Intralesional beta-interferon treatment of cervical intraepithelial neoplasia associated with human papillomavirus infection.

AIMS AND BACKGROUND: Interferons (IFN) have offered considerable advances in the therapy of genital warts even those associated with cervical intraepithelial neoplasia (CIN); intralesional therapy either alone or in combination with other modalities such as cryosurgery and laser surgery provides improved clearing and cure of these often recalcitrant lesions. The purpose of this study was to evaluate the effectiveness of intralesional IFN therapy in patients with CIN associated with human papillomavirus (HPV) infection. METHODS: Beta-IFN was injected intra-perilesionally into the cervix in 41 patients with CIN associated with HPV infection. RESULTS: The regimen of 3 million international units (IU) injected intralesionally daily in the 1st week and 3 times a week in the 2nd and 3rd weeks for a total of 11 injections and a total dosage of 33 million IU yielded an 80 percent cure rate and may be more advantageous than other treatment options in certain instances. Cytocolposcopic and histologic examination was carried out before and after treatment and 24 lesions were also analyzed for type-specific papillomaviruses using in situ DNA hybridization. CIN disappeared in 33 patients 6 months after the end of therapy. Side effects of intralesional IFN therapy are dose related and for the most part readily tolerated. CONCLUSIONS: Intralesional IFN proved to be effective treatment for CIN associated with HPV infection (cure rate: 80%) and well accepted because hospitalization is not required and no important side effects occur.

[Vulval vestibular papillomatosis: anatomo-clinical study]. / La papillomatosi vestibolare vulvare: studio anatomo-clinico.

Vestibular papillomatosis of the vulva is only by some authors considered as a viral lesion, and its origin is controversial. A study of 44 women with vestibular papillomatosis was undertaken, and in all the cases biopsies of vulvar skin were taken. We did not reveal any presence of koilocytotic change suggestive of viral infection, and no human papillomavirus sequences were detected by DNA probe technique. These results suggest that this vestibular papillomatosis of the vulva can be considered as an anatomical variant of the vestibular mucosa. Only in case of viral over-infection, ablative treatment is justified.

[Human papillomavirus infections in the lower genital tract of women]. / Le infezioni da human papillomavirus (HPV) del basso tratto genitale femminile.

Viral infections of the lower female genital tract have gained increasing clinical, epidemiological and cyto-histopathological relevance in the last few years. From January 1981 to December 1990, 14,090 patients who referred to the center of cervical-vaginal-vulvar physiopathology of the Ob/Gyn Institute (University of Florence), underwent a cytologic, colposcopic and, if necessary, histologic examination. Patients were divided in two groups: the first group consisting of 8635 women and relating to the period 1981-1986, the second group consisting of 5455 patients and relating to the period 1987-1990. This division in groups was necessary because vulvoscopy (after 3-5% acetic acid application) was performed as a routine examination starting in 1987, so that the former period could not be considered homogeneous to the latter for vulvar results. About genital condylomatosis were made some observations: localization, morphology and the different prevalence in the various age groups verifying the statistic reliability using chi 2 test. Finally the association of intraepithelial neoplasias to HPV infection was related to the age of patients, localization and morphology of condylomatous lesions. In the first group 466 patients (5.4%) were affected by genital condylomatosis, 1041 patients (19.1%) were affected in the second group. The yearly prevalence of HPV infection increased during the decade of observation changing from 1.9% of 1981 to 21% of 1990. The prevalence of condylomatous lesions reduces significantly as the age increases (p < 0.0001) showing a maximum of prevalence under twenty-five years of age. Genital condylomatosis is localized in most cases (76%) in a single seat of the lower genital tract and cervical localization is the most commonly involved (43.13% in the first group; 42.65 in the second). Sporadic is the vaginal localization as the sole one. The vulvoperineal seat, after the cervical, is the most frequently involved (1st group: 29.82%; 2nd group: 31.03%). It seems that HPV infection assumes different morphologies according to its localization, generally flat on the cervix and florid at vulvo-vaginal level.(ABSTRACT TRUNCATED AT 400 WORDS)

[Treatment of female genital condylomatosis with intramuscular beta interferon]. / Trattamento della condilomatosi genitale femminile con beta-interferone per via intramuscolare.

Intramuscular injections of beta-interferon were used to treat a first group of 64 outpatients with clinically diagnosed genital condylomata at single doses of 3 x 10(6) IU for 10 consecutive days. A second group of 30 patients affected by HPV genital infection has been treated with placebo intramuscular injections. Patients were checked at 3, 6 and 12 months after therapy and twice during a one year follow-up after the disappearance of the warts. In the first group 29 patients (45.3%) were cured after 3 months, another 6 after 6 months and 1 patient after one year. In the second group only 3 (10%) patients were cured after 3 months, while in 2 cases (6.7%) lesions disappeared after 6 months (p value less than 0.001). Therapy was most effective on flat lesions in the cervical area. Follow-up of the patients with complete regression of lesions showed three recurrences of condylomatous lesion.