Possible role of interleukin 21 and interleukin 33 in patients with genital warts

Genital warts (GWs) are most prevalent sexually transmitted infections, presenting especially among the sexually active young population of both sexes. Efficient cell‐mediated immunity is needed for regression of GWs. To clarify the reactivity of cellular immunity among patients with GWs by means of measurements of their levels of serum interleukin (IL)‐21 and IL‐33, hence, to identify the possible role of IL‐21 and IL‐33 in GWs, this study aimed to evaluate serum levels of IL‐21 and IL‐33 among patients with GWs in comparison with the results of the controls. Levels of serum IL‐21 and IL‐33 were assayed utilizing commercially enzyme‐linked immune‐sorbent assay kits in 45 patients with GWs and 45 healthy control subjects. Levels of serum IL‐21 and IL‐33 were significantly decreased among patients with GWs in comparison with the controls (p < .0001). There was a highly significant positive correlation between IL‐21 and IL‐33 (r = .73, p < .0001). Low levels of serum IL‐21 and IL‐33 could have a contributive role in development, persistence, severity, and recurrence of GWs which rely basically on the defectiveness of cell‐mediated immunity. This could receive new light on nonconventional strategies for the prospective medical therapies of GWs by means of regulation of IL‐21 and IL‐33.     

Clearance of genital warts in pregnant women by mild local hyperthermia: a pilot report

Genital warts acquired during pregnancy tend to grow fast, and management is challenging. We treated two cases of primipara with extensive genital warts by local hyperthermia at 44°C for 30 minutes a day for 3 consecutive days plus 2 additional days 1 week later, then once a week till there showed signs of clinical regression. The warty lesions in the patients resolved in 5 and 7 weeks, respectively. There was no sign of recurrence during a 6‐month follow‐up. This suggests that local hyperthermia seems to be a promising method for treating genital warts in pregnant women.     

Prognostic factors for the response to treatment in males with genital warts

Background  Factors predicting an unfavourable course of genital warts to treatment have not been determined.
Materials and methods  Behavioural and baseline disease characteristics were recorded from 246 males with anogenital warts. Urethral swabs were obtained and examined using the Hybrid Capture 2 Microplate assay. Patients were treated for their anogenital warts with cryotherapy, imiquimod cream 5% or podophyllotoxin. They were followed up every 3 months for 1 year.
Results  Patients with a negative or low-risk initial test tended to respond earlier to treatment than those with a high/intermediate-risk human papillomavirus (HPV) or with a dual infection ( P  = 0.028). The response rate was unrelated ( P  > 0.05) to the duration, number and anatomical location of the lesions and to the patient's age and sexual orientation, and only marginally to the initial extent of the lesion ( P  = 0.046). However, the type of treatment predicted a favourable response (P ≤ 0.001), with patients who received both imiquimod and crotherapy responding worse. Considering all factors simultaneously in logistic regression, only the type of treatment and extent of the disease were found to influence the response rate.
Conclusion  The type of treatment and extent of the disease were the only factors found critical for patients' response.     

Recent advances in management of genital ulcer disease and anogenital warts

ABSTRACT:   Genital ulcer disease (GUD) constitutes a major public health problem. Most of them are the result of sexually transmitted diseases. Genital herpes, syphilis, lymphogranuloma venereum, granuloma venereum, or chancroid are the commonly encountered GUD. The treatment modalities for these disorders have changed with advent and use of drugs such as azithromycin. The treatment modalities differ in patients with HIV disease. Further vaccines for herpes genitalis and human papilloma virus has opened new avenues in management of these diseases. In regions where there are no diagnostic facilities or where the costs of diagnostic tests are prohibitive, syndromic management of GUD is preferred.     

魏县地区女性肛门及肛管尖锐湿疣的流行病学调查

目的:分析魏县地区女性肛门及肛管尖锐湿疣的临床与流行病学特征,以期为女性肛门及肛管尖锐湿疣的防治提供借鉴。方法:回顾2013年6月至2014年6月到我院就诊的女性肛门及肛管尖锐湿疣患者的资料,采用个体匹配,调查每1个病例的同时,调查3个职业和年龄相同的正常人作为对照。对患者的一般情况、个人社会行为、个人性行为、感染HPV病毒的亚型、复发的情况等,统计并分析其流行性特征。结果:我们发现女性肛门及肛管尖锐湿疣患者年龄平均(27.74±7.21)岁,受教育程度相对较高、易发生抑郁,肛交(OR=7.621,95%CI:2.610~22.256)、患有梅毒或HIV(OR=3.840,95%CI:2.079~7.093)、使用公共用品(OR=1.860,95%CI:0.721~3.027)、性病防护知识差(OR=1.649,95%CI:1.052~2.585)、多性伴侣(OR=1.109,95%CI:1.075~1.146)是女性患者发生肛门及肛管尖锐湿疣的危险因素,嗜酒、熬夜、吸烟、皮损HPV型别为16型、皮损HPV型别为复合型是女性患者发生肛门及肛管尖锐湿疣复发的主要促进因素。结论:针对高危人群应加强性健康教育普及,提高性安全意识,尤其针对肛交性行为者应当予以广泛关注并采取良好有效的干预机制,对于女性肛门及肛管尖锐湿疣应注意禁止饮酒、不熬夜,以防止复发。     

Clearance of recalcitrant warts in a pediatric patient following administration of the nine-valent human papillomavirus vaccine

Verruca vulgaris is a common, benign infection of the skin and mucous membranes caused by human papillomavirus (HPV). Although many therapeutic options for warts exist, they have limited efficacy and there is no definitive cure for warts. We report the case of a 10-year-old girl with recalcitrant cutaneous warts persisting more than two years which resolved completely following vaccination with the nine-valent HPV vaccine.     

Intravenous cidofovir treatment for recalcitrant warts in the setting of a patient with myelodysplastic syndrome

Cidofovir is an acyclic nucleoside phosphonate with broad-spectrum activity against DNA viruses, including human papilloma virus (HPV). However, data on the efficacy of cidofovir in an immunosuppressive setting remain contradictory. We report for the first time on the promotion of the healing of recalcitrant warts in a patient with myelodysplastic syndrome with intravenous cidofovir treatment.     

33例SLE患者狼疮带试验与临床资料分析

目的：探讨LBT临床意义及在SLE诊断标准中的价值。方法：收集我科1996年6月～2002年7月间住院病人33例对LBT检查结果及临床资料进行分析。结果：33例中24例LBT阳性，总阳性率72．7％(24／33)，其中24例皮损、7例暴光部位正常皮肤、2例非暴光部位正常皮肤LBT阳性率分别为75％(18／24)、57．1％(4／7)、100％(2／2)。Ig沉积种类及ANA、anti—dsDNA、C3异常者与病情活动有关。结论：对不满足ARA标准的病人，LBT是诊断SLE指标之一。     

Increased risk of dementia in patients with genital warts: A nationwide cohort study in Taiwan

Genital warts are a common sexually transmitted disease caused by human papillomavirus (HPV) infections. The prevalence of dementia is 4–8% in those aged 65 years or older in Taiwanese community studies, with a high social and economic burden for patients, family caregivers, the community and society. Previous studies have shown that viral infections such as herpes simplex and herpes zoster were associated with dementia. This study aimed to investigate the association between dementia and HPV infections. A population-based cohort study using data from Taiwan’s National Health Insurance Research Database was conducted. Fine and Grays’s survival analysis was employed to estimate the hazard ratios (HR) and 95% confidence intervals (CI) for the association between genital warts and dementia. From all of the potential participants aged 50 years or more, a total of 16 116 patients were enrolled, including 4029 genital warts-infected patients, with 12 087 sex-, age- and indexed date-matched controls (1:3). The cumulative incidences of dementia were 10.72 per 10³ person-years and 6.43 per 10³ person-years in the genital warts and control group, respectively. There were 475 dementia cases from the genital warts cohort during the follow-up period of 15 years. The adjusted HR for dementia was 1.485 (95% CI, 1.321–1.668; P < 0.001) for genital warts patients after adjusting for all of the covariates. Our study indicates that genital warts infection may increase the risk of dementia.     

系统性红斑狼疮与乙型肝炎病毒感染

目的：了解系统性红斑狼疮（SLE）和乙型肝炎病毒（HBV）感染的关系。方法：用ELISA法检测102例SLE和95例其它皮肤病患者的HBV血清学标记。结果：SLE患者HBV感染状况与其它皮肤病患者相似。结论：SLE与HBV感染无明显关系,HBV阳性的SLE患者与HBV阴性患者的临床体征,免疫学指标无明显差异。     

A mutilating arthropathy, "rhupus hands" associated with multiple synovial cysts in a patient with systemic lupus erythematosus

"Rhupus hands" is a phrase coined to describe one of the deforming arthropathies associated with systemic lupus erythematosus (SLE), because the clinical features are indistinguishable from those of rheumatoid arthritis. Herein, we report a case of rhupus hands with multiple synovial cysts arising in a 60-year-old woman with SLE.     

系统性红斑狼疮病人活性氧基与自身抗体变化的观察

对比观察６０例ＳＬＥ病人血浆脂质过氧化物（ＬＰＯ）、红细胞超氧化物歧化酶（ＳＯＤ）及过氧化氢酶（ＣＡＴ）含量与ＡＮＡ、ｄｓ－ＤＮＡ、Ｓｍ和Ｕ１ＲＮＰ自身抗体的变化。活动期病人活性氧基（ＯＲ）水平增高，以致ＳＯＤ及ＣＡＴ活性下降，ＬＰＯ含量增高；非活动期ＳＯＤ及ＣＡＴ活性相对增高，ＬＰＯ含量降低，提示体内ＯＲ水平下降。抗ｄｓ－ＤＮＡ抗体滴度与红细胞ＳＯＤ、ＣＡＴ、血浆ＬＰＯ含量及疾病的严重程度密切相关。内源性ＯＲ的增加可导致Ｔ抑制细胞功能下降，Ｂ淋巴细胞异常增殖，以致体内产生多种自身抗体，诱发免疫炎症反应     

Topical treatment for human papillomavirus-associated genital warts in humans with the novel tellurium immunomodulator AS101: assessment of its safety and efficacy

Background  Various methods are currently used for the treatment of anogenital warts. However, a complete cure is unlikely, and the rate of recurrence is high.
Objectives  The purpose of this open-label, multicentre trial was to evaluate the safety and clinical efficacy of a new treatment using the immunomodulator ammonium trichloro (dioxoethylene- O , O ') tellurate (AS101; Biomas Ltd, Kefar Saba, Israel) 15% w/w cream to clear vulval/perianal condylomata acuminata.
Methods  Study participants comprised 48 women and 26 men, age range 18–62 years. Of the 48 woman, 44 were diagnosed with vulval condylomata and four with perianal condylomata. All 26 men were diagnosed with perianal condylomata. All the patients in the study received AS101 15% w/w cream twice a day. Maximal treatment duration was 16 weeks. To evaluate the safety and clinical efficacy, patients were examined and lesional areas photographed on a biweekly basis.
Results  By the end of the treatment, 56 of 74 (76%) patients were considered completely cleared. Complete cure was achieved in 35 of 44 (80%) patients with vulval condylomata and in 21 of 30 (70%) patients with perianal condylomata. No scarring of treated areas was observed. Complete cure was achieved within a time range of 10–109 days. The most frequent side-effects observed were mild-to-moderate itching, soreness, burning and erythema. In post-treatment follow up of up to 6 months, disease recurrence was observed in two patients (4%), at 105 and 144 days following completion of treatment.
Conclusions  AS101 15% w/w cream is an effective and safe, self-administered therapy used for the treatment of external vulval and perianal warts. The cream is applied topically twice daily for up to 16 weeks. A very low recurrence rate was reported.     

Vagarious successful treatment of recalcitrant warts in combination with CO2 laser and imiquimod 5% cream

Abstract

Background. Imiquimod 5% cream is widely regarded as a safe and effective option when treating recalcitrant warts, owing to the ointment's negligible side effects. However, our observations highlighted case of a patient incurring severe adverse reactions due to application of the cream, although the treatment proved successful in curing recalcitrant warts which had developed on the external auditory canal and external ear. Methods. All lesions were entirely removed with short-pulsed CO₂ laser. As soon as the wound-healing process was completed, imiquimod 5% cream was self-applied on the healing wounds once daily for 5 days per week in a total of 2 weeks. Results. The patient appeared normal after the CO₂ laser treatment and experienced severe redness, itching, exudation, and incrustation after a 2-week imiquimod 5% cream therapy. All lesions showed no recurrence during the 12-month followed-up process. Conclusions. We concluded that a feasible treatment modality to cure recalcitrant cutaneous warts is in combination of CO₂ laser and imiquimod. Immunoenhancement plays an important role in the treatment of recalcitrant warts.     

Acquired haemophilia in a patient with systemic lupus erythematosus

INTRODUCTION: In patients with lupus, the most common acquired circulating anticoagulant is antiprothrombinase which is responsible for thrombosis. The presence of antibodies directed against factor VIII is rarely found in systemic lupus erythematosus. A case of acquired haemophilia in a patient with lupus is reported. CASE REPORT: A 30 year-old woman with systemic lupus erythematosus developed a right coxalgia and ecchymotic skin lesions which were prominent on the right arm and forearm. Laboratory values were as follows: positive antinuclear antibodies > 1: 2 560, anti-DNA antibodies (300 IU/ml), prolonged activated partial thromboplastin time, reduced factor VIII activity (1 p. 100) and the presence of antibodies against factor VIII. Magnetic nuclear resonance of the right hip confirmed the presence of an intramuscular hematoma. The patient was initially treated with intravenous pulse and oral corticosteroids, intravenous immunoglobulins and intravenous cyclophosphamide. Clinical and biological improvement was promptly obtained. DISCUSSION: In our patient with systemic lupus erythematosus, bleeding revealed acquired haemophilia with antibodies against factor VIII. It should be pointed out that the association between lupus and haemophilia is uncommon and that at present no standardized treatment can be recommended.