podophyllin and Genital-Diseases--Male

30% of people with anogenital warts (AGW) have spontaneous regression of lesions but there is no way to determine whether a specific lesion will remain. There are a wide range of options available for treating people with AGW and selection is based on clinician's experience, patient preferences and adverse effects. The imiquimod could offer the advantages of patient-applied therapies without incurring the limitations of provider-administered treatments.. To assess the effectiveness and safety of imiquimod for the treatment of AGW in non-immunocompromised adults.. We searched the Cochrane Sexually Transmitted Infections Group Specialized Register (15 April 2014), CENTRAL (1991 to 15 April 2014), MEDLINE (1946 to 15 April 2014), EMBASE (1947 to 15 April 2014), LILACS (1982 to 15 April 2014), World Health Organization International Clinical Trials Registry (ICTRP) (15 April 2014), ClinicalTrials.gov (15 April 2014), Web of Science (2001 to 15 April 2014) and OpenGrey (15 April 2014). We also handsearched conference proceedings, contacted trial authors and reviewed the reference lists of retrieved studies.. Randomized controlled trials (RCTs) comparing the use of imiquimod with placebo, any other patient-applied or any other provider-administered treatment (excluding interferon and 5-fluorouracil which are assessed in other Cochrane Reviews) for the treatment of AGW in non-immunocompromised adults.. Three review authors independently assessed trials for inclusion, extracted data and assessed risk of bias. We resolved any disagreements through consensus. The quality of the evidence was assessed using the GRADE approach.. Ten RCTs (1734 participants) met our inclusion criteria of which six were funded by industry. We judged the risk of bias of the included trials as high. Six trials (1294 participants) compared the use of imiquimod versus placebo. There was very low quality evidence that imiquimod was superior to placebo in achieving complete and partial regression (RR 4.03, 95% CI 2.03 to 7.99; RR 2.56, 95% CI 2.05 to 3.20, respectively). When compared with placebo, the effects of imiquimod on recurrence (RR 2.76, 95% CI 0.70 to 10.91), appearance of new warts (RR 0.76, 95% CI 0.58 to 1.00) and frequency of systemic adverse reactions (RR 0.91, 95% CI 0.63 to 1.32) were imprecise. We downgraded the quality of evidence to low or very low. There was low quality evidence that imiquimod led to more local adverse reactions (RR 1.73, 95% CI 1.18 to 2.53) and pain (RR 11.84, 95% CI 3.36 to 41.63).Two trials (105 participants) compared the use of imiquimod versus any other patient-applied treatment (podophyllotoxin and podophyllin). The estimated effects of imiquimod on complete regression (RR 1.09, 95% CI 0.80 to 1.48), partial regression (RR 0.77, 95% CI 0.40 to 1.47), recurrence (RR 0.49, 95% CI 0.21 to 1.11) or the presence of local adverse reactions (RR 1.24, 95% CI 1.00 to 1.54) were imprecise (very low quality evidence). There was low quality evidence that systemic adverse reactions were less frequent with imiquimod (RR 0.30, 95% CI 0.09 to 0.98).Finally, two trials (335 participants) compared imiquimod with any other provider-administered treatment (ablative methods and cryotherapy). There was very low quality of evidence that imiquimod did not have a lower frequency of complete regression (RR 0.84, 95% CI 0.56 to 1.28). There was very low quality evidence that imiquimod led to a lower rate of recurrence during six-month follow-up (RR 0.24, 95% CI 0.10 to 0.56) but this did not translate in to a lower recurrence from six to 12 months (RR 0.71, 95% CI 0.40 to 1.25; very low quality evidence). There was very low quality evidence that imiquimod was associated with less pain (RR 0.30, 95% CI 0.17 to 0.54) and fewer local reactions (RR 0.55, 95% CI 0.40 to 0.74).. The benefits and harms of imiquimod compared with placebo should be regarded with caution due to the risk of bias, imprecision and inconsistency for many of the outcomes we assessed in this Cochrane Review. The evidence for many of the outcomes that show imiquimod and patient-applied treatment (podophyllotoxin or podophyllin) confer similar benefits but fewer systematic reactions with the Imiquimod, is of low or very low quality. The quality of evidence for the outcomes assessing imiquimod and other provider-administered treatment were of very low quality.

Topics: Adult; Aminoquinolines; Anus Diseases; Female; Genital Diseases, Female; Genital Diseases, Male; Humans; Imiquimod; Immunocompetence; Interferon Inducers; Keratolytic Agents; Male; Podophyllin; Podophyllotoxin; Randomized Controlled Trials as Topic; Recurrence; Self Administration; 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: Adjuvants, Immunologic; Aminoquinolines; Biopsy; Condylomata Acuminata; Contraindications; Cryotherapy; Diagnosis, Differential; Female; Genital Diseases, Female; Genital Diseases, Male; Humans; Imiquimod; Keratolytic Agents; Male; Podophyllin; Pregnancy

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: 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

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

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

One hundred and sixty five heterosexual men and women with genital warts were treated with inosine pranobex (Imunovir) or conventional treatment, or both. Inosine pranobex was found to be more effective in lesions of longer duration, whereas conventional treatment was more effective in genital warts of a shorter duration. Supplementation of conventional treatment with inosine pranobex increased the success rate from 41% to 94%. Immunological studies in 134 patients with genital warts showed an increased number of B cells in 21% of peripheral blood samples. Absence of major defects among circulating lymphocytes suggested that patients with genital warts may have a local immune reaction.

Topics: Adjuvants, Immunologic; Adult; Clinical Trials as Topic; Female; Genital Diseases, Female; Genital Diseases, Male; Humans; Inosine; Inosine Pranobex; Male; Podophyllin; Prospective Studies; Random Allocation; Warts

Seventy-three patients with anogenital warts were randomly allocated to a double-blind comparison of treatment with trichloracetic acid (50%) and podophyllin (25%) versus podophyllin (25%) alone. There was no significant difference in the resolution of warts in the two treatment groups among patients followed for three months. Of patients free of warts at six weeks, treatment with trichloracetic acid/podophyllin required significantly fewer applications (mean 2.9) compared with podophyllin alone (mean 4.0). Five (17%) patients in the former group reported side effects but none in the latter group.

Topics: Anus Diseases; Clinical Trials as Topic; Double-Blind Method; Drug Therapy, Combination; Genital Diseases, Male; Humans; Male; Podophyllin; Trichloroacetic Acid; Warts

One hundred and forty male patients with ano-genital warts were randomly allocated to a double-blind study of 10% and 25% podophyllin in tincture of benzoin compound. One hundred and nine patients attended for a three-month period of surveillance. Only 24 (22%) patients were free of warts after having podophyllin treatment alone, 12 each after treatment with 10% and 25% podophyllin. There was no significant difference in the number of applications needed with each treatment. Neither hypersensitivity nor chemical ulceration occurred.

Topics: Anus Diseases; Clinical Trials as Topic; Double-Blind Method; Genital Diseases, Male; Humans; Male; Podophyllin; Random Allocation; Warts

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

Topics: Aminoquinolines; Antineoplastic Agents; Caustics; Cryotherapy; Electrosurgery; Female; Genital Diseases, Female; Genital Diseases, Male; Humans; Imiquimod; Laser Therapy; Male; Papillomaviridae; Papillomavirus Infections; Podophyllin; Tumor Virus Infections

572 patients with solitary or multiple genital warts attending the Department of Genitourinary Medicine at the Royal Victoria Hospital, Bournemouth, U.K. between January 1981 and December 1981 were allocated to either podophyllin or cryotherapy for the treatment of their warts. Of 350 patients successfully treated for their warts and returned for a follow-up examination 6 weeks or more after completing their treatment, 206 (139 men and 67 women) were treated with podophyllin, and 144 (86 men and 58 women) with cryotherapy. One hundred five (51%) of those treated with podophyllin and 114 (79%) treated with cryotherapy were free of warts at their follow-up examination. Patients treated with podophyllin required a mean of 6.7 +/- SD 3.5 treatments over a mean of 4.7 +/- SD 2.4 weeks, whereas those receiving cryotherapy required a mean of 2.6 +/- SD 2.0 applications over a mean of 2.3 +/- SD 1.2 weeks.

Topics: Cryosurgery; Female; Follow-Up Studies; Genital Diseases, Female; Genital Diseases, Male; Humans; Male; Podophyllin; Warts

Topics: Female; Fluorouracil; Genital Diseases, Female; Genital Diseases, Male; Humans; Male; Podophyllin; Warts

A total of 56 cases with warts in which podophyllin treatment was either contraindicated or a failure, were treated with nitrous oxide using a Keymed 500 cryosurgical appliance. Forty-three patients who completed treatment were followed-up for three months. Thirty-seven of these had received applications of podophyllin twice weekly for an average period of three months before cryosurgery. The remaining cases in whom podophyllin was considered to be contraindicated included five with vulval warts (two were pregnant, two were bronchial asthmatics taking oral prednisolone, and one was taking oral clomiphene citrate), and a diabetic patients with penile warts. Thirty-two were cured and 11 relapsed. The latter were re-treated at the end of the follow-up period with two freezing cycles of 45 seconds at an interval of 30 minutes. Seven were cured and the remaining four men who failed to respond belonged to the podophyllin-resistant group and included three with metal warts and one homosexual with anogenital warts. Cryosurgery gave a cumulative success rate of 91%. A single freezing cycle was free from complications but a double freezing cycle was often followed by severe local reaction.

Topics: Cryosurgery; Female; Genital Diseases, Female; Genital Diseases, Male; Humans; Male; Podophyllin; Warts

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