Carbon dioxide (CO2)-laser therapy cures macroscopic lesions, but viral genome is not eradicated in men with therapy-resistant HPV infection.

BACKGROUND AND OBJECTIVES: We have evaluated the efficacy of CO2-laser in eradicating human papillomavirus (HPV) DNA from genitoanal skin lesions. STUDY DESIGN: Biopsies of 38 male patients with histologically confirmed HPV-infection after an average of 2 years of follow-up were analyzed. Post-treatment biopsies were obtained from all residual or recurrent HPV-suspect (acetowhite) lesions in 23 patients. RESULTS: After an average of three separate CO2-laser treatments, 15 of 38 patients were devoid of any clinical or acetowhite lesions. By in situ hybridization (ISH), the frequency of HPV-types 6/11 decreased from 52% to 26%, and HPV-types 16/18 decreased from 48% to 17%, respectively, in 23 patients biopsied twice. When ISH-negative biopsies were further analyzed with polymerase chain reaction (PCR) and southern blotting (SB) for HPV-16, HPV-types 16/18 were detected in a total of 65% of biopsies before CO2-laser therapy, and in 61% after the therapy. The cure rate achieved with CO2-laser was 39% (15/38) according to clinical, 61% (14/23) according to histopathological, and 26% (6/23) according to molecular biological criteria. The frequency of Bowenoid papulosis was reduced from 57% (13/23) to 17% (4/23). CONCLUSIONS: Although CO2-laser is ineffective in eradicating HPV genome from therapy-resistant penile warts, the treatment reduces the recurrence of atypical changes and visible warts.

Single-dose oral azithromycin versus seven-day doxycycline in the treatment of non-gonococcal urethritis in males.

One hundred and twenty male patients with signs and symptoms compatible with non-gonococcal urethritis were enrolled in a prospective-randomized study to compare the efficacy and safety of a single oral-dose of 1 g azithromycin and a seven-day course of 100 mg doxycycline twice-daily. Clinical examination and culture samples for Chlamydia trachomatis were performed before and approximately 8, 15 and 35 days after starting treatment. Both treatment groups were comprised of 30 chlamydia-positive patients evaluable for efficacy. The eradication rate of C. trachomatis in baseline-positive patients at the first follow-up visit in the azithromycin group was 96% with one persistent case, and 100% in the doxycycline group. After about two weeks, there were two re-occurrences in the azithromycin group, resulting in a cumulative eradication rate of 90% with three culture-positive cases. The corresponding figure in the doxycycline group was still 100%, but there were leucocytes present in the urethral smear of two patients who later proved to be true culture-positive re-occurrences. After about five weeks, there was an additional re-occurrence in the azithromycin group leading to a cumulative eradication rate of 87%, while two re-occurrences in the doxycycline group gave a cumulative eradication rate of 93%. There was no statistically significant difference in efficacy between the single-dose azithromycin and seven-day course of doxycycline in the treatment of patients with chlamydial urethritis.(ABSTRACT TRUNCATED AT 250 WORDS)

Imedeen for the treatment of degenerated skin in females.

Imedeen, a new compound for oral administration consisting of special protein fractions and some glucosaminoglycans extracted from marine fish, has been shown in previous pilot studies to have a repairing effect on sun-damaged skin. In an open study, 10 females with sun-damaged skin, aged 39-61 years, were treated with 0.5 g/day Imedeen for 90 days. At baseline and after 30, 60 and 90 days, the following parameters were clinically evaluated: wrinkles; mottles; dryness of skin; and brittleness of hair and nails. After 90 days' treatment all signs of sun-damage had improved and brittleness of hair and nails was normalized in all cases. These clinical observations were confirmed by changes in skin thickness and elasticity. In a second double-blind study, 30 females in the same age range and with similar signs of sun-damage were treated with 0.5 g/day Imedeen or placebo for 90 days. The results in the Imedeen-treated group corresponded to those in the first study whereas no response to treatment was observed in the placebo treatment group.

Topical idoxuridine for treatment of genital warts in males. A double-blind comparative study of 0.25% and 0.5% cream.

Fifty heterosexual male patients with histologically verified genital warts of short duration (less than 3 months) were randomly allocated to treatment with either 0.25% or 0.5% idoxuridine cream. The application of the cream to the warts was performed twice daily for an initial period of 14 days, whereafter patients with partial improvement or no response were retreated in the same way for another period of 14 days. Patients not completely healed after 28 days were regarded as treatment failures and withdrawn from the study. After the initial treatment period of 14 days, 19 of 25 patients (76%) treated with 0.5% idoxuridine cream, and 9 of 25 patients (36%) treated with 0.25% idoxuridine cream were completely healed. This difference is significant (p less than 0.01). The corresponding figures at the second follow-up examination (28 days after start of the study) were 19 of 25 (76%) and 13 of 25 (52%), respectively. At the last follow-up examination three months after start of treatment, four patients treated with 0.5% idoxuridine cream and five patients treated with 0.25% idoxuridine cream had a relapse. Thus, the overall rate of complete healing was 15 of 25 (60%) for the patients treated with 0.5% idoxuridine cream and 8 of 25 (32%) for those treated with 0.25% idoxuridine cream. The difference is significant (p less than 0.01). No adverse reactions were observed or reported by the patients.

A comparative study of topical analgesia with a lidocaine/prilocaine cream (EMLA) and infiltration anesthesia for laser surgery of genital warts in men.

Treatment of genital warts by laser surgery was performed in 100 male patients under local infiltration (2-6 ml 1% Xylocaine) or topical anesthesia with 2.5-7.5 ml EMLA cream. EMLA cream was applied to the warts ten minutes before the operation. Pain was significantly less during application of EMLA than during infiltration of Xylocaine. Infiltration anesthesia resulted in better surgical analgesia than EMLA, although the difference was small. The combined pain scores of application and surgery were significantly smaller in the EMLA group. The result suggests that EMLA applied for ten minutes constitutes a less painful treatment and is thus the anesthetic of choice for the laser surgery of genital warts.

Combination of laser-therapy with 0.5% idoxuridine cream in the treatment of therapy-resistant genital warts in male patients: an open study.

Forty heterosexual male patients with therapy resistant penile warts of long duration (mean 12.9 months) were treated with carbon dioxide laser, immediately followed by topical application of 0.5% idoxuridine cream twice daily for 14 days. In case of incomplete or no response to the initial treatment, the treatment procedure was repeated once. All patients had previously been repeatedly treated with podophyllotoxin 0.5% solution and/or carbon dioxide laser surgery. After two weeks of treatment, 32 patients (80%) were completely healed. The remaining eight patients were retreated and four weeks after the start of the study 35 patients (87.5%) showed complete response. Three months after the study had been initiated 34 patients (85%) were still completely healed. No adverse reactions were observed. It was concluded that laser surgery followed by topical application of 0.5% idoxuridine cream for two to four weeks seems to be highly effective in the treatment of longstanding, therapy-resistant genital warts in men. Because of the uncontrolled nature of the present study and the relatively small number of patients treated, it would be important to carry out controlled studies in larger study populations and to carry out a follow-up examination of at least six months after treatment.

Pivampicillin versus doxycycline in the treatment of chlamydial urethritis in men.

Pivampicillin and doxycycline were compared in the treatment of chlamydial urethritis in 80 heterosexual men. The trial was carried out in a double-blind, comparative parallel group fashion. Forty patients were treated with 700 mg of pivampicillin twice daily and another 40 with 200 mg of doxycycline on the first day and thereafter with 100 mg of doxycycline and one placebo tablet daily. Both treatments lasted for 9 days. Follow-up examinations were carried out 2 weeks (14-16 days) and 4 weeks (26-30 days) after the start of treatment. Altogether five (12.5%) of the forty pivampicillin-treated patients were clinical failures and three (7.5%) still harbored Chlamydia trachomatis after treatment. The corresponding figures for the doxycycline-treated patients were two (5.1%) and one (2.6%). The difference between the treatment results of the two groups did not reach statistical significance.

Effects of dietary supplementation with polyunsaturated ethyl ester lipids (Angiosan) in patients with psoriasis and psoriatic arthritis.

A total of 80 patients with chronic, stable psoriasis, 34 of whom also had psoriatic arthritis, were treated with 1122 mg/day eicosapentaenoic acid ethyl ester and 756 mg/day docosahexaenoic acid ethyl ester. Before the study and after 4 and 8 weeks of treatment a Psoriatic Association scoring index (PASI) score was assessed. Before treatment the mean PASI score was 3.56, after 4 weeks 1.98 and after 8 weeks 1.24; the decrease in the score was highly significant (P less than 0.001). The degree of pruritus decreased most rapidly, followed by scaling and induration of the plaques, and erythema was most persistent. At the end of the trial, seven patients were completely healed and in 13 other patients more than 75% healing was observed but in 14 patients the result was poor. The majority of patients with psoriatic arthritis reported a subjective improvement in joint pain during the study. It is concluded that polyunsaturated ethyl ester lipids may be useful for the treatment of psoriasis and psoriatic arthritis and may provide an important adjuvant to standard therapy of both conditions.

Ciprofloxacin versus amoxycillin and probenecid in the treatment of uncomplicated gonorrhoea.

In a randomized study 100 patients, 78 males and 22 females, with uncomplicated gonorrhoea were treated with either a single oral dose of 250 mg of ciprofloxacin or a single oral dose of 3 g of amoxycillin and 1 g of probenecid. Three of the gonococcal strains produced penicillinase and, in addition, nine strains had MIC-values of amoxycillin ranging between 0.6 and 1.2 mg/l and five other strains MIC-values higher than 1.2 mg/l. Twenty-two patients had a concomitant infection due to Chlamydia trachomatis. All patients treated with ciprofloxacin were cured, while two patients treated with amoxycillin had treatment failures. Neither treatment regimen had any effect on the chlamydial infections. No adverse effects were observed. It was concluded that ciprofloxacin is the drug of choice in the treatment of uncomplicated infections due to Neisseria gonorrhoeae.

Ciprofloxacin versus doxycycline in the treatment of uncomplicated urogenital Chlamydia trachomatis infections. A double-blind comparative study.

Two-hundred patients with confirmed Chlamydia trachomatis infection of the urogenital region were treated with either ciprofloxacin 1.5 g/day or doxycycline 100 mg/day for seven days. One-hundred and fifty-seven patients were males and 43 females. C. trachomatis was isolated prior to treatment from urethra alone in 155 patients, from cervix alone in 27 and from both urethra and cervix in 15. The first re-examination was carried out at the end of treatment and the second one week later. Six patients in the ciprofloxacin group and three in the doxycycline group never returned for the first re-examination. At the second re-examination there were seven defaulters in the ciprofloxacin group and 11 in the doxycycline group. Altogether there were 12 bacteriological failures in both groups. Clinical failure despite bacteriological cure occurred in 20 patients in the ciprofloxacin group and eight in the doxycycline group. The total number of treatment failures was 32 in the ciprofloxacin group and 20 in the doxycycline group. The results suggested that neither treatment was efficient enough in the treatment of uncomplicated urogenital infections caused by C. trachomatis.