podophyllin and Condylomata-Acuminata

The treatment of Condylomata acuminata often causes disappointment to both the physician and the patient since most of the current medical approaches require multiple examines while on the other hand success rates are low and recurrence rates remain high. The treatment approaches include surgical as well as non-surgical methods. The non-surgical treatment includes the application of local agents such as imiquimod, podophyllotoxin, and 5-fluorouracil. Other local agents, used in outpatient treatment settings, include trichloroacetic acid (TCA), podophyllin, or the intralesional application of agents such as interferon and bleomycin. The surgical methods include cryotherapy, electrosurgery, excision and laser therapy. Their major goal is the removal of the visible lesions. The development of the laser systems and the new HPV vaccines are a significant progress in the treatment and prevention of the HPV infections.

Topics: Alphapapillomavirus; Aminoquinolines; Antimetabolites; Caustics; Condylomata Acuminata; Cryotherapy; Electrosurgery; Female; Fluorouracil; Genital Diseases, Female; Humans; Imiquimod; Interferon Inducers; Podophyllin; Trichloroacetic Acid

External genital warts (EGWs) are sexually transmitted benign epidermal growths caused by the human papillomavirus (HPV), on the anogenital areas of both females and males. About 50% to 60% of sexually active women aged 18 to 49 years have been exposed to HPV infection, but only 10% to 15% will have genital warts.. We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of treatments for external genital warts? What are the effects of interventions to prevent transmission of external genital warts? We searched: Medline, Embase, The Cochrane Library, and other important databases up to December 2009 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).. We found 55 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.. In this systematic review we present information relating to the effectiveness and safety of the following interventions: bi- and trichloroacetic acid; condoms; cryotherapy; electrosurgery; imiquimod; intralesional, topical, or systemic interferons; laser surgery; podophyllin; podophyllotoxin; surgical excision; and vaccines.

Topics: Condylomata Acuminata; Double-Blind Method; Humans; Papillomaviridae; Papillomavirus Infections; Papillomavirus Vaccines; Podophyllin

Although cutaneous warts are one of the most common skin conditions affecting children, their management can be challenging, especially in complex cases and even more so during a single emergency department encounter. Anogenital warts require particular attention because of their possible but nonspecific association with sexual abuse. This review will focus on cutaneous warts and anogenital warts, with a discussion of their recognition and treatment, especially in the emergency department. The medicolegal implications of anogenital warts in children are also reviewed.

Topics: Adolescent; Child; Child Abuse, Sexual; Condylomata Acuminata; Cryotherapy; Diagnosis, Differential; Emergency Service, Hospital; Female; Humans; Keratolytic Agents; Medicine, Traditional; Papillomavirus Infections; Papillomavirus Vaccines; Pediatrics; Podophyllin; Salicylic Acid; Skin Diseases; Uterine Cervical Neoplasms; Warts

Human papillomaviruses (HPV) are found in most human epithelia and some tumors. Most HPV strains associated with cutaneous lesions belong to three types, named alpha, beta and gamma. Although the causal link between genital human papillomavirus infection and cervical neoplasia is well established, the role of beta-HPV in non melanoma skin cancers is unclear. HPV mainly causes benign cutaneous lesions on the hands and soles. Genital HPV infection is the most common sexually transmitted infection. It is generally asymptomatic. The genitals can be infected by two low-risk HPV types (6 and 11), which are responsible for benign anogenital warts (condylomata acuminata). The implications of anogenital warts in children are highly controversial as regards sexual abuse. Treatments (chemical, physical or immunological) are lengthy, expensive, inconvenient and often painful. Recurrence is frequent because of HPV persistence in perilesional skin.

Topics: Adult; Child; Condylomata Acuminata; Cryotherapy; Curettage; Female; Humans; Infant, Newborn; Keratolytic Agents; Male; Middle Aged; Papillomavirus Infections; Penile Diseases; Podophyllin; Recurrence; Time Factors; Uterine Cervical Diseases; Warts

Topics: Aminoquinolines; Condoms; Condylomata Acuminata; Cryotherapy; Electrosurgery; Female; Genital Diseases, Female; Genital Diseases, Male; Humans; Imiquimod; Interferon Inducers; Interferons; Laser Therapy; Male; Podophyllin; Podophyllotoxin; Trichloroacetic Acid

Topics: Aminoquinolines; Condoms; Condylomata Acuminata; Cryotherapy; Electrosurgery; Female; Genital Diseases, Female; Genital Diseases, Male; Humans; Imiquimod; Interferons; Male; Podophyllin; Podophyllotoxin

Topics: Adult; Aminoquinolines; Condylomata Acuminata; Cryosurgery; Diagnosis, Differential; Drug Administration Schedule; Humans; Imiquimod; Keratolytic Agents; Male; Penile Diseases; Penis; Podophyllin; Podophyllotoxin; Self Administration; Skin Diseases, Papulosquamous; Treatment Outcome; Trichloroacetic Acid

Topics: Aminoquinolines; Antiviral Agents; Condylomata Acuminata; Cryosurgery; Electrosurgery; Evidence-Based Medicine; Humans; Imiquimod; Interferons; Keratolytic Agents; Laser Therapy; Podophyllin; Podophyllotoxin; Trichloroacetic Acid

Topical application of podophyllin solution, long considered the therapy of first choice against condylomata acuminata, can no longer be recommended due to its low efficacy and gross toxicity. Self-treatment with 0.15-0.5% purified podophyllotoxin preparations, applied twice daily for 3 days, is now advocated as the alternative first-line therapy of choice, when significant improvement is conveniently, and cost-effectively, accomplished within a few weeks. This review provides a summary of the comparative efficacy and utility of podophyllin versus podophyllotoxin as well as a compilation of in vivo and in vitro safety evaluations. In light of overwhelming safety and efficacy data in favor of podophyllotoxin-derived products, it is concluded that podophyllin preparations have no place in the modern treatment portfolio for anogenital warts.

Topics: Administration, Topical; Animals; Cats; Clinical Trials as Topic; Condylomata Acuminata; Evidence-Based Medicine; Guinea Pigs; Humans; Keratolytic Agents; Mice; Mutagenicity Tests; Podophyllin; Podophyllotoxin; Practice Guidelines as Topic; Rabbits; Rats; Reproduction; Toxicity Tests

Podophyllin, a crude plant extract with low efficacy, high toxicity, and a serious mutagenicity profile does not comply with the WHO guidelines for plant derived treatments and should be removed from clinical treatment protocols. Home treatment with pharmaceutical products based on podophyllotoxin-the purified, standardised active antiwart ingredient of podophyllin-represents safe and effective first line therapy for patients with anogenital warts.

Topics: Condylomata Acuminata; Female; Humans; Keratolytic Agents; Phototherapy; Plant Extracts; Podophyllin; Podophyllotoxin

Topics: Adjuvants, Immunologic; Aminoquinolines; Biopsy; Condylomata Acuminata; Contraindications; Cryotherapy; Diagnosis, Differential; Female; Genital Diseases, Female; Genital Diseases, Male; Humans; Imiquimod; Keratolytic Agents; Male; Podophyllin; Pregnancy

Although many treatments are available for genital warts caused by human papillomavirus (HPV), none are uniformly successful in the treatment of this disease. Most current treatment options work by destroying affected tissue, either by a cytotoxic or a physically ablative mode of action. Interferons have antiviral, antiproliferative, and immunomodulatory activities, but these have not translated into a high level of cure rates against warts. With all current treatments, recurrent warts are common. Therapies currently being investigated include a 5-fluorouracil/epinephrine collagen gel that achieves high concentrations of 5-fluorouracil at the site of injection. Other new treatment modalities focus on activating the host's immune system or improving the delivery of therapeutic compounds to the affected site. Imiquimod, a novel immune-response modifier, induces interferon and a number of other endogenous cytokines. A cream formulation containing 5% imiquimod resulted in good total clearance rates and generally tolerable side effects in controlled clinical trials of patients with external genital warts. Perhaps the most effective means for managing HPV disease would be a vaccine that prevents the occurrence of genital warts. Although it is unlikely that such a vaccine will be introduced in the near future, preliminary studies indicate that it may be possible to develop suitable prophylactic and therapeutic vaccines.

Topics: Adjuvants, Immunologic; Aminoquinolines; Antimetabolites; Antiviral Agents; Condylomata Acuminata; Cryotherapy; Drug Therapy, Combination; Electrosurgery; Fluorouracil; Humans; Imiquimod; Injections, Intralesional; Interferons; Keratolytic Agents; Laser Therapy; Papillomaviridae; Papillomavirus Infections; Podophyllin; Podophyllotoxin; Tumor Virus Infections

Genital warts is a common sexually transmitted disease treated by a variety of medical specialists. Standard therapies offer symptomatic relief but cannot ensure lasting remission. Using the clinical literature, claims databases, and a panel of experienced practitioners, the relative efficacy, cost, and cost effectiveness of five common treatments for genital warts were assessed in this study.. We reviewed the clinical literature for the following genital wart therapies: podofilox, podophyllin, trichloroacetic acid, cryotherapy, and laser therapy, focusing on their relative efficacy. Physicians experienced in treating genital warts defined standard treatment protocols for men and women patients with moderate wart burdens. Using national claims data and protocols developed by physicians, we derived three economic models based on provider charges, third-party payments, and a resource-based relative value scale, respectively.. The literature review demonstrated highly variable success and recurrence rates among treatment methods and failed to show that one treatment provides consistently superior efficacy. In the economic models, treating women generally proved more costly than treating men per episode of care. This was due to the need for more extensive follow-up visits in the treatment of women. Total costs were highest for cryotherapy and lowest for a patient-applied therapy that reduced the need for follow-up visits.. Clinicians should consider both clinical and cost issues when choosing the appropriate treatment for patients with genital warts.

Topics: Clinical Protocols; Condylomata Acuminata; Cost-Benefit Analysis; Cryotherapy; Fees, Medical; Female; Follow-Up Studies; Genital Diseases, Female; Genital Diseases, Male; Health Care Costs; Humans; Insurance, Health, Reimbursement; Keratolytic Agents; Laser Therapy; Male; Models, Economic; Podophyllin; Podophyllotoxin; Recurrence; Relative Value Scales; Remission Induction; Sex Factors; Trichloroacetic Acid

Topics: Anal Canal; Anus Diseases; Child, Preschool; Chronic Disease; Combined Modality Therapy; Condylomata Acuminata; Cryosurgery; Electrocoagulation; Humans; Keratolytic Agents; Male; Podophyllin; Recurrence

The treatment of genital warts remains frustrating since it is often painful, expensive, and unsuccessful. Moreover, little is known about the infectivity and natural history of exophytic genital warts or subclinical genital infection with human papillomavirus. The traditional goals of therapy for sexually transmitted diseases--eradication of infection, elimination of symptoms, prevention of long-term sequelae, and interruption of transmission--are currently not attainable for or applicable to genital warts. The medical literature from January 1988 to August 1993 was reviewed for recent studies on the treatment of exophytic warts. The following treatments were included in the reviewed studies: podofilox (which was recently approved by the Food and Drug Administration), podophyllin, cryotherapy, topical 5-fluorouracil, intralesional interferon, systemic interferon, and laser surgery. No single treatment modality was superior to another, and recurrence rates associated with all modalities were high. Treatment of genital warts should be guided by preferences of the patient, and a specific therapeutic regimen should be chosen with consideration of expense, efficacy, convenience, and potential for adverse effects.

Topics: Condylomata Acuminata; Cryotherapy; Female; Fluorouracil; Humans; Interferons; Laser Therapy; Male; Papillomaviridae; Papillomavirus Infections; Podophyllin; Podophyllotoxin; Sexual Partners; Tumor Virus Infections

Topics: Adult; Cell Transformation, Neoplastic; Child; Condylomata Acuminata; Cryotherapy; Female; Humans; Interferons; Laser Therapy; Male; Podophyllin; Prognosis

The incidence of human papillomavirus infection is increasing. More than 60 types of human papillomavirus have been isolated; some types are known to have malignant potential. Differential diagnosis of the lesions includes condyloma latum, seborrheic keratoses, nevi, pearly penile papules and neoplasms. The goal in treating noncervical human papillomavirus infection is the elimination of lesions; eradication of the virus is not yet possible. Current forms of treatment include cryotherapy, podophyllum resin, podophilox, trichloroacetic acid, laser ablation, loop electrosurgical excision procedure (LEEP), fluorouracil and alpha interferon. Success in treating condyloma may be increased if the area is first soaked with 5 percent acetic acid to more clearly show the extent of the local infection. Recurrence is a problem no matter what form of therapy is used.

Topics: Condylomata Acuminata; Cryosurgery; Diagnosis, Differential; Electrocoagulation; Female; Fluorouracil; Humans; Injections, Intralesional; Interferon-alpha; Laser Therapy; Male; Papillomaviridae; Penile Diseases; Podophyllin; Trichloroacetic Acid; Vulvar Diseases

The main goal of the therapy of human papillomavirus (HPV) infection is the management of the virus. There is no cure for HPV infections. The treatment goal for the female patient is to destroy lesions that are malignant or premalignant. The male patient is treated because he is a carrier of HPV who can infect previously uninfected women and possibly reinfect an already treated partner with a potentially oncogenic virus. Various treatment modalities are discussed.

Topics: Condylomata Acuminata; Cryosurgery; Female; Fluorouracil; Humans; Laser Therapy; Male; Papillomaviridae; Podophyllin; Trichloroacetic Acid; Tumor Virus Infections; Uterine Cervical Neoplasms

Topics: Antineoplastic Agents; Condylomata Acuminata; Cryosurgery; Electrosurgery; Female; Genital Neoplasms, Female; Genital Neoplasms, Male; Humans; Interferons; Laser Therapy; Male; Papillomaviridae; Podophyllin; Podophyllotoxin; Trichloroacetic Acid

The therapeutic approaches to the five common skin problems described range from standard topical and systemic agents to newly introduced alternative medications and techniques. In acne, the type of lesion found on physical examination determines the severity of the disease and its subsequent treatment. When necessary, appropriate precautions must be taken before and during therapy. Fortunately, with the drugs available today, only the most extreme cases of acne should progress to the stage where physical and/or psychological scarring occurs. The number of therapeutic approaches to psoriasis, from steroids to UV light, pays testament to the difficulty in treating this cyclic disease. Until an effective and safe medication is developed, research is sure to continue. Sources of the antigen causing contact dermatitis are sometimes unusual, but the lesions have a characteristic appearance. Several topical and systemic agents are available. Patient education and prophylactic measures play an important role. Therapies for both venereal and nonvenereal warts are proliferating. The evolving understanding of viral oncogenesis in both types of warts promises that this will be an area of continued intense research in the next few years.

Topics: Acne Vulgaris; Adrenal Cortex Hormones; Condylomata Acuminata; Cryosurgery; Dermatitis, Contact; Dermatologic Agents; Humans; Keratolytic Agents; Photochemotherapy; Podophyllin; Psoriasis; Retinoids; Ultraviolet Therapy; Warts

An evolutionary process that began 50 years ago with a crude plant resin (podophyllum) has currently developed to the point where a fine chemical podophyllotoxin can be safely and effectively applied by patients for the treatment of external genital warts. In this brief review, the fundamental chemistry, pharmacology, and toxicology of podophyllotoxin will be reviewed, along with the sequence of clinical studies that resulted in the development of patient applied podophyllotoxin.

Topics: Condylomata Acuminata; Humans; Male; Penile Neoplasms; Podophyllin; Podophyllotoxin

Topics: Condylomata Acuminata; Humans; Podophyllin

Topics: Antiviral Agents; Bleomycin; Condylomata Acuminata; Cryosurgery; Dinitrofluorobenzene; Electrocoagulation; Female; Fluorouracil; Formaldehyde; Genital Diseases, Female; Genital Diseases, Male; Genital Neoplasms, Female; Genital Neoplasms, Male; Humans; Immunotherapy; Laser Therapy; Male; Podophyllin; Salicylates; Warts

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.

Topics: Clinical Trials as Topic; Combined Modality Therapy; Condylomata Acuminata; Drug Administration Schedule; Female; Genital Neoplasms, Female; Genital Neoplasms, Male; Humans; Interferon Type I; Laser Therapy; Male; Pilot Projects; Podophyllin; Random Allocation

Topics: Adolescent; Adult; Age Factors; Anus Neoplasms; Child; Condylomata Acuminata; Cryosurgery; Dichloroacetic Acid; Electrosurgery; Female; Genital Neoplasms, Female; Humans; Infant, Newborn; Male; Podophyllin; Pregnancy; Pregnancy Complications, Neoplastic; Recurrence; Sex Factors; Sexually Transmitted Diseases; Trichloroacetic Acid

Topics: Administration, Oral; Administration, Topical; Chemical Phenomena; Chemistry; Condylomata Acuminata; Female; Humans; Male; Mitosis; Podophyllin; Podophyllotoxin; Skin

Condylomata acuminata are benign epitheliomas which are caused by the human papilloma virus. 8 subgroups (variants) of the virus are known up to now. Condylomata acuminata are infectious, the virus being transferred by direct contact with a lesion. Condylomata acuminata are found more often in males than in females and never occur in children prior to the age of two years. The peak incidence is between 19 and 22 years of age. Greatly proliferating condylomata acuminata (type Buschke-Löwenstein) may lead to malignant degeneration. There exists a broad spectrum of topical therapeutic modalities: cytotoxic substances such as podophyllin (10 to 25%), colchicine (8%), 5-fluorouracil (1 to 5%), cryotherapy (solid carbon dioxyde or liquid nitrogen), surgical treatment (excochleation, electrocautery or laser beam. Vaccination therapy may prove successful in certain cases in the future.

Topics: Adult; Cell Transformation, Neoplastic; Colchicine; Condylomata Acuminata; Cryosurgery; Electrocoagulation; Female; Fluorouracil; Humans; Laser Therapy; Male; Papillomaviridae; Podophyllin; Viral Vaccines

Many therapeutic modalities are available for treating genital warts; however, the effectiveness of both diphenylcyclopropenone and podophyllin is still controversial.. To evaluate the effectiveness and safety of diphenylcyclopropenone and podophyllin in treating genital warts.. This study included 57 patients, divided randomly into two groups. Group (A): diphenylcyclopropenone (. Higher clearance was achieved in group A, with 19 of 29 (65.5%) patients, than in group B, with 9 of 28 (32.1%) (. Diphenylcyclopropenone shows a higher success rate than podophyllin in treating genital warts and a lower recurrence rate.

Topics: Condylomata Acuminata; Cyclopropanes; Humans; Podophyllin; Warts

Anogenital warts (AGWs) are a common therapeutic challenge. All therapies are associated with burning, pain, and frustrating high rate of recurrence. The search for a new alternative continues. Recently, a diterpene ester extracted from the Euphorbia peplus plant (ingenol mebutate [IM]) has been shown to possess activity against AGWs.. This study aimed to compare and evaluate the therapeutic efficacy and safety of topical 0.05% ingenol gel with another herbal extract medication (topical 25% podophyllin solution) in treatment of AGWs.. This was a comparative single blinded nonrandomized, 2-arm trial of ingenol 0.05% gel versus podophyllin solution 25% administered up to 6 times to patients with AGWs. To evaluate the therapeutic efficacy, the complete clearance rate and recurrence rate were assessed 1 and 12 weeks after last treatment, respectively. Safety was assessed by occurrence and severity of pain and local skin reaction (LSR).. Of 31 and 36 patients in the IM group and podophyllin group who completed the study, initial complete resolution was observed in 20 (64.5%) and 14 (38.9%) patients, respectively (P = 0.03). The initial clearance was faster in the IM group (2.00 ± 0.91 weeks) compared with the podophyllin group (4.21 ± 1.05 weeks, P = 0.00). After 3 months, recurrence was seen in 13 (65.0%) of 20 patients in the IM group and 6 (42.8%) of 14 in the podophyllin group (P = 0.20). The number of patients with complete resolution after 3 months was not different between the 2 groups (7/31 in the IM group and 8/36 in the podophyllin group, P = 0.97). The mean ± SD severity scores for LSR and pain in the IM group were 6.65 ± 1.76 and 6.13 ± 2.57, respectively, which was significantly higher than their scores (3.39 ± 1.57 and 2.58 ± 1.38) in the podophyllin group (P = 0.00).. Ingenol mebutate 0.05% gel is effective as podophyllin 25% solution in treating AGWs, with further benefit of being much more rapid. However, high recurrence rate, sever pain, and LSR limit its use.

Topics: Adult; Anus Diseases; Condylomata Acuminata; Diterpenes; Female; Gels; Genital Diseases, Female; Genital Diseases, Male; Humans; Male; Podophyllin; Prospective Studies; Treatment Outcome

Zinc sulfate is beneficial in the treatment of epithelial warts. We conducted this study to compare the efficacy of combination therapy of oral zinc sulfate with conventional treatments in the treatment of vulvar warts.. This study was a randomized controlled trial. The sample size was 42 in each group. Women aged 20-50 years were placed by the block randomized method into six groups: the podophyllin-, imiquimod- and cryotherapy-treated groups, and another three groups receiving 8-week combination therapy of 400 mg oral zinc sulfate with one of the above-mentioned treatments. Data were analyzed using anova and Fischer's exact test with spss16.. A total of 228 patients were recruited and completed the study in six treatment groups. No significant difference was observed in the response to treatment among these groups. Relapse after 6 months was significantly higher in the podophyllin-, imiquimod- and cryotherapy-treated patients compared to patients receiving these treatments in combination with oral zinc sulfate (P<0.05).. Combined therapy of oral zinc sulfate with conventional treatments of vulvar warts appears to reduce the relapse rate.

Topics: Administration, Cutaneous; Administration, Oral; Adult; Aminoquinolines; Astringents; Combined Modality Therapy; Condylomata Acuminata; Cryosurgery; Female; Humans; Imiquimod; Interferon Inducers; Iran; Keratolytic Agents; Middle Aged; Patient Dropouts; Podophyllin; Secondary Prevention; Skin Cream; Vulvar Diseases; Young Adult; Zinc Sulfate

We describe a prospective study designed to assess the effectiveness of the commonly used clinic-based treatments for genital warts individually and in combination. Patients presenting with new or recurrent genital warts were randomly allocated to one of five treatments on a weekly basis. The clinical endpoint was wart clearance or eight treatments, whichever occurred sooner. If there was not a good response by the eighth treatment, an alternate modality was offered. Four hundred and nine individuals were enrolled in the study. Almost no patients withdrew in any group due to adverse effects. Three-quarters of patients treated with podophyllin 25% and cryotherapy concurrently required only two treatments to clear their warts. All had clearance in less than eight treatments. Single therapy with either trichloracetic acid or podophyllin 25% resulted in longer time to wart clearance, and more persistent warts.

Topics: Adult; Ambulatory Care Facilities; Caustics; Combined Modality Therapy; Condylomata Acuminata; Cryotherapy; Female; Humans; Keratolytic Agents; Male; Podophyllin; Prospective Studies; Trichloroacetic Acid

High DNA viral load in Human Papillomavirus type 16 cervical dysplastic lesions has been proposed as a marker of progression towards malignancy. To evaluate the prognostic value of DNA viral load in infection by HPV type other than HPV-16, a longitudinal study of patients with Anogenital Condylomata (AC) was designed. The study included 40 patients, 25 men and 15 women. Clinical data were collected through standard interview and routine serum analyses. Viral type in lesions was assayed by PCR with general primers (MY09-MY11) and Restriction Fragment Length Polymorphism (RFLP). Viral load was determined by PCR end point determination with type specific primers on serial sample dilutions. The duration of ano-genital lesions upon liquid nitrogen standard cryotherapy or Podofillin chemotherapy was correlated with viral and clinical data. Patients with higher lesional viral load at study entry showed a markedly longer disease clinical course than patients with lower viral loads. The HPV-6 was observed in 31 out of 40 patients (77.5%), much more frequently than HPV-11 (7/40 17.5%), the latter being associated with higher titres of viral load. Two cases (5%) remained undetermined. No HPV-16 or other high-risk type was detected, while HPV-61, not uncommon in Italy, was found once in a double infection carried by an HIV positive patient. No significant association was observed between clinical outcome and demographic and epidemiological data, or risk factors.

Topics: Anus Diseases; Condylomata Acuminata; Cryotherapy; DNA, Viral; Female; Humans; Longitudinal Studies; Male; Papillomaviridae; Podophyllin; Polymerase Chain Reaction; Prognosis; Treatment Outcome; Viral Load

The aims of this study were to: 1) ascertain if podophyllin resin in 0.5% [PE(0.5%)] and 0.25% [PE(0.25%)] in ethanol (PE) self-applied sequentially for 3 days with 4 days break cycle is as effective as supervised podophyllin 25% in tincture benzoin (PB) applied in the clinic biweekly in treating penile warts and 2) ascertain if PE causes less skin irritation than PB.. The clearance rate of penile warts was 36.4% (4/11) in PE (0.5%) treated group, 66.7% (4/6) in the PE (0.25%) treated group and 33.3% (6/18) for PB treated group after 1 week (ns). The wart clearance rate at 6 weeks for PE (0.5%) treated group, PE (0.25%) treated group and PB treated group were 81.8% (9/11), 100% (6/6) and 83.3% (15/17) respectively (ns). There were 47 individual warts on the penis of the 17 patients in the PE treated group and 58 individual warts on the penis of the 18 patients in the PB treated group. Based on the response of individual warts to the 2 treatment regimens, the clearance rate was 42.6% (20/47) for the PE treated group and 25% (15/56) for the PB treated group after 1 week treatment (ns). At 6 weeks follow-up, the clearance rate for the PE treated group and the PB treated group were 85.1% (40/47) and 73.2% (41/56) respectively (ns). Skin irritation including superficial erosions, pain and itch were observed in 47% (8/17) in patients treated with PE compared to 38.9% (7/18) in patients treated with PB (ns) during the 6 weeks follow-up period. The clearance rate of patients treated with PE (0.25%) was compared to those treated with PE (0.5%). Four out of six of PE (0.25%) treated patients had clearance of warts after 1 week and 100% clearance at the end of 6 weeks. None experienced any skin irritation.. This study demonstrates that 0.5% podophyllin (and possibly 0.25% podophyllin) in ethanol is effective in eradicating penile warts. It can be used by patients for self-treatment at home with greater convenience and is more cost effective than the conventional podophyllin 25% in tincture benzoin paint.

Topics: Adult; Aged; Condylomata Acuminata; Emollients; Ethanol; Humans; Keratolytic Agents; Male; Middle Aged; Penile Diseases; Plant Extracts; Podophyllin; Solvents; Styrax

To compare the effectiveness and cost of self treatment of penile warts with a commercial preparation of podophyllotoxin 0.5% (PDX 0.5%) with podophyllin 0.5% and podophyllin 2.0% sourced from Podophyllum emodii.. A prospective double blind randomised study.. 315 patients with penile warts attending two departments of genitourinary medicine.. Absence of warts, cessation of treatment due to severe side effects at 5 weeks.. Of the 315 patients, 244 conformed to the protocol. Analysis was on an intention to treat basis. At 5 weeks no significant differences were found in the extent of healing of warts or in side effects for the three treatment groups. The costs of drug treatment (excluding staff time) are at least pounds 10.00 less for podophyllin than podophyllotoxin. A fourfold variation in the active constituents of the podophyllin preparations did not produce appreciably different clinical responses. In a subanalysis no evidence of deterioration in effectiveness of podophyllin over time was demonstrated.. Penile warts in selected cases can be safely treated with 0.5-2.0% podophyllin self applied by the patient at a fraction of the cost of commercially available podophyllotoxin. The shelf life of the podophyllin extracts is at least 3 months. These findings may be especially relevant in countries where resources for health care are limited.

Topics: Condylomata Acuminata; Double-Blind Method; Drug Stability; Humans; Keratolytic Agents; Male; Penile Diseases; Podophyllin; Podophyllotoxin; Prospective Studies; Self Administration

The primary objective was to determine if six weeks treatment with subcutaneous interferon alpha-2a (IFN) and podophyllin 25% W/V administered twice per week, preceded by IFN alpha-2a three times weekly for one week showed a greater complete response rate in patients with primary condylomata acuminata when assessed at week 10 than treatment with podophyllin and placebo injections in the same schedule. The secondary objective was to compare recurrence rates in complete responders at six months in the two treatment groups.. Randomised, double-blind parallel group study.. Multicentre study in six genitourinary clinics within the U.K.. One hundred and twenty-four patients with primary anogenital warts.. Complete response rate at week 10, and recurrence rate at week 26 in complete responders.. At week 10 analysis of the efficacy population showed complete response in 36% (15/42 patients) of IFN-treated group and 26% (11/43 patients) in the placebo group (no significant difference). Analysis of the safety population at week 26 showed persistence of the complete response in 57% (8/14 patients) of the IFN-treated group and 80% (12/15 patients) of the placebo group (no significant difference). Adverse effects were more common in IFN-treated patients, involved particularly application site reaction and malaise but were generally mild.. At the dose and with the regime described treatment with IFN alpha-2a in combination with podophyllin is no more effective in the treatment of primary anogenital warts than podophyllin alone and is associated with more adverse events.

Topics: Adolescent; Adult; Aged; Anus Diseases; Condylomata Acuminata; Double-Blind Method; Drug Therapy, Combination; Female; Genital Diseases, Female; Genital Diseases, Male; Humans; Interferon-alpha; Male; Middle Aged; Podophyllin; Recurrence; Time Factors; Treatment Outcome

to compare the response to treatment and recurrence rate of condylomata accuminata using subcutaneous injection of interferon alfa 2a 1.5 million units three times weekly for four weeks, or podophyllin resin 25% applied to lesions twice weekly for up to six weeks.. Randomised open study.. Multicentre European study in genitourinary medicine, dermatovenereology, and gynaecology departments.. 87 males and 67 females with condylomata acuminata for less than six months and no history of previous treatment.. Complete clearance of lesions and evidence of recurrence at three months and nine months after treatment commenced.. A complete response was achieved at three months in 15 of 64 (23%) in the interferon treated group, and 31 of 69 (45%) in the podophyllin treated group (p = 0.003). At nine months 10 of 13 patients in the interferon group and 22 of 30 patients in the podophyllin group remained completely clear of lesions.

Topics: Administration, Topical; Adolescent; Adult; Aged; Condylomata Acuminata; Female; Humans; Injections, Subcutaneous; Interferon alpha-2; Interferon-alpha; Male; Middle Aged; Patient Acceptance of Health Care; Podophyllin; Recombinant Proteins; Recurrence

A study of 37 women with typical condylomas and so-called squamous micropapilloma was undertaken to determine their response to systemic interferon and/or podophyllin treatment. Thirty lesions were classified as condylomas and 9 as squamous micropapillomas; two women had both lesions. Twenty-six (87%) of 30 condylomas responded, whereas only 1 (11%) of the 9 cases of micropapillomatosis showed a partial response (P less than .001) to podophyllin and/or interferon. Twenty-six biopsies from condylomas in which sufficient DNA was available for analysis contained human papillomavirus (HPV) DNA sequences that hybridized to an HPV 6 + 16 probe mix under nonstringent conditions. In contrast, HPV DNA sequences could not be detected in any of the nine cases of micropapillomatosis. Immunoperoxidase studies performed on these lesions failed to demonstrate viral capsid antigen. Thus, despite certain similarities in the clinical presentation and microscopic features of condylomas and squamous micropapillomas, it is not clear at present whether micropapillomas are HPV-related lesions.

Topics: Condylomata Acuminata; DNA, Viral; Drug Therapy, Combination; Female; Humans; Interferon Type I; Neoplasm Recurrence, Local; Papilloma; Papillomaviridae; Podophyllin; Vulvar Neoplasms

Four hundred and fifty patients were enrolled into a randomised clinical trial in a public sexually transmitted diseases clinic to evaluate the efficacy of podophyllin, cryotherapy, and electrodesiccation for treatment of external genital warts. Complete clearance of warts was observed in 41%, 79%, and 94% of patients who received up to six weekly treatments of podophyllin, cryotherapy, and electrodesiccation, respectively. Relapses occurred in 25% of all patients, yielding 3 month clearance rates of 17%, 55%, and 71% for podophyllin, cryotherapy, and electrodesiccation, respectively. Wart volume and duration did not influence treatment outcome. Response to therapy was greater in women than in men, and did not differ by treatment modality. Electrodesiccation and cryotherapy were more effective than podophyllin for the treatment of external genital warts, but none of these three treatments were highly successful.

Topics: Adult; Condylomata Acuminata; Cryosurgery; Electrocoagulation; Female; Humans; Male; Podophyllin; Randomized Controlled Trials as Topic

To determine the value of combining interferon with standard local therapy in the treatment of human papillomavirus infection, 97 patients with anogenital warts were randomized to a short course of either interferon plus podophyllin or podophyllin alone. Interferon alpha 2b (1.5 x 10(6) IU) was injected intralesionally and podophyllin resin applied topically to each of three warts once weekly for 3 weeks. Maximal responses occurred within 2 weeks of therapy, and overall there was complete clearance of treated warts in 67% of interferon and podophyllin versus 42% of podophyllin recipients (P less than .05, chi 2). Clearance rates were greater in women, patients with warts of less than or equal to 12 months' duration, and HIV-seronegative patients. Of patients with complete clearance, 67% of interferon and podophyllin and 65% of podophyllin recipients experienced recurrences. Thus, in short treatment courses of anogenital warts, intralesional interferon enhanced the effect of topical podophyllin, and trials of combination therapy using more intensive or prolonged regimens of interferon are warranted.

Topics: Administration, Topical; Adolescent; Adult; Analysis of Variance; Combined Modality Therapy; Condylomata Acuminata; Female; Follow-Up Studies; HIV Seropositivity; Humans; Injections, Intralesional; Interferon alpha-2; Interferon Type I; Interferon-alpha; Male; Middle Aged; Podophyllin; Recombinant Proteins; Recurrence

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.

Topics: Adult; Anal Canal; Anus Neoplasms; Condylomata Acuminata; Female; Genital Neoplasms, Female; Genital Neoplasms, Male; Genitalia; Humans; Male; Middle Aged; Podophyllin; Prospective Studies; Random Allocation

In a multicentre, prospective, randomised, placebo controlled study of 55 patients with histories of genital warts for at least one year, a four week course of inosine pranobex 3 g a day improved the clinical response to conventional treatment (primarily podophyllin or trichloroacetic (now called trichlorethanoic) acid). Although more patients given inosine pranobex improved than those given placebo, the difference in general response between the two groups was not significant. When other variables (numbers of warts and extent of lesions) were considered, however, the patients given inosine pranobex fared significantly better. These results suggest that inosine pranobex may be worth considering as adjunct to treatment of patients with refractory genital warts.

Topics: Adult; Clinical Trials as Topic; Condylomata Acuminata; Double-Blind Method; Female; Humans; Immunotherapy; Inosine; Inosine Pranobex; Male; Multicenter Studies as Topic; Placebos; Podophyllin; Prospective Studies; Trichloroacetic Acid

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.

Topics: Clinical Trials as Topic; Combined Modality Therapy; Condylomata Acuminata; Drug Administration Schedule; Female; Genital Neoplasms, Female; Genital Neoplasms, Male; Humans; Interferon Type I; Laser Therapy; Male; Pilot Projects; Podophyllin; Random Allocation

Topics: Adult; Anal Canal; Anus Neoplasms; Condylomata Acuminata; Female; Humans; Male; Middle Aged; Podophyllin; Recurrence

The efficacy and tolerance of human lymphoblastoid interferon (Wellferon) were studied in an open label trial of 17 patients with resistant and persistent condyloma acuminata. Patients were treated intramuscularly with 5 X 10(6) U (5 MU)/m2 daily for 28 days followed by thrice weekly injections for two weeks. Sixteen patients were considered evaluable; eight experienced complete clearance, seven had significant reduction (greater than 50%) in lesion size, and one showed no response during the course of this trial. Biologic side effects of interferon occurred in all patients during initial dosing and diminished during thrice weekly therapy. Intramuscular injections and associated side effects were tolerated well. This study shows that systemic human lymphoblastoid interferon is active in treating severe recurrent genital warts in women with a history of recalcitrant disease.

Topics: Adolescent; Adult; Blood Cell Count; Clinical Trials as Topic; Condylomata Acuminata; Dinitrochlorobenzene; DNA, Viral; Fatigue; Female; Fever; Genital Neoplasms, Female; Headache; Humans; Immunoglobulins; Interferon Type I; Lymphocytes; Middle Aged; Nausea; Papillomaviridae; Podophyllin

Topics: Adult; Clinical Trials as Topic; Condylomata Acuminata; Drug Resistance; Female; Humans; Laser Therapy; Male; Podophyllin

This article describes an approach to the evaluation and treatment of condyloma acuminatum (anogenital warts) that is based on the results of new clinical research on the biology of the human papillomavirus. A more extensive diagnostic protocol, including routine cervicovaginal examination and Papanicolaou smear, is proposed for female patients because of the close association of genital human papillomavirus infections with cervical carcinoma. Two highly effective therapies, cryosurgery and carbon dioxide laser photocoagulation, are described and compared with older regimens. Recent developments in immunotherapy for resistant condyloma acuminatum are also discussed.

Topics: Clinical Trials as Topic; Condylomata Acuminata; Cryosurgery; Electrocoagulation; Female; Fluorouracil; Genital Neoplasms, Female; Genital Neoplasms, Male; Humans; Immunotherapy; Interferons; Laser Therapy; Male; Ointments; Papanicolaou Test; Podophyllin; Urethral Neoplasms; Uterine Cervical Neoplasms; Vaginal Neoplasms; Vaginal Smears

60 patients with first-episode perianal condylomata acuminata were randomly assigned to podophyllin application or surgical excision. 58% of the male patients were homosexual and 33% of the female patients regularly had anal intercourse. Podophyllin completely cleared warts from 23 of 30 (76.6%) patients compared with 28 of 30 (93.3%) for surgical excision. After wart clearance the cumulative recurrence rates were 18% for surgical excision and 43% for podophyllin at 3 months (p less than 0.05), 22% and 56% at 6 months (p less than 0.01), 26% and 56% at 9 months (p less than 0.01), and 29% and 65% at 12 months (p less than 0.01). All patients were treated as outpatients and all surgical procedures were carried out under local anaesthesia. Both regimens were well tolerated.

Topics: Adolescent; Adult; Anus Neoplasms; Clinical Trials as Topic; Condylomata Acuminata; Female; Humans; Male; Neoplasm Recurrence, Local; Podophyllin; Prospective Studies; Random Allocation

Topics: Condylomata Acuminata; Drug Evaluation; Humans; Male; Neoplasm Recurrence, Local; Penile Neoplasms; Podophyllin; Self Administration

The effect of alcoholic solutions with 20% podophyllin from Podophyllum peltatum and Podophyllum emodi, 8% podophyllotoxin, and 8% colchicine, when applied to penile condylomata acuminata in 227 men, were statistically alike. Of the patients initially judged to be cured after 1-2 applications, 13% showed recurrence, thus bringing down the permanent cure frequency to only 43%. Local side effects were absent after only half the series of colchicine applications, whereas as much as about 3/4 of the treatment course with podophyllin and pure podophyllotoxin could be completed without provoking discomfort. Warts in the urinary meatus healed significantly less well than warts on the other genital mucous membranes. Eighty-nine per cent of patients who had previously been cured of concylomata became wart-free after 1-2 treatments, as opposed to only 40% of those who had never had this wart type previously. The use of the commercially available colchicine offers an opportunity to establish a standardized therapy; following application of an 8% solution, rinsing off should be performed after 6-8 hours.

Topics: Administration, Topical; Clinical Trials as Topic; Colchicine; Condylomata Acuminata; Drug Evaluation; Humans; Male; Penile Neoplasms; Podophyllin; Podophyllotoxin

The purpose of this study is to investigate disease trend of genital wart through changes in each treatment method over the past 10 years in Korea.. From 2010 to 2019, surgical treatment including cauterization, excision, cryotherapy, and laser therapy, non-surgical treatment such as podophyllin, and surgical treatment for anorectal lesion were extracted and analyzed from 2010 to 2019. For each treatment method, characteristics such as sex, age, region, medical cost and average number of procedures were analyzed.. The number of patients following all treatment modalities increased every year. Surgical treatment of genital wart and anorectal wart showed a significant increase in male patients. Number of non-surgical treatment decreased in males but increased in females. Surgical removal of the anorectal wart increased more than 250% in over 10 years, and males underwent surgery 4 times more than females. In both surgery and non-surgery, the mean session was higher in males. Most of them were carried out in primary medical institutions. In Seoul and Gyeonggi-do, the largest number of patients received treatment regardless of treatment method.. Treatment for genital warts has increased rapidly over the past 10 years, and the increase in males is remarkable. The main treatment was surgery, and males mainly received surgical treatment, and females mainly received drug treatment. The primary medical institution was in charge of the most treatment. As the number of patients and related medical expenses are increasing rapidly, more attention and response to diseases are needed.

Topics: Condylomata Acuminata; Delivery of Health Care; Female; Humans; Male; Podophyllin; Republic of Korea; Warts

A role of human papilloma virus (HPV) vaccines as a therapy for genital warts was suggested, nevertheless; it has not been established in clinical trials and has yet to be determined. The objective of this study is to evaluate a potential benefit of intralesional injection of bivalent HPV (Cervarix) vaccine as a treatment for anogenital warts versus topical podophyllin resin 25%. Forty-four patients with anogenital warts were included in the study, 22 patients received intralesional Cervarix every 2 weeks until clearance of lesions or for a maximum of five sessions. The other 22 patients received topical podophyllin resin 25% twice weekly until complete resolution or for a maximum of 4 weeks. Follow up was done for 6 months. Dermatology life quality index (DLQI) was measured. Complete clearance of warts was achieved in 10 patients (45.5%) in Cervarix group versus six patients (27.3%) in Podophyllin group. The difference was statistically insignificant. No recurrence of warts was reported in Cervarix group while two patients (33.3%) showed recurrence in Podophyllin group. Both treatments were well tolerated. All patients reported significant improvement of their DLQI. Intralesional Cervarix is a promising modality showing higher rates of complete response, high safety, and no recurrence.

Topics: Condylomata Acuminata; Humans; Injections, Intralesional; Papillomavirus Infections; Papillomavirus Vaccines; Pilot Projects; Podophyllin; Warts

Topics: Administration, Cutaneous; Condylomata Acuminata; Humans; Podophyllin; Salicylic Acid; Warts

Topics: Administration, Cutaneous; Administration, Oral; Condylomata Acuminata; Dermatologic Agents; Drug Therapy, Combination; Humans; Isotretinoin; Keratolytic Agents; Male; Penile Diseases; Podophyllin; Recurrence

External genital warts, caused by human papillomavirus, have a significant clinical, epidemiological, and financial impact, including the risk for malignant transformation. Treatment modalities include: (a) destructive (ablative); (b) cytotoxic (proapoptotic) and (c) immunomodulatory, with success and recurrence rates varying from 23% to 94% and from 4.1% to 77%, respectively. Most studies evaluated only single modality therapy, with few reports examining a combined approach for external genital warts management. The introduction of sinecatechins ointment in recent years has resulted in very low recurrence rates of 4.1-10.6%, despite lower initial clearance rates than ablative methods. We present a retrospective review of 27 patients who underwent combined therapy for external genital warts by using one or two sessions of cryodestruction combined with 25% podophyllin as the cytotoxic agent, and post-ablation immunomodulation with topical sinecatechins 15% ointment. This approach resulted in an excellent initial clearance rate of 96.3% with a recurrence rate of 7.4% after a total period of six months of follow-up. We suggest the importance of the combined approach in external genital warts management including post-ablative immunomodulation to augment the immune response and combat the residual latent infection. We hope to encourage trials examining the combined approach to the treatment of external genital warts.

Topics: Administration, Cutaneous; Adolescent; Adult; Aged; Anti-Infective Agents, Local; Catechin; Combined Modality Therapy; Condylomata Acuminata; Cryosurgery; Female; Humans; Immunomodulation; Male; Middle Aged; Ointments; Papillomaviridae; Plant Extracts; Podophyllin; Retrospective Studies; Treatment Outcome; Young Adult

Condyloma acuminatum are caused by human papillomavirus. Giant condyloma acuminatum is a locally invasive, destructive, and large sized mass. Risk factors for the development of giant condyloma acuminatum include an immunodeficient state, such as human immunodeficiency virus infection, post-organ transplantation, or post-allogeneic bone marrow transplantation. However, reports of giant condyloma after bone marrow transplantation are extremely rare (0.3 to 1.3%). The standard treatment for giant condyloma acuminatum is recommended as wide surgical resection due to its high rate of success and low rate of recurrence.. A 31-year-old Korean man presented to our hospital with anal discomfort for more than one month due to a protruding mass. He had a history of BCR-ABL-positive acute lymphoblastic leukemia and had undergone an allogenic stem cell transplantation. Gross findings revealed a large perianal cauliflower-like mass over 7cm in size with invasion of the anal orifice. He was diagnosed with giant anal condyloma occurring after an allogeneic bone marrow transplantation. However, we achieved successful treatment using a combination of topical podophyllin and cryotherapy and transanal surgical excision, followed by bleomycin irrigation.. We report an extremely rare case of giant condyloma acuminatum of anus due to human papillomavirus type six in a patient with acute lymphoblastic leukemia following an allogeneic bone marrow transplantation. The tumor was successfully treated with a combination of topical podophyllin and cryotherapy and transanal surgical excision, followed by bleomycin irrigation.

Topics: Adult; Antibiotics, Antineoplastic; Antineoplastic Agents, Phytogenic; Anus Neoplasms; Bleomycin; Bone Marrow Transplantation; Condylomata Acuminata; Cryotherapy; Human papillomavirus 6; Humans; Male; Papillomavirus Infections; Podophyllin; Transplantation, Homologous; Treatment Outcome

Females with systemic lupus erythematosus (SLE) have higher prevalence of human papillomavirus (HPV) infection, which can lead to the development of warts. Herein we report the first case of giant disseminated condylomatosis (GDC) in a SLE female on mycophenolate mofetil (MMF).. The patient, a 33-year-old, Black female, was diagnosed with SLE during her first pregnancy in 2003 based on the features of arthritis, skin rash, seizures, nephritis and presence of antinuclear antibodies. Her pregnancy resulted in preterm delivery of a stillborn fetus at 28 weeks. Since that time she has been treated with steroids and different regimens of immunosuppressive drugs such as cyclophosphamide, azathioprine and lately MMF. In the last few years she presented GDC involving the genital area in addition to skin on the lower abdomen. Topical therapy with trichloroacetic acid, imiquimod and podophyllin was only partially effective. Different types of HPV were identified in the lesions, being HPV-11 in abdomen, HPV 6, 11, 42 in vulva, HPV-6, 11 in vagina and HPV-6, 11 in endocervix.. GDC may be a complication of SLE, secondary to the disease itself, its treatment or other factors not yet identified.

Topics: Adult; Aminoquinolines; Condylomata Acuminata; Drug Therapy, Combination; Female; Humans; Imiquimod; Immunosuppressive Agents; Lupus Erythematosus, Systemic; Mycophenolic Acid; Papillomaviridae; Podophyllin; Treatment Outcome; Trichloroacetic Acid

Topics: Aged; Anus Diseases; Condylomata Acuminata; Female; Humans; Papillomaviridae; Papillomavirus Infections; Podophyllin; Postmenopause

To describe the treatment pattern of condyloma acuminata in female.. The 5-year medical records of 449 women treated for genital condyloma acuminata at the Gynecologic Infectious Diseases and Female Sexually Transmitted Disease (GID-FSTD) unit were reviewed. Data included the distribution of age, client by category, anatomical site and size, serologically coexisting sexually transmitted infection (STI), and treatment modalities.. About half, 50.1%, of treatment was the application of topical trichloroacetic acid; followed by podophylline in the proportion of 35.5%. While the electric cauterization and imiquimod applications were uncommon therapy. Two-fifth ofthe subjects, 40.7%, was completely cured, and the remaining cases required additional management.. The present setting, the wide range of treatment available is reflection of the fact that there is no ideal management.

Topics: Adjuvants, Immunologic; Administration, Topical; Adult; Aminoquinolines; Caustics; Cautery; Condylomata Acuminata; Female; Genital Diseases, Female; Humans; Imiquimod; Ointments; Podophyllin; Retrospective Studies; Treatment Outcome; Trichloroacetic Acid; Young Adult

Longitudinal data from a case series indicated that clearance rates (95% CIs) of anogenital warts (AGW) by silver nitrate (n = 14) and podophyllin (n = 34) were 93% (79.35, 100) and 14.7% (3, 27) respectively; and RR, 6.31 (95% CI 2.77, 14.37, p = 0.052), relative benefit increase, 532% (410, 654), and NNT, 1 (1, 2). The total effort needed US$28(BB$56) vs US$598 in 1-3 vs 1-37 visits to achieve one successfully treated patient respectively. While subject to the errors of an open, non-randomized case series, silver nitrate was highly efficacious and cost-effective and should replace podophyllin at the Winston Scot Polyclinic.

Topics: Adolescent; Adult; Antiviral Agents; Condylomata Acuminata; Cost-Benefit Analysis; Female; Humans; Male; Middle Aged; Podophyllin; Retrospective Studies; Silver Nitrate; Treatment Outcome; Young Adult

Topics: Condylomata Acuminata; Female; Humans; Infant; Keratolytic Agents; Podophyllin; Vulvar Diseases

To determine whether an educational event can affect treatment choice for ano-genital warts, genitourinary medicine clinicians attending a wart management lecture were shown 14 photographs of genital warts of differing morphology at different sites and asked to choose their preferred method of treatment. Study questionnaires were completed pre-lecture and repeated after the lecture and discussion. Podophyllin was chosen significantly less frequently and cryotherapy more frequently post-lecture for certain wart types. Podophyllotoxin was favoured for multiple small penile and posterior fourchette warts, whereas imiquimod was chosen predominantly for large or bulky lesions. Trichloracetic acid was infrequently chosen as a treatment option (<6% of respondents). This study has shown that clinicians attending a lecture on the management of ano-genital warts do change their treatment choice for certain clinical scenarios. Whether opting for a particular treatment in a lecture setting translates to altered practice in the clinical setting requires further study.

Topics: Condylomata Acuminata; Cryosurgery; Education, Medical, Continuing; Female; Humans; Inservice Training; Keratolytic Agents; Male; Physicians; Podophyllin; Podophyllotoxin; Practice Patterns, Physicians'

Topics: Burns, Chemical; Condylomata Acuminata; Humans; Keratolytic Agents; Male; Middle Aged; Penis; Podophyllin; Scrotum; Self Administration

Topics: Administration, Topical; Child, Preschool; Condylomata Acuminata; Female; Humans; Infant; Keratolytic Agents; Male; Podophyllin

This was a cross-sectional survey that collected data relating to management of anogenital warts (AGW) during a single-patient visit only at genitourinary medicine clinics. Single-agent use of cryotherapy, podophyllotoxin and trichloroacetic acid (TCA) were the most common treatment modalities, accounting for over two-thirds of all modalities used. Podophyllin, alone or in combination with other agents, was used for about 20% of first-line treatments. Podophyllin was included in about 15% of all treatment modalities. Guidelines for the management of AGW continue to recommend the use of podophyllin, but this may need to be modified in the light of recent publications. Podophyllin, TCA, podophyllotoxin or combinations of these agents are commonly used to treat keratinized warts. About 11% of all treatments involved a combination of two or more agents.

Topics: Condylomata Acuminata; Cross-Sectional Studies; Cryosurgery; Female; Humans; Keratolytic Agents; Male; Medical Audit; Podophyllin; Podophyllotoxin; Practice Patterns, Physicians'; Pregnancy; Pregnancy Complications, Infectious; Trichloroacetic Acid

Topics: Administration, Topical; Anus Diseases; Condylomata Acuminata; Diagnosis, Differential; Female; Genital Diseases, Female; Humans; Infant; Infectious Disease Transmission, Vertical; Keratolytic Agents; Podophyllin; Sexually Transmitted Diseases

Our objective was to identify patterns of treatment and resources used in achieving complete clearance of external genital warts (EGWs) A retrospective case note review was carried out at six genitourinary medicine (GUM) clinics in the UK. Case notes from 2366 patients presenting with EGWs were reviewed and 1200 patients with complete episodes of care were identified. Analysis showed that staff-applied therapy dominated treatment practice but there was considerable diversity in treatment modalities across study sites. The average number of visits was 5.71 visits for males: 6.25 visits for females but a substantial minority of patients attended significantly in excess of these averages. Approximately two-thirds of patients failed to achieve complete clearance of warts with their initial therapy. There is little consistency in treatment patterns of care for EGWs across the sites studied. Initial therapy choices are largely ineffective, requiring changes in treatment modality and multiple clinic visits. Increased utilization of patient-applied therapies might result in increased cost effectiveness.

Topics: Adult; Age Distribution; Ambulatory Care Facilities; Caustics; Combined Modality Therapy; Condylomata Acuminata; Cryotherapy; Female; Humans; Keratolytic Agents; Male; Office Visits; Podophyllin; Practice Patterns, Physicians'; Retrospective Studies; Sex Distribution; Treatment Outcome; Treatment Refusal; Trichloroacetic Acid; United Kingdom

A retrospective study in the referral centre for sexually transmitted infections (STIs) in Singapore to describe the epidemiology and treatment outcome of patients with anogenital warts.. We reviewed the case records of 301 patients with anogenital warts who were seen over a 1-year period (1999). We also attempted to interview every patient by telephone to find out if they had any clinical recurrences for which treatment was sought elsewhere.. There were 255 males and 46 females with a mean age of 34 years. Two hundred and nineteen (72.8%) presented with symptoms lasting 12 weeks or less. In males, warts occurred most frequently in the preputial cavity (52.5%) and on the penile shaft (40.8%). In females, they occurred most frequently on the external genitalia (91.3%). Two hundred and thirty-five males were treated with cryotherapy and 69% (95% CI, 62.6% to 74.8%) achieved clinical resolution after a mean of 6 treatment cycles. Seven males were treated with podophyllin 0.25% in ethanol and 71% (95% CI, 29.0% to 96.3%) were clinically cured after a mean of 4 treatment cycles. Thirty-nine females were treated with cryotherapy and 67% (95% CI, 49.8% to 80.9%) achieved clinical cure after a mean of 4 treatment cycles. Of the 290 patients treated at the centre, 212 (73%; 95% CI, 67.3% to 77.8%) patients (184 males, 28 females) achieved clinical cure after a mean of 7 weeks (range, 1 to 34 weeks); 90% (95% CI, 86.0% to 93.2%) of them by 15 weeks. Seven-two patients defaulted follow-up and 6 responded partially to treatment. Of the 212 patients who achieved clinical cure, 195 were interviewed by telephone, on an average, 17.7 months after clinical resolution. Thirty-seven (19%; 95% CI, 13.7% to 25.2%), all males, relapsed clinically after a mean of 100 days (range, 5 to 329 days); 90% (95% CI, 84.6% to 93.6%) relapsed by 228 days.. Podophyllin 0.25% in ethanol was the most cost-effective treatment for males. One in 5 patients had a recurrence of their warts and most had their recurrence within 8 months of initial resolution.

Topics: Adolescent; Adult; Aged; Aminoquinolines; Antineoplastic Agents; Condylomata Acuminata; Cost-Benefit Analysis; Cryosurgery; Female; Genital Diseases, Female; Genital Diseases, Male; Humans; Imiquimod; Keratolytic Agents; Male; Middle Aged; Outcome Assessment, Health Care; Podophyllin; Recurrence; Retrospective Studies; Singapore

External genital warts (EGWs) are visible warts that occur in the perigenital and perianal regions. They are due primarily to non-oncogenic human papillomavirus (HPV) types, usually types 6 and 11. Physical examination assisted by bright light and magnification is the recommended approach for primary diagnosis. Biopsy is indicated when EGWs are fixed to underlying structures or discolored or when standard therapies are not effective. Recurrences are common, and there is no single treatment that is superior to others. Among women with atypical squamous cells, molecular HPV testing may be useful in determining who should be referred for colposcopy. Condoms may provide some protection against HPV-related diseases and thus are recommended in new sexual relationships and when partnerships are not mutually monogamous. Because the efficacy of cesarean section in preventing vertical transmission of HPV infection from women with EGWs to their progeny has not been proved, it is not recommended.

Topics: Aminoquinolines; Antineoplastic Agents; Condylomata Acuminata; Cryotherapy; Education; Electrosurgery; Female; Floxuridine; Humans; Imiquimod; Interferons; Laser Therapy; Male; Papillomaviridae; Papillomavirus Infections; Podophyllin; Podophyllotoxin; Tumor Virus Infections

Topics: Combined Modality Therapy; Condylomata Acuminata; Cryosurgery; Humans; Keratolytic Agents; Podophyllin

Treatment of perianal condyloma acuminata is frustrating because most treatment options are fraught with high recurrence rates and patient discomfort. We propose that surgical excision followed by vaccination with an autogenous condyloma acuminata vaccine is the most effective therapy available in primary and recurrent perianal condyloma acuminata.. Eighty-three patients with perianal condyloma acuminata were treated from 1985 to 1992. Treatment was divided for patients as follows: surgical excision, 20; bichloroacetic acid, 10; podophyllin and interferon A, 5; excision followed by autogenous condyloma acuminata vaccination twice weekly using 0.1 ml subcutaneously for three weeks increasing to 1.0 ml subcutaneously for seven weeks, 43. Syphilis was diagnosed in seven patients; two were human immunovirus-positive. All but three patients were male. Of those patients treated with the vaccination protocol, 25 had primary and 18 had recurrent disease.. Recurrence rates were: excision alone and bichloroacetic acid, 50 percent; podophyllin and interferon A, 85 percent; whereas only 4.6 percent recurred when treated with excision and vaccination. Mean follow-up was 13 (range, 6-23) months. All patients treated with the vaccination protocol tolerated the full course of therapy.. We believe that excision of perianal condyloma acuminata followed by autogenous condyloma acuminata vaccination for approximately ten weeks is the most effective and definitive treatment option and, moreover, should be considered in all patients with perianal condyloma acuminata.

Topics: Adult; Anus Diseases; Combined Modality Therapy; Condylomata Acuminata; Dichloroacetic Acid; Female; Follow-Up Studies; HIV Infections; Humans; Interferon-alpha; Male; Middle Aged; Papillomaviridae; Podophyllin; Recurrence; Retrospective Studies; Syphilis; Viral Vaccines

Topical application of podophyllin is a routine procedure in patients with ano-genital warts. Podophyllin is a crude plant extract and is therefore not a well-defined product. It may contain variable amounts of the active lignan podophyllotoxin and the majority of the dry weight of podophyllin is made up of substances never identified.. The purpose of the study was to estimate in podophyllin 20% the amounts of two mutagenic substances, quercetin and kaempherol.. Using high-pressure liquid chromatography the amounts of quercetin and kaempherol were determined in 3 batches of podophyllin 20%.. Quercetin and kaempherol constitutes 2.5-3.8% and 6.0-6.4% of podophyllin dry substance, respectively. Podophyllotoxin constitutes in comparison 12.7-13.8% of podophyllin dry substance.. As approximately 10% of the amount of dry substance in podophyllin 20% is composed of two mutagenic flavonoids, quercetin and kaempherol, efforts should be focused on the production of a well-defined purified podophyllotoxin preparation that may replace podophyllin for clinic use in patients with genital warts. Self-medication with purified podophyllotoxin 0.5% may be considered as first-line treatment in well-instructed patients with external genital warts.

Topics: Chromatography, High Pressure Liquid; Condylomata Acuminata; Contraindications; Flavonoids; Mutagens; Podophyllin; Quercetin

One hundred and forty-eight cases of anogenital warts comprising 98 males and 50 females were seen at the Special Treatment Clinic, University College Hospital, Ibadan between May 1977 and 1984. The ages of the patients ranged from 11 months to 49 years. Ten cases occurred in children under 9 years. The peak incidence was in the 20-24 years age group. Local applications with podophyllin was the most frequently recommended therapy as the first line of treatment and produced a cure rate of 38.8% in those treated for three weeks. Thirty-three percent of the patients treated with podophyllin showed marked improvement before they were lost to follow up. Cryotherapy gave a cure rate of 85% but was recommended only for 20 patients. The clinical implication of these findings as well as the limitations encountered in the management of anogenital warts in a developing country are discussed.

Topics: Adolescent; Adult; Child; Child, Preschool; Condylomata Acuminata; Cryotherapy; Female; Follow-Up Studies; Humans; Incidence; Infant; Male; Middle Aged; Nigeria; Podophyllin; Population Surveillance; Treatment Outcome

Topics: Adolescent; Adult; Burns, Chemical; Condylomata Acuminata; Female; Genital Diseases, Female; Humans; Medication Errors; Podophyllin; Self Administration; Vulvitis

Topics: Condylomata Acuminata; Contraindications; Female; Humans; Papillomaviridae; Papillomavirus Infections; Podophyllin; Pregnancy; Pregnancy Complications, Infectious; Tumor Virus Infections

Topics: Combined Modality Therapy; Condylomata Acuminata; Cryosurgery; Humans; Podophyllin

The mechanisms of action for local treatments used against condylomata acuminata are unknown, but most are believed to cause physical destruction of infected tissue.. Our purpose was to determine whether liquid nitrogen, trichloroacetic acid (TCA), and podophyllin damage HPV DNA found in condylomata acuminata.. Fourteen genital warts were excised from 14 patients and divided. One part was treated with liquid nitrogen, the second and third parts were treated with TCA and podophyllin, respectively, and the remainder served as a control. DNA was then extracted from tissue by proteolytic digestion and amplified by the polymerase chain reaction. Dot blots were performed with the use of radiolabeled consensus and HPV type-specific probes.. HPV DNA was amplified and detected in 100% of untreated specimens, in 92% of specimens treated with liquid nitrogen, and in 15% and 7% of specimens treated with podophyllin and TCA, respectively.. TCA and podophyllin damage HPV DNA more effectively than does liquid nitrogen.

Topics: Biopsy; Condylomata Acuminata; Cryosurgery; DNA, Viral; Evaluation Studies as Topic; Humans; Immunoblotting; Nucleic Acid Hybridization; Papillomaviridae; Podophyllin; Polymerase Chain Reaction; Trichloroacetic Acid

Podophyllin, a plant derivative of variable composition, is used widely within New Zealand as a treatment for genital warts. One local source of podophyllin has been tested for ability to cause mutagenic effects in Salmonella typhimurium as well as for effects on chromosomes of Chinese hamster AA8 cells. Although only weakly mutagenic in one strain of Salmonella, podophyllin caused structural aberrations as well as changes in chromosome number in the Chinese hamster cells. The range of aberrations was similar to those caused by teniposide, a close structural relative of the major component, which was used as a positive control in the Chinese hamster cell experiments. A literature review revealed that podophyllin was shown to cause changes of chromosome number in the mouse cervix in vivo, although aberrations were not studied. Patients treated with podophyllin will usually possess one form of the papilloma virus, and this itself may have some oncogenic potential. We suggest that podophyllin could potentiate these effects and question its continued widespread use.

Topics: Animals; Cells, Cultured; Chromosome Aberrations; Condylomata Acuminata; Cricetinae; Cricetulus; Mutagenicity Tests; Podophyllin

Topics: Condylomata Acuminata; Humans; Podophyllin; Urogenital Neoplasms

Topics: Condylomata Acuminata; Female; Humans; Infant; Podophyllin; Recurrence

A retrospective analysis of 45 cases of condyloma acuminata seen at the gynecology clinic of the University of Nigeria Teaching Hospital between January 1976 and December 1985 was carried out. The prevalence of condyloma acuminata was found to be highest in the single, young and sexually active age group. There was no definite trend in the yearly incidence of vulval warts. Marked association with moniliasis and trichomoniasis was found. Gonorrhea was detected in two patients, but there was no confirmed case of syphilis seen. The mainstay of treatment was the application of 25% podophyllin resin in benzoin tincture either alone or in combination with cold knife excision or diathermy excision. The overall response to all methods of treatment was 64% while treatment with podophyllin alone gave a success rate of 80% and 60% in mild and moderate cases, respectively. The overall incidence of condyloma acuminata was 2.7 per 1000 women seen.

Topics: Adult; Condylomata Acuminata; Developing Countries; Female; Hospitals, Teaching; Humans; Incidence; Nigeria; Podophyllin; Pregnancy; Pregnancy Complications, Neoplastic; Prevalence; Retrospective Studies; Vulvar Neoplasms

A case of squamous cell carcinoma developing in a perianal condyloma acuminatum in a 38-year-old man treated for over 5 years with podophyllin is presented. Although there are many reports of malignant transformation of condyloma acuminatum in the skin and mucosal surfaces of the male and female genitalia, it is quite rare in the perianal region. In this case there were foci of carcinoma in-situ and of frank invasion, as well as areas of squamous cell carcinoma in the large perianal condyloma. The lesion was widely excised, and completely removed, and the site covered with a split-thickness graft from the thigh. Later, repeated dilatations of the anus were required. Repeated histologic examinations of condyloma acuminatum are needed to diagnose possible malignant transformation.

Topics: Adult; Animals; Anus Neoplasms; Carcinoma, Squamous Cell; Cell Transformation, Neoplastic; Condylomata Acuminata; Humans; Male; Podophyllin

Topics: Condylomata Acuminata; Cryosurgery; Humans; Male; Nitrous Oxide; Podophyllin; Urethral Neoplasms

A 22-year-old man developed a severe sensorimotor neuropathy following ingestion of podophyllin, which had been prescribed for genital condylomata. The initial toxic symptoms were vomiting and diarrhoea, followed by peripheral neuropathy. The neuropathy was still present 18 months later. Nerve conduction studies and sural nerve biopsy confirmed the presence of axonal degeneration.

Topics: Adult; Axons; Biopsy; Condylomata Acuminata; Humans; Male; Nerve Degeneration; Neural Conduction; Penile Neoplasms; Peripheral Nervous System Diseases; Podophyllin; Sural Nerve

Topics: Condylomata Acuminata; Female; Fluorouracil; Genital Neoplasms, Female; Genital Neoplasms, Male; Humans; Laser Therapy; Male; Podophyllin

During the period 1.1.1967 to 31.12.1986, a total of 34 children with condylomata acuminata were treated in the County Hospitals in Copenhagen. Nineteen of these were treated during the last five years of the period. A retrospective study revealed that 12 of the children were under the age of two years when the condylomata appeared. In eight of these, one or both of the parents had condylomata at the time of the child's birth suggesting that infection of the child may have occurred during delivery. Among the remaining 22 children, a possible source of infection was revealed in only one case. In the children, condylomata were much more frequently localized perianally or anally than in adults. There was no evidence of sexual abuse in any of the children but systematic investigation with this in mind was not undertaken. The finding of condylomata in children raises the suspicion of sexual abuse but does not prove this. Investigation and treatment should, as a rule, be undertaken by a multidisciplinary team preferably in a paediatric department.

Topics: Adolescent; Age Factors; Child; Child, Preschool; Cohort Studies; Condylomata Acuminata; Denmark; Female; Humans; Infant; Laser Therapy; Male; Podophyllin

Topics: Administration, Topical; Adolescent; Anesthesia, Epidural; Condylomata Acuminata; Diagnostic Errors; Female; Humans; Laser Therapy; Morphine; Podophyllin; Vaginal Neoplasms; Vulvar Neoplasms

Topics: Administration, Topical; Condylomata Acuminata; Female; Humans; Podophyllin; Pregnancy; Pregnancy Complications, Neoplastic

Topics: Condylomata Acuminata; Female; Genital Neoplasms, Female; Genital Neoplasms, Male; Humans; Immunoblotting; Male; Podophyllin

The safety and efficacy of intralesionally administered interferon alfa-2b were assessed in 11 patients suffering from condylomata acuminata for four to 10 months for whom application of podophyllum resin had proved unsuccessful. Three warts from each patient were injected with 10(6) IU interferon alfa-2b three times a week for three weeks. Treatment was followed by a 13 week observation period. Interferon alfa-2b treatment resulted in a highly significant (p less than 0.0001) reduction in the mean size of the treated warts, which decreased from an initial size of 29 mm2 to 2-3 mm2 by week 16. In six out of the 10 patients completing the trial, both the test condylomata and adjacent control warts cleared completely; a recurrence was observed in one of these six patients. Influenza like symptoms (headache and myalgia) were the most common side effects reported, though they were mild in nature and not disabling. These results corroborate those of previous trials with interferon preparations and indicate that its antiviral activity makes it a possible treatment for this sexually transmitted disorder.

Topics: Adult; Condylomata Acuminata; Drug Resistance; Female; Humans; Injections; Interferon alpha-2; Interferon Type I; Interferon-alpha; Male; Middle Aged; Podophyllin; Recombinant Proteins

Topics: Condylomata Acuminata; Humans; Male; Podophyllin; Self Administration

The increasing incidence of genital warts has led to more public awareness of this infection and its possible sequelae. Currently available treatment remains unsatisfactory, and there is pressure to develop effective and convenient alternatives. Podophyllotoxin is standardised and stable, whereas podophyllin has a variable composition. In an open comparison of self applied podophyllotoxin 0.5% versus podophyllin 20% applied by a doctor to treat external penile warts, podophyllotoxin was more effective and gave quicker resolution than podophyllin. Side effects were similar for both preparations, and few patients experienced complications severe enough to stop treatment. Podophyllotoxin can therefore be used safely and effectively for home treatment monitored at an outpatient clinic and provides a useful alternative to treatment with podophyllin at overburdened genitourinary medicine clinics.

Topics: Adult; Condylomata Acuminata; Humans; Male; Middle Aged; Penile Neoplasms; Podophyllin; Podophyllotoxin; Self Administration

Topics: Administration, Cutaneous; Adolescent; Adult; Anesthesia, General; Condylomata Acuminata; Female; Humans; Podophyllin; Pregnancy; Pregnancy Complications, Neoplastic

Topics: Condylomata Acuminata; Cryosurgery; Electrocoagulation; Female; Fluorouracil; Genital Neoplasms, Female; Genital Neoplasms, Male; Humans; Injections, Intramuscular; Injections, Subcutaneous; Interferon Type I; Laser Therapy; Male; Podophyllin; Trichloroacetic Acid

The histologic changes of podophyllin-treated condylomata acuminata were studied at 24-hour, 48-hour, and 7-day intervals. The 24-hour specimens had scattered individual atypical cells, whereas 48-hour specimens demonstrated small focal areas of atypia. Seven-day specimens exhibited very mild atypia of cells. All treated specimens had inflammation-necrosis ranging from scattered inflammatory cells to degeneration of the squamous epithelium.

Topics: Administration, Topical; Condylomata Acuminata; Female; Genital Neoplasms, Female; Genital Neoplasms, Male; Humans; Male; Podophyllin

Two methods of podophyllin application, namely hospital-application (regimen A) and self-application (regimen B) of 25% podophyllin in tincture of benzoin compound for the treatment of penile condylomata were compared. The objective was to compare the response and safety of self-application with traditional hospital-application. A total of 100 men were selected, of which 64 were valid for evaluation of response. At six weeks' follow-up 66% and 72% of patients treated with regimen A and B, respectively were cured. Patients treated with regimen A were less compliant making only 58% of the required number of applications as compared with those treated with regimen B who made 92% of the applications. Of the patients successfully treated, 43% and 20% of those treated with regimens A and B, respectively were cured after only one or two applications (p greater than 0.1). Three patients--two treated with regimen A and one treated with regimen B suffered local reactions to the first application of podophyllin. All these patients recovered without sequelae. Self-application of podophyllin can therefore be used safely and effectively in selected men with penile condyloma acuminata.

Topics: Administration, Topical; Adult; Ambulatory Care; Condylomata Acuminata; Humans; Male; Patient Compliance; Penile Neoplasms; Podophyllin; Self Administration

Topics: Condylomata Acuminata; Female; Herpes Genitalis; Humans; Laser Therapy; Male; Podophyllin; Sexually Transmitted Diseases

25 patients (2 females, 23 males, 20 to 40-year-old) suffering from condylomata acuminata (19 genital, 2 anal, and 4 genitoanal lesions) were locally treated with salicylic acid containing 5-fluorouracil (Verrumal) once a day. This therapy resulted in complete healing within 12 days on an average. 5 patients showed a relaps after 2 weeks to 5 months and were treated again. The treatment failed in a 40-year-old patient suffering from condylomata acuminata genitalis.

Topics: Administration, Topical; Adult; Condylomata Acuminata; Female; Fluorouracil; Genital Neoplasms, Female; Genital Neoplasms, Male; Humans; Male; Neoplasm Recurrence, Local; Podophyllin

We report on a comparative clinical study on 0.5% condyline solution and cream versus 20% podophyllin solution given to 75 patients suffering from condylomata acuminata. Podophyllin was applied once a week during a 6 weeks hospital care; therapy with condyline was carried out by the patients at home twice a day during 4 consecutive days. After therapy, full remission was obtained in 17 out of the 25 patients (68%) treated with condyline solution, in 17 out of the 26 patients (65%) treated with condyline cream, and in 8 out of the 24 patients (38%) treated with podophyllin. 8 biopsies taken from 6 patients did not reveal any atypical "podophyllin cells". Part of the patients showed transitional irritation, sometimes with erosions, which occurred more often after condyline treatment than after podophyllin therapy. This side effect of the cytotoxic drug, however, is to be expected.

Topics: Adolescent; Adult; Aged; Condylomata Acuminata; Dose-Response Relationship, Drug; Female; Humans; Male; Middle Aged; Neoplasm Recurrence, Local; Penile Neoplasms; Podophyllin; Podophyllotoxin; Vulvar Neoplasms

316 women with genital warts were studied to relate treatment response to concomitant genital infection at presentation. There was a highly significant difference between the response patterns of those patients who presented with warts alone, and those presenting with other infections (most commonly candidiasis and non-specific vaginitis). The diagnosis and treatment of associated infections hastens the response of warts to cytotoxic therapy, but there appears to be a subgroup amongst women presenting with warts alone, who require a considerably longer course of treatment. The relevance of these findings to the pathogenesis and management of genital warts is discussed.

Topics: Candidiasis, Vulvovaginal; Condylomata Acuminata; Female; Gonorrhea; Humans; Podophyllin; Time Factors; Trichomonas Vaginitis; Vaginitis

Topics: Adolescent; Child; Child, Preschool; Condylomata Acuminata; Electrocoagulation; Female; Fluorouracil; Freezing; Genital Neoplasms, Female; Genital Neoplasms, Male; Humans; Infant; Male; Nitrogen; Podophyllin

The medical records of 48 patients who underwent laser vaporization of therapy-resistant or recurrent condylomata acuminata were studied with regard to history of immunosuppression, location of original lesion, type and duration of therapy, and whether magnification devices were used prior to or during therapy. The genitalia of the patients' sexual partners were examined in all cases in which the condylomata recurred after initial control of the lesions with conventional methods. In 46 of the 48 cases, possible reasons for the failure of conventional therapy could be found: unresponsive to chemical therapy (11 patients); reinfection by the sexual partner (4); immunosuppression (8); several factors (6); and incomplete eradication of the lesion (20). Thirty-eight of the 48 patients (79%) were treated successfully with one-time laser ablation of the lesions. Six patients with recurrent condylomata after laser therapy underwent a second laser treatment, and four of the six patients (total, 87%) have remained free of disease. The laser appears to be an effective method of treatment for recurrent or persistent condylomata acuminata provided that (1) the patient is not immunosuppressed, (2) the potentially infected sexual partner is examined and treated, if necessary, and (3) the external genitalia, including the anus, vagina and cervix, are carefully examined colposcopically to rule out the persistence of small lesions.

Topics: Adolescent; Adult; Aged; Condylomata Acuminata; Female; Genital Neoplasms, Female; Humans; Laser Therapy; Middle Aged; Podophyllin; Recurrence

Four cases of condylomata acuminata in children (two boys, two girls) are reported. Three children had perianal warts and one vulvar warts. One of the four children had been sexually assaulted, but a history of sexual contact was absent in the other three. Surgical excision was undertaken in one case and the others responded well to the local application of 25% podophyllin in benzoin tincture compound. In the absence of sexual contact, a non-coital mode of transmission of infection could be a possibility.

Topics: Child; Condylomata Acuminata; Female; Genital Neoplasms, Female; Humans; Infant; Male; Podophyllin; Rectal Neoplasms

Topics: Condylomata Acuminata; Female; Humans; Male; Molluscum Contagiosum; Phenols; Podophyllin; Pregnancy

Topics: Condylomata Acuminata; Female; Humans; Male; Penile Neoplasms; Podophyllin; Self Administration

Topics: Adult; Anus Neoplasms; Condylomata Acuminata; Cryosurgery; Female; Genital Neoplasms, Female; Genital Neoplasms, Male; Humans; Male; Podophyllin

This article deals with surgical as well as with conservative treatment of condylomata acuminata, e.g. 10% podophyllin in liquid paraffin. Both methods are equally successful and may be combined in special cases.

Topics: Combined Modality Therapy; Condylomata Acuminata; Humans; Neoplasm Recurrence, Local; Podophyllin; Skin Neoplasms

The effects of resin of podophyllin on lesions of condyloma acuminatum have posed problems to pathologists who sought to differentiate them histologically from squamous cell carcinoma in situ. The most striking histologic changes in lesions of condyloma acuminatum following application of resin of podophyllin occur within the first 48 hours. They are pallor of the epidermis secondary to both intracellular and intercellular edema, numerous necrotic keratinocytes in the lower half of the epidermis, and a marked increase in the number of mitotic figures there. Within the edematous papillary dermis, there is a scattered infiltrate of lymphocytes, histiocytes, and neutrophils. The absence of nuclear atypia, multinucleated keratinocytes, and dyskeratotic cells, and the presence of the orderly sequence of maturation of keratinocytes within the epidermis permit histologic differentiation of podophyllin-treated condyloma acuminatum from true squamous-cell carcinoma in situ. The acute histologic changes induced by podophyllin begin to wane by 72 hours after the resin has been applied. At this time, necrotic keratinocytes are found mostly within the upper portion of the epidermis and few mitotic figures are seen. By 1 week after application of podophyllin there are virtually no histologic abnormalities within the epidermis.

Topics: Adult; Carcinoma in Situ; Carcinoma, Squamous Cell; Condylomata Acuminata; Diagnosis, Differential; Humans; Podophyllin; Resins, Plant; Skin Neoplasms

Topics: Anus Neoplasms; Child; Condylomata Acuminata; Electrocoagulation; Genital Neoplasms, Male; Humans; Infant; Laryngeal Neoplasms; Male; Podophyllin; Vocal Cords

Eighty-four cases of condyloma acuminatum were presented, with conventional treatment, e.g., surgical excision and fulguration with or without Podophyllin application. Recurrence rate was 28 per cent to 65 per cent, depending on the number and duration of treatments. Immunotherapy was used on 17 patients with recurrent and giant condyloma acuminatum. Condylomata were successfully eradicated in 94.1 per cent of patients, which indicates that immunotherapy is a very effective alternative in the treatment of recurrent and giant condyloma acuminatum.

Topics: Adolescent; Adult; Anus Neoplasms; Child; Child, Preschool; Condylomata Acuminata; Electric Stimulation Therapy; Female; Humans; Immunotherapy; Infant; Male; Middle Aged; Neoplasm Recurrence, Local; Podophyllin

Topics: Condylomata Acuminata; Humans; Neoplasm Recurrence, Local; Podophyllin; Skin Neoplasms

A young woman presented with podophyllin intoxication following topical application of podophyllin resin to genital condylomata acuminata. The disorder was marked by hallucinatory psychosis, bone marrow depression, and mild hepatic dysfunction. The psychosis and systemic disturbances resolved within 3 weeks, but were followed by autonomic and sensorimotor peripheral neuropathy. This case illustrates the transient central neurotoxicity and persistent peripheral neurotoxicity of podophyllin.

Topics: Adult; Autonomic Nervous System Diseases; Condylomata Acuminata; Delusions; Female; Genital Neoplasms, Female; Hallucinations; Humans; Nervous System Diseases; Neural Conduction; Podophyllin; Psychoses, Substance-Induced

Topics: Administration, Topical; Adolescent; Adult; Condylomata Acuminata; Drug Eruptions; Female; Humans; Male; Plants, Medicinal; Plants, Toxic; Podophyllin; Podophyllum; Pregnancy

Topics: Adult; Condylomata Acuminata; Humans; Male; Mouth Neoplasms; Podophyllin

A case demonstrating suspected teratogenic effects of topical podophylium is presented. Podophyllum resin was applied five times for a duration of 4 hr from the 23rd to the 29th week of pregnancy. At birth a simian crease on the left hand and a preauricular skin tag were noted. It is suggested that podophyllum be avoided during pregnancy. Alternative treatment for warts of the vaginal, perineal, or anal area are presented.

Topics: Abnormalities, Drug-Induced; Administration, Topical; Adult; Chloroquine; Condylomata Acuminata; Female; Humans; Podophyllin; Pregnancy; Pregnancy Complications, Infectious; Teratogens

Topics: Adolescent; Adult; Condylomata Acuminata; Female; Humans; Middle Aged; Podophyllin; United Kingdom

Topics: Adult; Bone Marrow Diseases; Condylomata Acuminata; Female; Humans; Perineum; Peripheral Nervous System Diseases; Podophyllin

Topics: Condylomata Acuminata; Humans; Podophyllin; Skin Neoplasms

A case is reported of apparent podophyllum toxicity. The patient was a 17-year-old female Indian who had received some 3 to 8 cc of a 20 percent mixture of podophyllum resin in compound tincture of benzoin (approximately equal to 0.4 gm of podophylotoxin) as an application to her vulvar condylomata. She returned to the hospital 20 hours after application in a comatose state. On examination she demonstrated severe toxicity including bone marrow, liver, and central nervous system. She required a charcoal hemoperfusion at the University of Colorado, and six months after the event has several neurologic and physiologic sequelae. Podophyllum is a potentially severely toxic drug. Great care must be taken when treating patients with this drug. A large mass of condylomata or the status of pregnancy should be relative contraindications to the use of podophyllum.

Topics: Adolescent; Condylomata Acuminata; Female; Hemoperfusion; Humans; Malabsorption Syndromes; Podophyllin; Pregnancy; Vulvar Neoplasms

Topics: Condylomata Acuminata; Cryosurgery; Female; Genital Neoplasms, Female; Humans; Immunotherapy; Podophyllin; Pregnancy; Trichloroacetic Acid

Topics: Adult; Child; Condylomata Acuminata; Female; Genital Neoplasms, Female; Humans; Male; Ointments; Penile Neoplasms; Podophyllin

A delineation of the medical problems associated with anal sexual eroticism has been presented. Our method of approach to both the patient and the various disease states has been described. Treatment of the most commonly encountered condition, condyloma acuminata, has been detailed. Precautionary measures to be taken and possible diagnostic pitfalls have been mentioned.

Topics: Anal Canal; Anus Diseases; Anus Neoplasms; Condylomata Acuminata; Enterobacteriaceae; Female; Foreign Bodies; Gonorrhea; Humans; Male; Podophyllin; Rectal Diseases; Sexual Behavior; Syndrome; Syphilis; Ulcer; Urinary Fistula; Warts

The toxicity of topically applied podophyllin in a 16-year-old girl is presented. Coma requiring respiratory support and major neurologic complications as well as hematologic and hepatic toxicity was observed. Therapy with a new modality, charcoal hemoperfusion, resulted in resolution of the acute toxicity, leaving a peripheral neuropathy which had not completely resolved after 4 months. The pharmacology and suggested treatment measures for the toxicity of this rarely reported agent are reviewed.

Topics: Administration, Topical; Adolescent; Charcoal; Chemical Phenomena; Chemistry; Condylomata Acuminata; Female; Hemoperfusion; Humans; Podophyllin; Podophyllotoxin; Skin; Vulvar Neoplasms

Topics: Adolescent; Condylomata Acuminata; Female; Humans; Leukopenia; Podophyllin; Thrombocytopenia

Topics: Abscess; Bartholin's Glands; Condylomata Acuminata; Cryosurgery; Cysts; Electrosurgery; Female; Fluorouracil; Humans; Immunotherapy; Laser Therapy; Podophyllin; Testosterone; Vulva; Vulvar Diseases; Vulvar Neoplasms

A case of Buschke-Löwenstein's tumour presenting with urinary fistula is described. The large lesion in the subpreputial sac occluded the preputial opening and infiltrated beneath the skin of the shaft of the penis resulting in a fungating growth encasing the fistulous tract. The lesion responded well to 25% podophyllin, which is reportedly unusual.

Topics: Adult; Condylomata Acuminata; Humans; Male; Penile Neoplasms; Podophyllin; Syndrome; Urinary Fistula

Topics: Anus Neoplasms; Child, Preschool; Condylomata Acuminata; Humans; Male; Podophyllin

5-Fluorouracil (5-FU) cream was compared with podophyllin 25 percent in alcohol for treating genital and urethral condylomata acuminata. The cure rate after four weeks was found to be 6 of 18 patients treated with 5-FU and 10 of 19 treated with podophyllin. By changing the treatment for those not cured, warts regressed after four weeks in four more patients in each group. Patients were followed up for four to nine months; 10 of 27 treated with 5-FU and 14 of 31 treated with podophyllin remained in remission. It is not possible to support earlier reports on the successful treatment of meatal warts using 5-FU cream. More than half of the patients given 5-FU reported side effects after 10 to 14 days' treatment, which in some cases led them to stop using the cream. Twenty-one men considered to be treatment failures or relapses were examined by urethroscopy. No intraurethral condylomata were found but three cases of warts in the fossa navicularis were doscovered; this prompted us to introduce an instrument to examine the urethral meatus and the fossa navicularis.

Topics: Condylomata Acuminata; Fluorouracil; Humans; Male; Penile Neoplasms; Podophyllin; Urethral Neoplasms

Topics: Amphotericin B; Chlamydia Infections; Chloramphenicol; Condylomata Acuminata; Female; gamma-Globulins; Genital Diseases, Female; Genital Diseases, Male; Herpes Zoster; Humans; Immunoglobulins; Lymphogranuloma Venereum; Male; Molluscum Contagiosum; Mumps; Mycoplasma Infections; Orchitis; Podophyllin; Tetracycline; Vaccination; Vaccinia; Virus Diseases

Topics: Condylomata Acuminata; Electrocoagulation; Humans; Immunotherapy; Male; Penile Neoplasms; Podophyllin; Salicylates; Thiotepa

Topics: Adult; Carcinoma, Squamous Cell; Condylomata Acuminata; Female; Humans; Neoplasm Metastasis; Podophyllin; Precancerous Conditions; Vulvar Diseases; Vulvar Neoplasms

Topics: Anus Neoplasms; Condylomata Acuminata; Formaldehyde; Genitalia; Humans; Immunotherapy; Nitrogen; Podophyllin; Salicylates; Skin Diseases, Infectious; Warts

Topics: Condylomata Acuminata; Female; Genital Diseases, Female; Herpes Simplex; Humans; Male; Penile Diseases; Podophyllin; Sexually Transmitted Diseases; Uterine Cervical Neoplasms; Warts

Topics: Carcinogens; Colchicine; Condylomata Acuminata; Female; Gonorrhea; Humans; Male; Penis; Phimosis; Podophyllin; Triethylenephosphoramide; Vulva

Topics: Administration, Topical; Adolescent; Adult; Condylomata Acuminata; DNA Viruses; Female; Humans; Male; Middle Aged; Podophyllin

Topics: Adult; Circumcision, Male; Condylomata Acuminata; Humans; Male; Podophyllin

Topics: Administration, Topical; Bleomycin; Chloroquine; Condylomata Acuminata; Electrocoagulation; Female; Humans; Interferon Inducers; Male; Podophyllin; Resorcinols; Silver Nitrate; Suspensions; Thiotepa

Topics: Aerospace Medicine; Anti-Bacterial Agents; Benzalkonium Compounds; Chancroid; Condylomata Acuminata; Doxycycline; Drug Resistance, Microbial; Drug Therapy, Combination; Gonorrhea; Granuloma Inguinale; Herpesviridae Infections; Hospitals, Special; Humans; Lymphogranuloma Venereum; Male; Molluscum Contagiosum; Podophyllin; Probenecid; Sexually Transmitted Diseases; Sulfisoxazole; Syphilis; United States; Urethritis; Vietnam

Topics: Adult; Condylomata Acuminata; Diabetes Mellitus, Type 1; Electrocoagulation; Humans; Male; Oxytetracycline; Penile Diseases; Podophyllin

Topics: Administration, Topical; Condylomata Acuminata; Female; Fluorouracil; Humans; Male; Podophyllin

Topics: Bibliographies as Topic; Condylomata Acuminata; Female; Humans; Male; Necrosis; Podophyllin; Recurrence

Topics: Adult; Anus Neoplasms; Carcinoma, Squamous Cell; Carcinoma, Transitional Cell; Cautery; Condylomata Acuminata; Female; Humans; Male; Middle Aged; Podophyllin; Precancerous Conditions

Topics: Administration, Topical; Adult; Condylomata Acuminata; Female; Humans; Perineum; Podophyllin; Vaginal Neoplasms; Vulvar Neoplasms

Topics: Adult; Condylomata Acuminata; Disorders of Sex Development; Gonorrhea; Humans; Male; Podophyllin; Spectinomycin; Transsexualism

Topics: Child; Child, Preschool; Condylomata Acuminata; Female; Humans; Male; Podophyllin

Topics: Adult; Anus Neoplasms; Chronic Disease; Condylomata Acuminata; Electrosurgery; Follow-Up Studies; Homosexuality; Humans; Male; Podophyllin; Recurrence

Topics: Antineoplastic Agents; Condylomata Acuminata; Drug Combinations; Female; Humans; Microscopy, Electron; Plant Extracts; Podophyllin; Solutions; Styrax; Vaginal Neoplasms; Vulvar Neoplasms

Topics: Administration, Topical; Condylomata Acuminata; Female; Humans; Plant Extracts; Podophyllin; Styrax

Topics: Condylomata Acuminata; Electrocoagulation; Female; Humans; Male; Microscopy, Electron; Papillomaviridae; Podophyllin

Topics: Adult; Carcinoma, Squamous Cell; Condylomata Acuminata; Diagnosis, Differential; Humans; Lymph Node Excision; Male; Penile Diseases; Penile Neoplasms; Podophyllin; Precancerous Conditions

Topics: Aluminum; Burns, Chemical; Circumcision, Male; Colchicine; Condylomata Acuminata; Female; Humans; Male; Mucous Membrane; Papilloma; Penile Diseases; Plants, Medicinal; Podophyllin; Syndrome; Urethral Diseases

Topics: Acetates; Antineoplastic Agents; Condylomata Acuminata; Cryosurgery; Cytodiagnosis; Female; Humans; Immunotherapy; Microscopy, Electron; Podophyllin; Vagina; Viral Vaccines; Vulva

Topics: Condylomata Acuminata; Humans; Male; Podophyllin; Propylene Glycols

Topics: Biopsy; Condylomata Acuminata; Female; Humans; Infant; Methods; Podophyllin; Pregnancy; Pregnancy Complications

Topics: Adult; Alcohols; Behcet Syndrome; Candidiasis, Vulvovaginal; Colposcopy; Condylomata Acuminata; Cryosurgery; Female; Fluorouracil; Genital Diseases, Female; Herpes Labialis; Humans; Lichen Planus; Menstruation Disturbances; Neurodermatitis; Nystatin; Podophyllin; Progestins; Testosterone; Triamcinolone Acetonide; Trichomonas Vaginitis; Vaginal Smears; Vulvovaginitis

Topics: Adult; Condylomata Acuminata; Female; Genital Diseases, Female; Humans; Podophyllin; Precancerous Conditions; Vulva; Vulvar Neoplasms

Topics: Carcinoma, Squamous Cell; Condylomata Acuminata; Humans; Male; Middle Aged; Podophyllin; Rectal Neoplasms

Topics: Condylomata Acuminata; Humans; Papilloma; Phytotherapy; Plants, Medicinal; Plants, Toxic; Podophyllin; Podophyllum; Virus Diseases

Topics: Condylomata Acuminata; Female; Humans; Hygiene; Male; Papilloma; Podophyllin; Virus Diseases

Topics: Adult; Arthritis, Infectious; Condylomata Acuminata; Cystoscopy; Female; Humans; Kidney; Nephrectomy; Papilloma; Podophyllin; Ureteral Neoplasms; Urinary Bladder; Urinary Bladder Neoplasms; Urography; Virus Diseases; Vulvar Neoplasms

Topics: Adult; Condylomata Acuminata; Female; Humans; Male; Papilloma; Phytotherapy; Plants, Medicinal; Plants, Toxic; Podophyllin; Podophyllum; Virus Diseases

Topics: Condylomata Acuminata; Female; Humans; Papilloma; Plants, Medicinal; Plants, Toxic; Podophyllin; Podophyllum; Pregnancy; Pregnancy Complications; Virus Diseases; Vulva

Topics: Adult; Alcoholic Beverages; Anal Canal; Condylomata Acuminata; Drug Synergism; Ethanol; Female; Humans; Male; Papilloma; Penis; Plants, Medicinal; Plants, Toxic; Podophyllin; Podophyllum; Virus Diseases

Topics: Condylomata Acuminata; Disease; Female; Humans; Podophyllin; Podophyllum; Pregnancy; Pregnancy Complications; Vulva; Vulvar Diseases

Topics: Condylomata Acuminata; Female; Humans; Papilloma; Podophyllin; Pregnancy; Pregnancy Complications; Vulvar Neoplasms

Topics: Animals; Condylomata Acuminata; Disease; Humans; Military Personnel; Podophyllin; Podophyllum; Thoracica; Warts

Topics: Anal Canal; Anus Diseases; Condylomata Acuminata; Disease; Genitalia; Humans; Podophyllin; Warts

Topics: Condylomata Acuminata; Humans; Podophyllin; Poisoning; Warts

Topics: Animals; Condylomata Acuminata; Humans; Male; Penile Diseases; Penis; Podophyllin; Thoracica; Warts

Topics: Condylomata Acuminata; Humans; Podophyllin; Warts

Topics: Condylomata Acuminata; Humans; Podophyllin

Topics: Condylomata Acuminata; Humans; Podophyllin

Topics: Condylomata Acuminata; Disease; Female; Humans; Podophyllin; Vulva; Vulvar Diseases; Vulvar Neoplasms

Topics: Condylomata Acuminata; Humans; Podophyllin; Podophyllum

Topics: Colchicine; Condylomata Acuminata; Humans; Podophyllin; Warts

Topics: Condylomata Acuminata; Humans; Podophyllin; Podophyllum; Resins, Plant; Warts

Topics: Condylomata Acuminata; Humans; Podophyllin; Warts

Topics: Benzoin; Condylomata Acuminata; Humans; Podophyllin

Topics: Benzoin; Condylomata Acuminata; Humans; Plant Extracts; Podophyllin; Styrax

Topics: Condylomata Acuminata; Humans; Podophyllin; Skin Diseases

Topics: Balanitis; Condylomata Acuminata; Humans; Male; Penile Diseases; Penis; Podophyllin

Topics: Condylomata Acuminata; Humans; Podophyllin

Topics: Condylomata Acuminata; Humans; Podophyllin; Podophyllum; Resins, Plant

Topics: Condylomata Acuminata; Humans; Podophyllin

Topics: Colchicine; Condylomata Acuminata; Humans; Podophyllin

Topics: Condylomata Acuminata; Humans; Male; Penile Diseases; Penis; Podophyllin

Topics: Condylomata Acuminata; Humans; Podophyllin