Abordagens terapêuticas do Condiloma Acuminado em crianças e adolescentes / Therapeutic approaches to Condyloma Acuminatum in children and adolescents

Objetivos: A infecção pelo papiloma vírus humano dos tipos 6 e 11 pode evoluir para Condiloma Acuminado. Sua transmissão é principalmente via sexual, de forma que a presença dessas verrugas em crianças deve ser consi-derada sinal de alarme para investigação de abuso. Eventualmente, contudo, ocorre por autoinoculação ou fômites. O tratamento é desafiador, dado que apesar do extenso arsenal, a recorrência se faz comum. A presente revisão siste-mática advém a comparar taxas de sucesso das estratégias terapêuticas, objetivando fornecer substrato para escolhaacertada no tratamento da doença em crianças e adolescentes. Métodos: Foi realizada Revisão Sistemática baseada no GuidelinePreferred Report Items for Systematic Reviews and Meta-Analyses (PRISMA), registrada na Plataforma PROSPERO sob identificação CRD42021262090. Resultados: 211 estudos foram encontrados nasdatabases con-sultadas, de forma que 30 atenderam as propostas de critérios estabelecidos na pesquisa sistematizada. Esses pas-saram extração de dados para síntese qualitativa, demonstrando eficácia de métodos não-invasivos a invasivos.Conclusões: Mediante bons resultados em resolução da doença e reduzidos efeitos adversos, a terapia mais popular entre os autores foi o Imiquimode. A pesquisa chamou atenção à necessidade de estudos mais robustos e metodo-logias mais complexas acerca das abordagens terapêuticas do Condiloma Acuminado em crianças e adolescentes. (AU)

Objectives: Infection with human papillomavirus types 6 and 11 can progress to Condyloma acuminata. Its transmission is mainly sexual, so these warts in children should be considered an alarm signal for abuse investigation. Eventually, however, it occurs by autoinoculation or fomites. Treatment is challenging, given that despite the extensive arsenal, recurrence is common. The present systematic review compares the success rates of therapeutic strategies, aiming to provide a substrate for the right choice in the treatment of the disease in children and adolescents. Methods: Asystematic review was performed based on the guideline for Preferred Report Items for Systematic Reviews and Meta-Analyses (PRISMA), registered on the PROSPERO Platform under identification CRD42021262090. Results: 211 studies were found in thedatabasesconsulted, and 30 met the proposed criteria established in the systematic research. These passed data extraction for qualitative synthesis, demonstrating the effectiveness of non-invasive to invasive methods. Conclusions: Due to good results in disease resolution and reduced adverse effects, the most popular therapy among the authors was Imiquimod. The research called attention to the need for more robust studies and more complex methodologies about the therapeutic approaches of Condyloma Acuminatum in children and adolescents. (AU)

Apoptotic and autophagic death union by Thuja occidentalis homeopathic drug in cervical cancer cells with thujone as the bioactive principle / 中西医结合学报

OBJECTIVE@#"Multi-targeting" drugs can prove fruitful to combat drug-resistance of multifactorial disease-cervical cancer. This study envisioned to reveal if Thuja homeopathic mother tincture (MT) and its bioactive component could combat human papillomavirus (HPV)-16-infected SiHa cervical cancer cells since it is globally acclaimed for HPV-mediated warts.@*METHODS@#Thuja MT was studied for its antiproliferative and antimigratory properties in SiHa cells followed by microscopic determination of reactive oxygen species (ROS) generation by 2',7'-dichlorodihydrofluorescein diacetate (DCFDA) staining and loss in mitochondrial membrane potential (MtMP) by rhodamine 123 (Rh123) staining. Apoptosis and autophagy inductions were studied by acridine orange/ethidium bromide (AO/EB) staining and immunoblot analyses of marker proteins. The bioactive component of Thuja MT detected by gas chromatography-mass spectrometry was studied for antiproliferative and antimigratory properties along with in silico prediction of its cellular targets by molecular docking and oral drug forming competency.@*RESULTS@#Thuja MT showed significant antiproliferative and antimigratory potential in SiHa cells at a 50% inhibitory concentration (IC50) of 17.3 µL/mL. An increase in DCFDA fluorescence and loss in Rh123 fluorescence prove that Thuja MT acted through the burst of ROS and loss in MtMP respectively. AO/EB-stained cells under the microscope and immunoblot analyses supported Thuja-induced cellular demise via dual pathways-apoptosis and autophagy. Immunoblots showed cleavage of caspase-3 and poly(adenosine diphosphate-ribose) polymerase-1 (PARP-1) along with upregulation of Beclin-1, microtubule-associated protein 1 light chain 3B (LC3B)-II, and p62 proteins. Hence, the apoptotic cascade followed a caspase-3-dependent pathway supported by PARP-1 cleavage, while autophagic death was Beclin-1-dependent and mediated by accumulation of LC3BII and p62 proteins. Thujone, detected as the bioactive principle of Thuja MT, showed greater anti-proliferative and anti-migratory potential at an IC50 of 77 µg/mL, along with excellent oral drug competency with the ability for gastrointestinal absorption and blood-brain-barrier permeation with nil toxicity. Molecular docking depicted thujone with the strongest affinity for mammalian target of rapamycin, phosphoinositide 3-kinase, and protein kinase B followed by B-cell lymphoma 2, murine double minute 2 and adenosine monophosphate-activated protein kinase, which might act as upstream triggers of apoptotic-autophagic crosstalk.@*CONCLUSION@#Robust "multi-targeting" anticancer potential of Thuja drug and thujone for HPV-infected cervical cancer ascertained its therapeutic efficacy for HPV infections.

Caracterización de pacientes con papiloma laríngeo / Characteristics of patients with lagyngeal papillomatosis

La papilomatosis laríngea es la neoplasia laríngea benigna más común y está causada por el virus de papiloma humano. Se considera que la papilomatosis laríngea tiene un papel independiente como factor de riesgo de cáncer; se clasifica dentro de tres grupos de acuerdo con sus características clínicas: juvenil, adulto y recurrente. Su incidencia asociada a neoplasia maligna es del 4%. Objetivos: Determinar si existen factores de riesgo asociados al tipo de papilomatosis laríngea; y si existe relación con el tipo de papilomatosis y neoplasias asociadas. Metodología: Estudio observacional descriptivo de pacientes que acuden al servicio de Otorrinolaringología del Hospital General San juan de Dios y su caracterización. Resultados: De los 33 pacientes evaluados con papilomatosis laríngea, 51 % fueron del género masculino, la edad promedio sin incluir pacientes pediátricos fue de 23 años. La mediana de reintervenciones es de 4 veces, y la mayoría tiene pérdida del seguimiento. La papilomatosis tipo infantil es la más común con pacientes de 7 a 14 años de edad. Los pacientes con papilomatosis adulta presentaron más factores de riesgo que los pacientes con papilomatosis infantil y recurrente, p=0.01. Los pacientes presentan ronquera, disfonía y dificultad respiratoria. El diagnóstico se realiza por clínica con laringoscopía sin biopsia en la mitad de los pacientes. El 9% de los pacientes estudiados presentaron neoplasia asociada. El número de reintervenciones está asociado a un mayor riesgo de progresión a neoplasia. Conclusión: Los pacientes con papilomatosis adulta presentaron más factores de riesgo que los pacientes con papilomatosis infantil, y el 9% de los pacientes presentan una neoplasia asociada, más alta de la reportada en la literatura.(AU)

Laryngeal papillomatosis is the most common benign neoplasm and is caused by the human papilloma virus. Laryngeal papillomatosis is considered to have an independent role as risk factor. Laryngeal papillomas are classified into three groups, according to their clinical characteristics: juvenile, adult and recurrent. 4% is associated with neoplasia. Objectives: Determine if there are risk factors associated with the type of laryngeal papillomatosis and if there is a relationship with the type of papillomatosis and associated neoplasms. Methodology: Descriptive observational study of patients attending the Otolaryngology service of the General Hospital San Juan de Dios de Guatemala and their characterization. Results: Of the 33 patients evaluated with laryngeal papillomatosis, 51% were male, with an average age of 23 years. The median number of reoperations is 4, and most do not return to follow-up. Infantile type papillomatosis is the most common, with patients 7 to 14 years of age. Patients with adult papillomatosis had more risk factors than patients with infantile and recurrent papillomatosis, p= 0.01. Patients present hoarseness, dysphonia and respiratory distress upon admission. Diagnosis is made clinically with laryngoscopy without biopsy in half of the patients. 9% of the patients studied had associated neoplasia. The number of reoperations is associated with an increased risk of developing a neoplasm. Conclusion: Patients with adult papillomatosis presented more risk factors than patients with infantile papillomatosis. And 9% of the patients present associated neoplasia, higher than reported in the literature

Papilomavírus humano: aspectos clínicos / Human papillomavirus: clinical aspects

A infecção pelo papilomavírus humano (HPV) é reconhecida como uma das principais causas de câncer relacionado à infecção em homens e mulheres. Embora a maioria das infecções pelo HPV seja assintomática e se resolva espontaneamente, a infecção persistente por tipos de HPV de alto risco pode levar a lesões precursoras e ao câncer. Em todo o mundo, a infecção pelo HPV causa até 4,5% (640.000 casos) de todos os casos novos de câncer mundial (8,6% mulheres; 0,9% homens), representando 29,5% de todos os cânceres relacionados com infecção. Os tipos de HPV de alto risco não são apenas responsáveis por praticamente todos os casos de câncer do colo do útero, mas também por uma fração dos cânceres de vulva, vagina, pênis, ânus e câncer de cabeça e pescoço. Além disso, o HPV também é a causa de verrugas anogenitais e papilomatose respiratória recorrente. Apesar da disponibilidade de múltiplas estratégias preventivas, o câncer relacionado ao HPV continua sendo uma das principais causas de morbimortalidade em muitas partes do mundo, principalmente nos países menos desenvolvidos.(AU)

ABSTRACTHuman papillomavirus (HPV) infection is recognized as one of the major causes of infection-related cancer in both men and women. Although most human papillomavirus (HPV) infections are asymptomatic and resolve spontaneously, persistent infection with high-risk HPV, may lead to precancerous lesions and cancer. Worldwide, HPV infection causes up to 4.5% (640,000 cases) of all new cancer cases worldwide (8.6% females; 0.9% males), representing 29.5% of all infection-related cancers. High-risk HPV types are not only responsible for virtually all cervical cancer cases but also for a fraction of cancers of the vulva, vagina, penis, anus, and head and neck cancers. Furthermore, HPV is also the cause of anogenital warts and recurrent respiratory papillomatosis. Despite the availability of multiple preventative strategies, HPV-related cancer remains a leading cause of morbimortality in many parts of the world, particularly in less developed countries.(AU)

Pegylated interferon for treating severe recurrent respiratory papillomatosis in a child: case report

ABSTRACT CONTEXT: Recurrent respiratory papillomatosis (RRP) is the most common laryngeal tumor. During childhood, it may present in extremely severe forms defined by the need for frequent surgical procedures to relieve respiratory distress and/or involvement of extralaryngeal sites such as lung involvement. Adjuvant therapies are indicated in these cases and interferon is one of the options. Pegylated interferon is more effective than conventional alpha interferon and, given its reported results in relation to treating hepatitis C over the past decade, we hypothesized that this might be more effective than conventional interferon also for treating respiratory papillomatosis. Use of a treatment strategy that eliminates the need for general anesthesia is particularly appealing, yet obtaining approval for use of medications that are not currently used for this purpose is challenging. CASE REPORT: We report the case of a child with severe RRP that had been followed for the preceding six years, who was treated with pegylated interferon after failure of other adjuvant therapies. There was noticeable improvement in the frequency of surgical procedures, which was regarded very receptively, considering the child's history and previous response to other therapies. CONCLUSION: Pegylated interferon may be a good option for diminishing the need for surgical intervention in severe cases of recurrent respiratory papillomatosis.

Oxidative stress: therapeutic approaches for cervical cancer treatment

OBJECTIVES: Oxidative stress results from an imbalance between the generation and elimination of oxidant species. This condition may result in DNA, RNA and protein damage, leading to the accumulation of genetic alterations that can favor malignant transformation. Persistent infection with high-risk human papillomavirus types is associated with inflammatory responses and reactive oxygen species production. In this context, oxidative stress, chronic inflammation and high-risk human papillomavirus can act in a synergistic manner. To counteract the harmful effects of oxidant species, protective molecules, known as antioxidant defenses, are produced by cells to maintain redox homeostasis. In recent years, the use of natural antioxidants as therapeutic strategies for cancer treatment has attracted the attention of the scientific community. This review discusses specific molecules and mechanisms that can act against or together with oxidative stress, presenting alternatives for cervical cancer prevention and treatment.

Infección genital masculina por virus de papiloma humano / Male genital infection by human papiloma virus

El virus del papiloma humano (VPH) es una de las enfermedades de transmisión sexual más comunes. Puede afectar tanto el aparato genital masculino y femenino, como también el área perianal, ano, y diversas áreas de cabeza y cuello y otorrinolaringológicas, ya sea como lesiones benignas o como promotor de lesiones malignas. Las lesiones benignas por VPH en genitales masculinos se caracterizan fundamentalmente por la aparición de lesiones verrugosas, aunque también puede manifestarse mediante lesiones planas atípicas. En algunos casos hay ausencia de lesiones macroscópicamente visibles que pueden hacerse evidentes con la prueba de ácido acético. La biopsia de la lesión, su evaluación anatomopatológica y, sobre todo, la determinación de la existencia y el tipo de virus involucrado mediante PCR (reacción en cadena de la polimerasa) permiten confirmar el diagnóstico. En algunas ocasiones es necesario realizar una cistoscopia para diagnosticar lesiones intrauretrales y vesicales. Los tratamientos propuestos son muy variados y de eficacia dispar, desde las topicaciones y la electrocirugía o la criocirugía, hasta el empleo de la tecnología láser. La prevención con el uso de protección durante el acto sexual así como la educación sexual son fundamentales. En los últimos 10 años se ha implementado el uso de la vacuna para el VPH en niñas con el fin de disminuir la incidencia de lesiones de alto grado y de cáncer de cuello uterino, pero su indicación en varones es menos clara y aún no ha sido consensuada. (AU)

Human papiloma virus (HPV) is one of the most common sexual transmitted diseases. It can affect the male genitalia, as well as the perianal and anal regions and multiple areas of the head and neck and otorhinolaryngological structures, as benign lesiones or as a promoter of malignant lesions. Benign male genitalia lesions are characterized mainly by verrucous lesions, although flat atypical lesions can be found, as well as the abscence of macroscopic visible lesions that in some cases can become evident using the acetic acid test. Lesion biopsy, its histological evaluation, and the determination of the existence and type of virus using PCR (Polymerase Chain Reaction) can confirm the diagnosis. In some cases is necessary to do a cistoscopy to diagnose intraurethral and vesical lesions. Proposed treatments are varied and with a wide range of efficacy, from topications to electro or cryosurgery, and the use of laser technology. Sexual education and the use of sexual protection are essential in prevention. In the last 10 years the use of VPH vaccine in girls was widely spread, in order to decrease the incidence of high grade lesions and cervix cancer. Its indication in male patients is less clear and not yet consented among specialists. (AU)

Tratamento cirurgico e terapias adjuvantes na papilomatose respiratoria / Surgical treatment and adjuvant therapies of recurrent respiratory papillomatosis

Papilomatose respiratória recorrente ou papilomatose laríngea recorrente é uma doença da laringe, causada pelo papiloma vírus humano, caracterizada por lesões epiteliais verrucosas e, geralmente, recorrentes. Na literatura são descritos diversos tipos de tratamento, como cirurgia a frio, a laser e/ou uso de microdebridador, além das terapias adjuvantes; todas no sentindo de diminuir possíveis sequelas permanentes da doença. OBJETIVO: Realizar uma revisão de literatura a respeito desta doença com ênfase nas técnicas cirúrgicas e terapias adjuvantes mais utilizadas atualmente. MÉTODO: Utilizou-se a metodologia de revisão bibliográfica, por meio de levantamentos em base de dados eletrônicos de domínio público, entre 1992-2012, utilizando-se as palavras-chave: papiloma, infecções por papillomavírus, laringe, terapêutica, vacinas contra papillomavírus. RESULTADOS: Foram levantados 357 artigos, dos quais 49 foram usados como base para esta revisão. Os trabalhos científicos apontam para a redução de recidiva na maioria das terapêuticas adjuvantes. Entretanto, o levantamento demonstrou metodologias e amostras diferentes, o que não permitiu comparar os tipos de tratamento e de terapias adjuvantes. CONCLUSÃO: A escolha da técnica cirúrgica varia entre os autores, porém, há uma tendência atual ao uso do microdebridador. As terapias adjuvantes recentes, como cidofovir, vacina tetravalente contra o papiloma vírus humano e bevacizumab, necessitam de estudos mais amplos. .

Recurrent respiratory papillomatosis or recurrent laryngeal papillomatosis is a disease of the larynx caused by human papilloma virus, characterized by verrucous epithelial lesions and usually recurring. In the literature there are several types of treatment, such as surgery to cold, laser and/or use of microdebrider, as of adjuvant therapies; all possible to decrease the permanent sequelae of the disease. OBJECTIVE: To review the literature regarding this disease with emphasis on surgical techniques and adjuvant therapies used today. METHOD: We used the literature review, through surveys based electronic data in the public domain, to search for articles between 1992-2012, using keywords: papilloma, human pappiloma virus infection, larynx, therapeutic, papilloma virus vaccine. RESULTS: We surveyed 357 articles, of which 49 were used as the basis for this review. Scientific studies indicate a reduction of relapse in most adjuvant therapeutic presented. However, the survey showed different methodologies and samples, which did not allow to compare the types of treatment and adjuvant therapies. CONCLUSION: The choice of surgical technique varies among studies, but there is a trend to use the microdebrider. The newer adjuvant therapies, such as cidofovir, quadrivalent vaccine against human papilloma virus and bevacizumab, require further studies. .

Aceptabilidad y conocimientos sobre la vacunación contra el virus del papiloma humano (VPH) en médicos ginecólogos de la Argentina

OBJETIVO: Evaluar entre los ginecólogos argentinos la aceptabilidad y prescripción de la vacuna contra el virus del papiloma humano (VPH), los conocimientos sobre sus características y uso, y las nociones médico-biológicas sobre infección por VPH y cáncer cervicouterino. MATERIAL Y MÉTODOS: Entre noviembre de 2009 y marzo de 2010 se encuestaron a 686 ginecólogos vía internet. RESULTADOS: Más de 80% de los encuestados prescribe la vacuna, conoce sus características y administración, y considera la necesidad de continuar con el tamizaje cervical en mujeres vacunadas. El 37% posee un conocimiento global de la relación entre vacuna y detección/tratamiento de la patología cervical. De los encuestados, 25% subestima la magnitud de la infección, ≈30% no reconoce el rol etiológico del VPH en la enfermedad, y ≈40% posee un conocimiento global del manejo de la infección. CONCLUSIONES: La aceptabilidad de la vacuna contra el VPH es alta. Debe reforzarse la capacitación de los profesionales sobre vacunación y patología cervical, así como las nociones médico-biológicas sobre infección por VPH y cáncer cervicouterino.

OBJECTIVE: To evaluate HPV vaccine acceptability and prescription; knowledge about HPV vaccine; and knowledge about HPV infection and cervical cancer among Argentinean gynecologists. MATERIALS AND METHODS: Between November 2009 and March 2010 we carried out an internet survey of 686 gynecologists. RESULTS: More than 80% of gynecologists prescribed HPV vaccine, knew characteristics of HPV vaccines, and knew that women will still need regular cervical cancer screening after HPV vaccination; 37% had global knowledge about relationship between vaccine, detection and treatment of cervical cancer; 25% underestimated the epidemiological extent of HPV infections, ≈30% was not aware of the causative relationship between HPV infection and cervical cancer and ≈40% had global knowledge about management of HPV infection. CONCLUSIONS: HPV vaccine acceptability is high. Physicians need to be fully informed on HPV vaccination and cervical cancer as well as HPV infection management.

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...

Importância da infecção anal pelo HPV em mulheres / Importance of Anal HPV Infection in women

O presente estudo visa realizar uma revisão da literatura em relação ao diagnóstico e tratamento das mulheres com infecção anal pelo HPV. A frequência do câncer anal, antes considerada baixa, tem apresentado elevação considerável nos últimos 30 anos, com aumento de 40% de incidência entre as mulheres. Já é conhecido que a infecção anal por subtipos específicos do HPV predispõe o indivíduo à neoplasia intraepitelial anal, que pode evoluir para o câncer anal, estabelecendo a relação causal entre o vírus e essa neoplasia, com patogenia de transformação maligna similar ao câncer do colo uterino. Nenhuma normatização em relação ao rastreamento das mesmas foi proposta até o momento, mas é estabelecido que, por se tratar de infecções geralmente assintomáticas, seriam necessários exames específicos para seu diagnóstico, como citologia oncótica, anuscopia e técnicas moleculares para a detecção de DNA. Atualmente, há procedimentos tópicos e invasivos ou ablativos para o tratamento dessas lesões. Diante da alta prevalência da infecção anal pelo HPV e do novo conceito de doença sexualmente transmissível para o câncer anal, torna-se necessário o desenvolvimento e aplicação de protocolos de rastreamento, garantindo diagnósticos e tratamentos precoces, com diminuição da morbimortalidade, aumento da sobrevida e melhora da qualidade de vida das pacientes.(AU)

The present study aims to review the literature regarding the diagnosis and treatment of women with anal HPV infection. Despite having been considered low, the frequency of anal cancer has shown an important increase in the last 30 years, with an increment incidence of 40% among women. It is known that anal infection by specific subtypes of HPV predisposes individuals to anal intraepithelial neoplasm, which may progress to anal cancer, establishing the causal relation between the virus and this cancer, with the pathogenesis of malignant transformation similar to cervical cancer. However, no standardization regarding their management has been proposed so far. Being generally asymptomatic, the majority of anal HPV infections would require specific tests such as smear cytology, anuscopy and molecular techniques for detection of DNA for diagnosis. Currently, there are local and invasive procedures or ablative treatment for such lesions. Given the high prevalence of anal HPV infection and the new concept of sexually transmitted disease for anal cancer, it is necessary to develop and implement protocols for screening, ensuring early diagnosis and treatment. Thus, with the decrease of morbidity and mortality, it will be possible to increase survival and improve quality of life of patients.(AU)

Ser mulher portadora do HPV: uma abordagem cultural / Being a woman with HPV: a cultural approach / Ser mujer portadora de VPH: enfoque cultural

Este trabalho foi realizado com o objetivo de investigar o nível de conhecimento das mulheres sobre o HPV, para, a partir daí, identificar crenças, mitos e tabus sobre a doença e analisar a influência destes elementos culturais no comportamento da mulher. Realizamos um estudo baseado nos pressupostos da teoria do cuidado transcultural. A pesquisa foi desenvolvida a partir do depoimento de quinze mulheres que realizavam tratamento para HPV. Através da investigação, foi possível perceber que, apesar das inúmeras fontes de informação sobre DST, o HPV ainda é uma doença desconhecida e cercada de mistério. Este desconhecimento, interagindo com fatores culturais, favorece o desenvolvimento de conceitos equivocados, tais como crenças e mitos.

This study was carried out in order to investigate the level of women's knowledge about HPV, to identify beliefs, myths and taboos about HPV, as well as to analyze the influence of these cultural elements on women's behavior. We performed a study based on the transcultural care theory. The research was developed from the testimonies of 15 women who were undergoing treatment for HPV. Through the investigation, it was possible to perceive that HPV is a disease that is still unknown and surrounded with mystery, despite all the sources of information about Sexually Trasmitted Diseases (STD). This ignorance, which interacts with cultural factors, favors the development of wrong concepts, such as beliefs and myths.

Este trabajo fue realizado con el objetivo de investigar el nivel de conocimientos de las mujeres sobre el VPH, para así identificar creencias, mitos y tabúes sobre la enfermedad y analizar la influencia de estos elementos culturales en el comportamiento de la mujer. Realizamos un estudio basado en los supuestos de la teoría del cuidado transcultural. La investigación fue realizada en base a los testimonios de quince mujeres en tratamiento para VPH. A través de la investigación fue posible percibir que, a pesar de las innúmeras fuentes de información sobre ETS, el VPH es aún una enfermedad desconocida y rodeada de misterios. Esta falta de conocimiento asociados a los factores culturales, favorecen el desarrollo de conceptos equivocados, tales como creencias y mitos.

Imiquimod en crema al 5% en el tratamiento de verrugas anogenitales asociadas a VPH: experiencia preliminar / Imiquimod 5% cream in the treatment of anogenital warts HPV associated

Antecedentes: La infección persistente por VPH de alto riesgo se asocia con cáncer cervicouterino, encontrándosepositividad en el 99,7% de los casos. Las verrugas anogenitales son una forma de presentación de la infección persistente. Objetivo: Investigar la eficacia y seguridad de imiquimod en crema al 5%, en el tratamiento de las verrugas anogenitales en mujeres. Método: Estudio prospectivo no randomizado, en mujeres portadoras de verrugas anogenitales asociadas a VPH. El tratamiento consiste en la autoaplicación de imiquiomod en crema al 5% tres veces a la semana por hasta un período de 16 semanas. Se define como respuesta completa al tratamiento aquella en que desaparece completamente la lesión; por respuesta parcial la disminución de al menos un 50% del volumen inicial de la lesión. Resultados: Durante un período de 8 meses fueron ingresadas y tratadas 38 pacientes La duración del tratamiento varió entre 1 y 4 meses. El número promedio de aplicaciones fue de 28,7. El 66% (25 casos) de las pacientes presentaron una respuesta completa, en tres casos no hubo respuesta, uno de ellos en una paciente inmunodeprimida, en 10 casos hubo respuestas parciales. En las pacientes con respuestas completas se necesitó un promedio de 28,7 aplicaciones hasta obtener el resultado. Conclusiones: Imiquimod es un fármaco con buena efectividad y seguridad en el tratamiento de las verrugas anogenitales asociadas a VPH, en tratamiento de tres veces por semana durante mínimo de 10 semanas.

Background: The chronic infection by high-risk HPV serotypes is strongly associated with cervical cancer, detection of HPV on tissue sample has been reported 99.7% of cases. The anal-genital warts represent the clinical manifestation of the persistent infection by this virus. Objectives: To investigate the efficacy and safety of Imiquimod cream 5% concentration, in the treatment of anal-genital warts in women. Methods: A non-randomized prospective study in women diagnosed with anal-genital warts HPV associated. The treatment consists in self-application of imiquimod cream 5%, three times a week for a period of 16 weeks or more. We define complete response to treatment in those patients where the lesion disappeared completely, and partial response to those where the lesion declined at least 50% of its initial volume. Results: Over a period of 8 months were admitted to the study and treated a total of 38 patients. Treatment duration varied between 1 and 4 months. The average number of applications was 28.7 times. 66% (25 cases) of the patients had a complete response, in three cases there was no response, one of them was an immunodepressed patients, in 10 cases there was partial response. The patients with complete response needed an average of 28.7 applications to get that result. Conclusions: Imiquimod is a drug with high effectiveness and safety in the treatment of anal-genital warts HPV associated, in a three times per week and at least 10 weeks total duration treatment.

Treatment of human papillomavirus with peg-interferon alfa-2b and ribavirin

We reported one case of human immunodeficiency virus and hepatitis C virus co-infected patient who presented a significant improvement of human papillomavirus (HPV) lesions during the treatment of chronic hepatitis using peg-interferon alfa-2b and ribavirin.

Quadrivalent human papillomavirus recombinant vaccine: the first vaccine for cervical cancers.

Gardasil is the first quadrivalent human papillomavirus (HPV)-types 6, 11, 16, 18 recombinant vaccine approved by the FDA on June 8, 2006. It induces genotype-specific virus-neutralizing antibodies and prevents infection with HPV. Various clinical trials demonstrated a reduction in the incidence of vaccine-type-specific persistent infections and of associated moderate- and high-grade cervical dysplasias and carcinomas in situ after its use. Gardasil is currently approved by FDA for prevention of genital warts, cancers and precancerous conditions of cervix and vulva in 9-26 year old females. Three doses of 0.5 ml of gardasil each at 0, 2 and 6 months are given intramuscularly. It is contraindicated in individuals who are hypersensitive to the active substances or to any of the excipients of the vaccine, patients with bleeding abnormalities or patients on anticoagulant therapy and during pregnancy. However, the vaccine, at an estimated $300-500 per course, is too expensive for many women in developing countries. Moreover, question regarding the longevity of the protection by vaccine is still unsolved. Hence, longer studies are required to establish its real status in cancer prevention.

Verrugas genitales e infección por papilomavirus humano / Genital warts and infection by human papilloma virus

Se discute el manejo y el tratamiento de la infección por papilomavirus humano. La conducta depende de la localización de las lesiones siendo diferente para las vulvovaginales y peneanas que para las cérvicouterinas. En estas últimas el examen coloscópico, la búsqueda de lesiones acetoblancas y la biopsia son indispensables. Entre los recursos terapéuticos disponibles se señalan las drogas citodestructoras (podofilino, podofilotoxina, ácido tricloroacético y 5-fluoruracilo); la cirugía y las drogas inmunomoduladoras (interferones y dinitroclorobenceno). También se han ensayado vacunas y antivirales. Se recalca la importancia de los controles periódicos de los pacientes tratados y en las mujeres del examen ginecológico, de la citología cérvicouterina y de la biopsia de las eventuales lesiones detectadas. Se comenta el tratamiento de las verrugas genitales de los niños y de las que se detectan en el curso del embarazo