Health related quality of life in patients with anogenital warts.

INTRODUCTION: The health-related quality-of-life (HRQoL) instruments are an important tool for the evaluation of medical outcomes. Sexually transmitted diseases (STDs) influence the patients' life. We aimed to evaluate the HRQoL in patients with anogenital warts at the time of and 1 month after the diagnosis. MATERIALS AND METHODS: We used the short-form (SF)-36 questionnaire to compare the HRQoL of 91 patients with anogenital warts to 53 control subjects with the same socioeconomic characteristics. RESULTS: There was no statistical difference in the overall HRQoL measurement between the anogenital wart patients and controls. However, there was an improvement in the scales of vitality (65.22 ± 15.70 vs. 69.04 ± 14.11, respectively; p < 0.05) and mental health (65.00 ± 20.09 vs. 69.43 ± 18.08, respectively; p < 0.05) in anogenital warts patients between the time of diagnosis and 1 month later. Furthermore, there was a significant deterioration in the scale of social functioning (73.47 ± 22.18 vs. 72.89 ± 19.28, respectively; p < 0.05). The small sample size is a limitation of our study. CONCLUSIONS: HRQoL does not appear to be influenced in anogenital wart patients, as measured by the generic instrument SF-36. It is therefore important to develop specific instruments for the measurement of HRQoL in this group of patients.

Prevalence of different HPV types and estimation of prognostic risk factors based on the linear array HPV genotyping test.

The aim of the study was to evaluate the prevalence and risk factors of HPV in a gynecologic population attending outpatient clinics using two new molecular tests. The Amplicor HPV test and the Linear Array (LA) HPV Genotyping test were used for the detection of HPV DNA in 320 women. Multiple logistic regression was used to identify independent prognostic factors of HPV positivity. The agreement between the two methods in terms of their qualitative results was 89.3% (kappa: 0.63). Based on the LA results, the overall prevalence of HPV DNA was 49.1%, 95% confidence interval (95% CI: 43.5%, 54.7%). The prevalence of high-risk HPV types was 30.3%. The predominant types were HPV-6 (24.8%) and HPV-16 (20.4%). Among women with normal cytology, the prevalence of HPV was much higher in those presenting other findings, such as inflammation, than those without other abnormal findings (49.5% vs. 31.5%). On the basis of multivariate analysis, the risk of HPV infection was higher among women with multiple sexual partners [>3 vs. 1: OR = 3.1, 95% CI: (1.5, 7.2)], Pap smear findings [low/high-grade lesions vs. negative: OR = 2.8, 95% CI: (1.2, 6.5)], the presence of warts [yes vs. no: OR = 3.0, 95% CI: (1.5, 6.3)] and no history of child birth [no vs. yes: OR = 2.6, 95% CI: (1.0, 6.7)]. Younger age was an additional risk factor for HPV infection with carcinogenic genotypes [OR for 1 year increase = 0.93, 95% CI: (0.89, 0.98)].

Comparison of cryotherapy to imiquimod 5% in the treatment of anogenital warts.

The aim of this study was to compare the efficacy of crotherapy versus imiquimod 5% in the treatment of anogenital warts. Eighty HIV-negative males were included in the analysis; 35 of them were treated with imiquimod 5% three times a week for 6-10 hours and 45 of them with cryotherapy once in three weeks. Follow-up appointments were arranged every month for the first three months and then at six and 12 months, or in between whenever the patients noticed any signs of recurrence. Treatment for both groups was continued for a total of 12 weeks or until the warts cleared. At the end of three months, irrespective of the type of treatment, 78.8% of the patients demonstrated 100% improvement. Cryotherapy was more effective, as 86.7% of patients showed 100% improvement compared with 68.6% of patients in the imiquimod group. On the contrary, 17.1% of the imiquimod group did not show any signs of improvement, compared with 2.2% of the cryotherapy group (P = 0.017). However, patients treated with imiquimod tended to improve earlier than patients on cryotherapy (P = 0.012). No statistically significant difference was observed regarding the recurrence rate between the two groups (P = 0.138). Treatment with imiquimod was less painful than cryotherapy (P = 0.034). Cryotherapy was more effective than imiquimod 5% for the treatment of anogenital warts in males but was more inconvenient.

Human papillomavirus assay in genital warts--correlation with symptoms.

Our purpose was to investigate the human papillomavirus (HPV) type distribution using the Hybrid Capture 2 (HC2) Microplate assay in males. We tested a urethral swab from 550 HIV-negative males with genital warts and 64 HIV-negative males clinically free of genital warts, partners of HPV-infected females, using the HC2 Microplate assay. A perianal swab was also obtained from patients with perianal warts. In the first group, HPV DNA of any type was detected in 280 (50.9%) patients. Relatively few patients with urethral or perianal warts demonstrated a negative test (both P < 0.0001). Low-risk types were commoner, accounting for 60.0% of the HPV cases, high/intermediate-risk types accounted for 23.6%, while 46 men (16.4%) were infected with both types. Of 13 subjects (20.3%) of the second group who tested positive for HPV DNA, 61.5% were infected by low-risk types, 23.1% by high/intermediate-risk types and 15.4% had a dual infection. In conclusion, male partners of infected females and males with genital warts are predominantly infected by low-risk HPV types, but a substantial proportion is also or only affected by high-risk types.

Determinants of genital wart case detection rates among STD clinic attendees in Athens, Greece.

BACKGROUND AND OBJECTIVE: To report significant sociodemographic and behavioral outpatient characteristics associated with the diagnosis of genital warts. METHODS: Cross-sectional hospital-based study (1990-96). RESULTS: Genital warts (n = 2988, 51.2%) represent the leading sexually transmitted disease (STD) among 5831 consecutive symptomatic Greek and foreign immigrant STD outpatients. In Greek heterosexuals a low rate of partner change was the main patient characteristic at diagnosis (median: one partner in the past 6 months). Lower detection rate and riskier behavior characterized immigrants. Although associated with risky behavior, homo/bisexual orientation in males and injecting drug use were not significantly associated with condyloma diagnosis in the context of STDs. CONCLUSION: Broader health education and secondary prevention are needed to control this infection, whereas low-risk behavior in Greek heterosexuals with condylomata facilitates further preventive interventions.

Incidence determinants of gonorrhea, chlamydial genital infection, syphilis and chancroid in attendees at a sexually transmitted disease clinic in Athens, Greece.

OBJECTIVE: To determine the specific impact on the incidence rate of some demographic and behavioral characteristics in outpatients with four bacterial sexually transmitted diseases (STDs). STUDY DESIGN: A cross-sectional hospital outpatient-based study was conducted from 1990 to 1996 on 1064 consecutive symptomatic STD cases (Chlamydia trachomatis, n = 375; gonorrhea, n = 369; early symptomatic syphilis, n = 288, and chancroid, n = 32) using a standardized questionnaire. RESULTS: In a reference STD population of 5831 symptomatic outpatients, the relative incidence of gonorrhea, syphilis and chancroid was found to be increased among immigrants. Low educational/socioeconomic level was also a significant incidence predictor. Older age characterized homo/bisexuals. The chlamydial infection detection rate was not affected by nationality, injecting drug use history or sexual orientation in males. CONCLUSION: Innovative preventive and control strategies are needed among immigrants, older men having sex with men and injecting drug users, apart from those targeting the general population.

Epidemiologic determinants of herpes genitalis case detection rates among STD clinic attendees.

BACKGROUND AND OBJECTIVE: to report significant sociodemographic and behavioural outpatient characteristics in Greeks and foreign immigrants associated with the diagnosis of symptomatic herpes genitalis. METHODS: A cross sectional hospital-based study (1990-96). RESULTS: In the context of an STD reference population (n = 5,831), herpes genitalis (n = 831) represents the second leading sexually transmitted disease (14.2%), more often affecting Greek outpatients. Immigrant women were found five times more infected than Greek. In Greek heterosexuals low partner change rate was the main characteristic at the moment of health seeking behaviour (median: 1 partner in the past six months). Homo/bisexual orientation in males resulted in lower detection rate. Injecting drug use history was not associated with an increased relative incidence. CONCLUSIONS: low risk behaviour in heterosexuals constitutes a background for further preventive interventions to reduce complications.