Experiencia en cirugía de condilomas anales en mayores de 15 años / Experience in anal condyloma surgery in patients older than 15 years

Resumen Objetivo: Describir la experiencia en cirugía electiva de condilomas anales en pacientes mayores de 15 años en un hospital terciario de la Región Metropolitana. Material y Método: Estudio observacional retrospectivo y descriptivo, en el cual se analizan las intervenciones quirúrgicas electivas realizadas entre 2008 a 2021. Resultados: Dentro del período analizado se obtuvo 165 cirugías de condilomas anales, lo que corresponde a 137 pacientes en total. El 85% de los pacientes son de sexo masculino, el 68% de los pacientes son VIH positivo, un 87% de los pacientes MSM (hombres que tienen sexo con otros hombres) son VIH positivo, el 34% de los pacientes tiene antecedente de ETS, el 46% de los pacientes recibió terapia tópica como tratamiento preoperatorio o posoperatorio. Un 25% de los pacientes presenta recidiva en su historia personal, un 21% de los pacientes presenta lesiones anales intraepiteliales de alto grado, un 6% presenta carcinoma escamoso infiltrante. No hubo mortalidad descrita. Discusión: El presente estudio, describe la experiencia en cirugía de condilomas de un hospital terciario de la Región Metropolitana de Chile, cuya población corresponde a un estrato socioeconómico medio y bajo. Se logra describir a la población que es intervenida de condilomas acuminados, además de sus resultados quirúrgicos precoces y a largo plazo. Conclusión: El presente estudio, presenta una población de 137 pacientes operados de condilomas anales, a partir de los hallazgos de la cirugía. Se cumple el objetivo del estudio de caracterizar en un período de 12 años los resultados quirúrgicos de dicha serie, algo no reportado previamente en la literatura chilena.

Objective: To describe the experience in elective surgery for anal condylomas in patients over 15 years of age in a tertiary hospital in the Metropolitan Region. Materials and Method: Retrospective and descriptive observational study about elective surgical interventions performed between 2008 to 2021. Results: Within the analyzed period, 165 anal warts surgeries were obtained, corresponding to 137 patients. 85% of the patients are male, 68% are HIV positive, 87% of the MSM patients are HIV positive, 34% of the patients have a history of STDs, 46% of the patients received topical therapy as preoperative or postoperative treatment. 25% present recurrence in their personal history, 21% present high-grade anal intraepithelial lesions, 6% present infiltrating squamous carcinoma. There was no reported mortality. Discussion: The present study describes the experience in condyloma surgery in a tertiary hospital in the Metropolitan Region of Chile, whose population corresponds to a medium and low socioeconomic stratum. It is possible to describe the population that undergoes surgery for this reason, in addition to its early and long-term surgical results. Conclusion: The present study presents a population of 137 patients operated on for anal condylomas, based on the findings of the surgery. The objective of the study to characterize the surgical results of this series over a 12-year period is fulfilled, something not previously reported in the Chilean literature.

Syphilis among HIV serodiscordant partners associated with Human Papillomavirus Infection in a bisexual man / Sífilis entre parceiros sorodiscordantes para HIV associada à infecção por papilomavírus humano em um homem bissexual

Introduction: Syphilis and HIV infections are sexually transmitted infections whose diagnosis and treatment contribute toward preventing congenital transmission. Objective: To report a case of three sexually transmitted infections detected in a male partner during Couple Consultation and syphilis in the female partner during prenatal care. Case report: A 34-year-old black female G2P1 pregnant woman was referred to an outpatient clinic of sexually transmitted infections in Vitória, Brazil, reporting a 30-day evolution of painless papular lesions in the external genitalia, suggestive of condylomata lata. Nontreponemal tests were positive for syphilis and negative for HIV. The husband reported unprotected receptive anal intercourse and possessed anal condylomatous lesions and perianal condylomata lata. He was positive for both HIV and syphilis. Histopathological findings showed low-grade HPV lesions and the PCR test found 16, 39, and 53 HPV subtypes. Treatment with benzathine penicillin G was successful for both partners. Conclusion: This study emphasizes the need for Couple Consultation during pregnancy to identify and treat possible sexually transmitted infections.

Introdução: As infecções por sífilis e HIV são infecções sexualmente transmissíveis cujo diagnóstico e tratamento contribuem para a prevenção da transmissão congênita. Objetivo: Relatar um caso de três infecções sexualmente transmissíveis detectadas em um parceiro masculino durante a consulta do casal e sífilis na parceira durante o pré-natal. Relato de caso: Uma gestante, negra, G2P1, 34 anos, foi encaminhada a um ambulatório de infecções sexualmente transmissíveis em Vitória, Brasil, relatando uma evolução de 30 dias de lesões papulares indolores na genitália externa, sugestivas de condiloma lata. Os testes não treponêmicos foram positivos para sífilis e negativos para HIV. O marido relatou relação sexual anal receptiva desprotegida e possuía lesões condilomatosas anais e condiloma lata perianal. Ele testou positivo tanto para HIV quanto para sífilis. Os achados histopatológicos mostraram lesão de HPV de baixo grau e o teste de PCR encontrou subtipos de HPV 16, 39 e 53. O tratamento com penicilina benzatina G foi bem­sucedido em ambos os parceiros. Conclusão: Este estudo enfatiza a necessidade de consultas de casal durante a gravidez para identificar e tratar possíveis infecções sexualmente transmissíveis.

Prevalencia y manejo de condilomas en población consultante en Chile: estudio "DIACON" / Prevalence and management of condylomas in consulting population in Chile: "DIACON study"

Resumen Introducción: Los condilomas o verrugas genitales (VG) son la infección de transmisión sexual (ITS) más diagnosticada en los centros de ITS en Chile, pero no existen estadísticas poblacionales. Objetivos: Describir la prevalencia de VG en pacientes de 18-60 años que acuden a consulta ambulatoria de dermatología, ginecología y urología; características demográficas de los pacientes y prácticas de diagnóstico y tratamiento. Material y Métodos: A una muestra de especialistas chilenos estratificados por región, población y sexo de pacientes se les proporcionó un diario de registro y aplicó un cuestionario. Resultados: Prevalencia VG grupo total: 2,4%; en grupo etario 18-34 años: 3,7%; en grupo etario 35-60 años: 1,29% (p = 0,0000). La edad media de los pacientes con VG fue 29,4 años en mujeres y 32,7 años en hombres (p = 0,019); la distribución por edad fue diferente según sexo y sistema de salud. La inspección visual fue el método diagnóstico más frecuente y la crema de imiquimod el tratamiento más común. Hubo diferencias en el uso de herramientas diagnósticas y terapéuticas según sexo del paciente, especialidad del médico y sistema de salud. Conclusiones: Existe una alta prevalencia de VG, que debería ser tomada en cuenta para planificar las intervenciones de salud pública para abordar este problema.

Introduction: Condylomas or genital warts (GW) are the most frequently diagnosed sexually transmitted infection (STI) in STI centers in Chile, but there are no population statistics available. Objectives: To describe the prevalence of GW in patients from 18-60 years of age who attend outpatient dermatology, gynecology and urology practice; the demographic characteristics of the patients and the diagnostic and treatment tools. Methods: A sample of Chilean specialists stratified by region, population and gender of patients was provided with a logbook and answered a questionnaire. Results: The GW prevalence was 2.44% for the whole group; 3.76% for the 18-34 age group and 1.29% for the 35-60 years group (p = 0.0000). The average age of patients with GW was 29.4 years in women and 32.7 years in men (p = 0.019). The distribution by age was different according to gender and health system. Visual inspection was the most frequent diagnostic method used and imiquimod cream the most common treatment, however, there were differences in the use of diagnostic and therapeutic tools according to the patient's gender, specialty of the doctor and health system. Conclusions: The high prevalence of GW confirmed the need and importance of public health interventions to address this problem.

Vulvar vitiligo-like depigmentation and multiple halos of hypomelanosis at the trunk following treatment with imiquimod 5% cream for vulvar condylomata: casual or related events?

A 25-year-old Caucasian female with multiple genital warts involving the vulvar area was treated with imiquimod 5% cream. During follow-up the patient developed areas of hypopigmentation at the site of application of imiquimod cream and areas of hypomelanosis around multiple preexisting nevi of the trunk. At 18 months follow-up genital depigmentation persisted and halo nevi of the trunk were still present. Different mechanisms of imiquimod-induced depigmentation have been reported. Halo nevi are considered expression of an autoimmune response. In the case presented here, it might be conceivable that both vitiligo-like depigmentation at the site of application and halo of hypomelanosis around melanocytic nevi have been induced by the same immunologic mechanism elicited by topical application of imiquimod.

Giant Condyloma Acuminatum of the Anorectum : Surgical or Topical Treatment.

Giant condyloma (Buschke-Loewenstein tumour) is a rare disease that commonly affects the urogenital area. We encountered an eighteen year old, nonhomosexual, HIV negative, male, who presented with a cauliflower like warty mass around perianal region. The mass was 8×6 cm in size, circumferential, soft and papillary in nature. Wide excision of mass was carried out with anoplasty reconstruction. Post-operatively, wound healing was uneventful. After wound healing, the topical applications of five percent imiquimod were done regularly under the care of dermatologist for three months. At six months of follow-up, patient is free from tumour, and is having neither signs of anal stenosis nor incontinence.

Aplicación Intralesional del Interferón alfa 2bHr cubano (Heberon Alfa R®) en el tratamiento de las verrugas genitales / Intralesion application of the Cuban 2bHr Alfa-Interferon (Heberon Alfa R®) in the treatment of genital warts

Introducción: la condilomatosis genital es la expresión clínica más frecuente de del virus del papiloma humano. De las alternativas de tratamiento existentes, no hay una de elección y absolutamente eficaz. Objetivo: describir la seguridad y el efecto del Interferón alfa recombinante, en el tratamiento de las verrugas genitales. meses mediante la curva de Kaplan-Meier. ..

Introduction: the genital condyloma is the more frequent clinical expression or the human papilloma virus. From the available alternative of treatment there is not one of election and totally effective. Objective: to describe the safety and the effect of recombinant alfa-Interferon in treatment of genital warts. Methods: a quasi-experimental study was conducted in 216 women and in 111 men. The above mentioned Interferon was applied in the basement of warts at a dose of 10 millions of international units weekly during 8-16 weeks...

Efficacy of topical imiquimod in HIV-positive patients with recurrent anal condylomata acuminata

INTRODUCTION: Imiquimod is a topical chemotherapic and immunostimulant agent with antitumoral and antiviral activities, used for anal condylomata acuminata treatment, mainly in recurrences. OBJECTIVE: Evaluate the imiquimod efficiency in chronic and recurrent anal condylomata acuminata in HIV-infected persons. METHOD: A prospective study that analyzed 61 patients with recurrent anal condylomata treated with topic 5% imiquimod, for at least 8 weeks. These patients had already been submitted to other topical and surgical treatments for anal warts. We evaluated the efficiency of this agent, through wart remission, with clinical examination and high-resolution anoscopy, CD4+ T lymphocyte count and side effects. The patients were 55 males and 6 females, from 22 to 63 years old. RESULTS: Remission was seen in 90%, being 46% complete remission and 44% partial remission. Other 10% did not respond to the treatment with imiquimod within the 16th week. Recurrences were observed in 11% of patients in 24-week follow-up. Statistics showed no differences in CD4+ T cell scores when groups with and without complete remission were compared. Adverse effects were reported by 45% of patients. They were mild to moderate burning (25%), intense burning (7%), ulcerative dermatitis (8%) and systemic symptoms (5%). CONCLUSION: Imiquimod was effective in controlling recurrent anal condylomata acuminata in HIV-positive patients, regardless of CD4+ T cell count. (AU)

INTRODUÇÃO: O imiquimode é agente tópico quimioterápico e imunoestimulante, com atividades antitumoral e antiviral, usado para tratamento dos condilomas acuminados perianais, principalmente os recidivantes. OBJETIVO: Avaliar a eficácia do imiquimode nos condilomas acuminados perianais crônicos e multirrecidivantes dos doentes soropositivos para o vírus da imunodeficiência adquirida (HIV). CASUÍSTICA E MÉTODO: Estudo clínico prospectivo por 12 meses em que observamos o uso tópico de imiquimode creme 5%, por no mínimo 8 semanas, em 61 portadores de condilomas acuminados perianais recidivantes e de difícil controle, e que já haviam sido submetidos a vários outros tratamentos clínicos e operatórios. Avaliamos a eficácia do produto quanto sua remissão (através de exame clínico e colposcópico), nível dos linfócitos T CD4+ e efeitos adversos. Foram 55 homens e 6 mulheres com idade entre 22 e 63 anos. RESULTADOS: Obtivemos 90% de remissão, sendo 46% de resposta completa, 44% de resposta parcial e 10% sem qualquer resposta em até 16 semanas de tratamento com imiquimode. A taxa de recidiva atingiu 11% em 24 semanas de seguimento. Quanto ao nível de linfócitos T CD4+, não observamos diferença estatística entre o grupo que atingiu remissão completa e o grupo que manteve lesões. Efeitos adversos foram relatados por 45% dos doentes, sendo ardor leve a moderado (25%), ardor intenso (7%), dermatite ulcerativa (8%) e efeitos sistêmicos (5%). CONCLUSÃO: O imiquimode foi efetivo no controle dos condilomas acuminados perianais recidivantes dos doentes HIV-positivo, independente da contagem sérica dos linfócitos T CD4+. (AU)

Tratamento do papiloma vírus humano na infância com creme de imiquimode a 5 por cento / Treatment of human papillomavirus in childhood with imiquimod 5 percent cream

Lesões decorrentes da infecção pelo papilomavírus humano na infância, em especial as verrugas anogenitais, são um importante problema epidemiológico e terapêutico. O tratamento das verrugas anogenitais na infância é um desafio terapêutico. Os tratamentos convencionais geralmente são dolorosos e necessitam de anestesia geral. O imiquimode, um imunomodulador tópico, constitui uma alternativa terapêutica. Serão descritos quatro casos tratados com sucesso utilizando creme de imiquimode a 5 por cento aplicado topicamente.

In children, lesions caused by the human papillomavirus (HPV) constitute a significant epidemiological issue and a therapeutic dilemma, particularly in the case of anogenital warts. The treatment of anogenital warts in children is a challenge, since standard treatments are generally painful and require the patient to be anesthetized. Imiquimod, a topical immune response modifier, constitutes an alternative therapeutic agent for the treatment of HPV. The present report describes four cases in which treatment with topically applied imiquimod 5 percent cream was implemented with successful results.

Silver nitrate may be far superior to podophyllin in clearing HPV external anogenital warts / El nitrato de plata puede ser muy superior a la podofilina para la eliminación de verrugas anogenitales externas causadas por HPV

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 = 0.0(5)2), 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.

Datos longitudinales de una serie de casos indicaron que las tasas de eliminación (95% CI) de verrugas anogenitales (VAG) mediante nitrato de plata (n = 14) y podofilina (n = 34) fueron 93% (79.35, 100); y 14.7% (3, 27) respectivamente; y RR, 6.31 (95% CI 2.77, 14.37, p = 0.0(5)2), aumento relativo de beneficios, 532% (410, 654), y NNT, 1 (1, 2). El esfuerzo total necesitó $28 USD (BB$56) vs $598 USD en 1-3 vs 1-37 visitas para lograr un paciente tratado con éxito respectivamente. Aunque sujeto a los errores de una serie de casos abierta no aleatorizada, el nitrato de plato fue altamente eficaz y costo-efectivo y debe reemplazar la podofilina en Winston Scot Polyclinic.

Uso del Interferón Alfa en enfermedades virales por vía tópica / The usage of topic Alfa interferon in viral diseases

El Interferón es un conjunto de proteínas que se producen principalmente frente a un estímulo viral, también favorece y promueve otros mecanismos inmunológicos por lo cual es considerado una Citoquina, siendo el uso más frecuente, el terapéutico, en aquellas enfermedades donde se sospeche un origen principalmente viral. Desde su descubrimiento en el año 1957, el uso terapéutico es en afecciones las cuales se sospeche un origen viral y el cáncer, siendo más limitado su empleo como estimulador del Sistema Inmunológico. En el presente trabajo hemos tomado un grupo de estudio constituido por 362 pacientes al cual se le aplicó el Interferòn por vía tópica comparado con un Grupo control formado por 343 pacientes tratados con la terapéutica convencional durante 10 años de tratamiento. A ambos grupos se les habían diagnosticado diversas afecciones Virales de Piel y Mucosas y fueron tratados por un espacio de 10 años, tomándose una muestra inicial antes del tratamiento y posterior al mismo con intervalos de 1, 3, 6,12 meses y a los dos años de iniciado el tratamiento, comparándose algunos parámetros de la respuesta inmunológica, detectándose posteriormente en el grupo de estudio un aumento de la Inmunidad Humoral Sistémica, una remisión de los síntomas de más de 6 años y pocas reacciones colaterales.

The Interferon is a group of proteins, produced mainly against a viral stimulus; it also favors and promotes other immunologic mechanisms and that is why it is considered a cytokine, being its most frequent use, therapeutic, mainly in diseases of suspected viral origin. Since it was discovered in 1957, it has been therapeutically used in affections of suspected viral origins and cancer, being more limitedly used as a stimulator of the Immunological System. In our work we had a study group composed by 362 patients, who received Interferon by topical way, compared to a control group of 343 patients treated with conventional therapy during 10 years. Both groups were diagnosed with various viral affections of the skin and the mucous membrane. They were treated during 10 years, taking a sample before the treatment began and at the end of the 1 st , 3 rd , 6 th , 12 th months and the 2 nd year after the beginning of the treatment. Some parameters of the immunologic answer were compared, detecting in the study group an increase of the Systemic Humoral Immunity, a remission of the more-than-6-years symptoms and few side effects.

Virus de papiloma humano: Revisión e indicaciones terapéuticas / Human papillomavirus: Review of the different therapeutic modalities

La infección por virus de papiloma humano constituye una de las más frecuentes enfermedades de transmisión sexual. Dentro de los más de 100 tipos de virus descriptos hasta el momento, varios de los mismos son capaces de inducir transformación maligna de las células huésped. El presente trabajo consiste en una revisión de las diferentes modalidades terapéuticas utilizando una estrategia de medicina basada en evidencia.

The infection by human papillomavirus is one of the most frequent sexually transmitted diseases. Among more than 100 types of HPV described, several are capable of inducing malignant transformation in host cells. This work intend to review the different therapeutic modalities using an evidence based medicine strategy.

Enfermedades de transmisión sexual en la infancia / Sexual transmission diseases in childhood

Las enfermedades de transmisión sexual tienen algunas características propias cuando afectan a la infancia, que las diferencian de las mismas patologías en los adultos. Altas tasas de ETS en los adultos se traducen en aumento de tasas de sífilis congénita y oftalmía neonatal. Sin embargo, en los países en desarrollo existe mayor permisividad en las conductas de abuso sexual contra menores, razón por la cual la transmisión sexual es importante en los adolescentes. Se calcula en centenares de miles el número de niñas y adolescentes dedicadas a la prostitución en el mundo. También es posible que estas enfermedades se transmitan como resultado del hacinamiento en que niños y adultos infectados comparten las mismas camas, ropas, toallas, etc. Entre las ETS relevantes en la infancia deben destacarse la sífilis, gonorrea, herpes simple y las infecciones por papiloma virus. Al igual que en los adultos, para hacer un manejo racional de estas patologías puede recurrirse al manejo sindrómico, en que se agrupan los síntomas y signos de estas enfermedades y se hace un tratamiento cuidando de abarcar el mayor número de patologías que se manifiestan por esos signos

Hepatitis B, virus herpes simple y condilomas acuminados asociados a embarazo / Hepatitis B, herpes simplex virus and acuminated condilomas associated to pregnancy

Existen enfermedades de transmisión sexual producidas por virus, que cuando se manifiestan durante el embarazo se pueden asociar a significativa morbilidad y mortalidad fetal y/o neonatal. Se presenta el caso de una embarazada que manifestó infección por virus de hepatitis B, virus papiloma humano y virus herpes tipo 2. Se realiza una revisión de la literatura