of involvement. In view of the neoplastic potential of the human papillomavirus, the ease with which it is transmitted sexually, and the difficulty in discerning certain kinds of warts without colposcopy, we believe colposcopic examination should be routine in all men with genital warts and in those whose sexual partners have tested positive for human papillomavirus.     

Effectiveness and safety profile of 40% trichloroacetic acid and cryotherapy for plantar warts

Plantar warts are one of the most common infectious skin disease caused by the human papillomavirus. In this study, cryotherapy with liquid nitrogen delivered by the physician, up to four treatments 2 weeks apart. Forty percent trichloroacetic acid (TCA) was applied to warts weekly up to four treatments. At the end of 4 weeks, the clinical improvement of the TCA group (n = 30) was six patients (20%) with no change, one patient (3.3%) with a mild response, 13 patients (43.3%) with a moderate response and 10 patients (33.3%) with a good response. In the cryotherapy group, clinical responses were 12 patients (40%) with no change, four patients (13.3%) with a mild response, 12 patients (40%) with a moderate response and two patients (6.7%) with a good response. There was a statistically significant difference in improvement between the two treatment groups (P = 0.027). According to our results, TCA 40% is more effective for clearance of plantar warts with significantly improved long‐term safety profile.