Evaluation of the efficacy of homologous autoinoculation therapy in treatment of multiple recalcitrant warts

Background Warts are infections caused by human papillomavirus (HPV). There are new trends towards the use of immunotherapy in treatment of warts. Homologous autoinoculation is a minimally invasive procedure, which treats warts by stimulating a specific immune response against HPV Objective To evaluate the efficacy of autoinoculation therapy in treatment of multiple recalcitrant warts. Methods Under local anesthesia and aseptic condition, inoculum was collected by paring a wart by scalpel and by pressing it between two sterile glass slides. After making a subcutaneous Pocket in non-dominant forearm, the inoculum was introduced in the subcutaneous pocket with forceps and dressed. Follow up for 1,2,12 and 16 weeks was done. Results Fourty patients were included. At 12 weeks of therapy 42.5% showed complete clearance, 27.5% showed moderate clearance, 15% showed mild clearance and 12.5% showed treatment failure. No significant complication was documented after 1 and 2 weeks of follow up except in 3 patients in form of mild inflammation and mild pain. There was no recurrence at16 weeks follow up session. Conclusion Autoinoculation is simple and effective method in treatment of different types of warts including genital wart. It also prevents recurrence.

Vulvar vestibular papillomatosis: All genital lesions are not sexually transmitted diseases

Vulvar vestibular papillomatosis (VVP) is considered as normal anatomical variant of the vulva. A 19-year-old female presented with asymptomatic pinkish filliform papules symmetrically distributed on vulva. She denied having any sexual exposure. Clinical differential diagnosis included genital wart and vestibular papillomatosis, however biopsy was consistent with Vestibular papillomatosis. PAS stain was negative. Application of 5% acetic acid did not show any change in color. We report this case to create awareness about normal variant of vulva and unnecessary exaggerated treatment and proper counseling of patient to decrease psychological trauma and associated venereophobia.

Water pipe Smoking and Genital Wart: Call for Epidemiological Research

The article's abstract is not available.

Measurement of serum interleukin 17 level in patients with genital warts before and after intralesional tuberculin injection

Introduction and aim: Genital wart infection is a distressing sexually transmitted infection that causes marked fear and stress to both males and females. Tuberculin Purified protein derivative (PPD) injection is an upcoming safe and effective modality for the treatment of genital warts. Interleukin 17 (IL-17) was found to be lower in wart patients than controls. This study aimed at measurement of serum level of IL-17 in genital warts patients before and after PPD injection. Patients and methods: The study was carried out as case-control interventional study on 63 patients (37 males and 26 females) with genital warts attending Dermatology and Andrology Clinics, faculty of medicine, Suez Canal University hospitals. 50 controls were enrolled in the study. All patients have injected 10 tuberculin units of PPD intradermally in the mother or largest warts every 2 weeks till 6 sessions. Serum level of IL-17 was measured by Sandwich ELISA technique to all patients before and after PPD injection and to all control subjects. Results: The mean age of patients was 30.8 years, the mean duration of warts was 4.73 months, the mean number of warts was 9.76 warts and 14.3% of patients experienced side effects to PPD. (58.7%) of patients were completely recovered from warts. Mean serum IL-17 was 81.1 ± 64.2 pg/mL versus 118.9 ± 93.8 pg/mL in genital wart patients versus controls respectively (P < 0.05) and 81.1 ± 64.2 pg/mL versus 107.1 ± 66.8 pg/mL before and after PPD injection respectively (P < 0.05). Conclusion: IL-17 serum level was significantly lower in genital wart patients than normal controls. IL-17 serum level had been increased significantly after PPD intralesional injection than pretreatment levels and significantly related to clinical response to PPD. IL-17 suggested having a role in the clinical efficacy of PPD in the treatment of genital warts.

RISK OF ANAL CANCER IN INFLAMMATORY BOWEL DISEASE PATIENTS IN THE US: A POPULATION-BASED STUDY 2008–2018

Background Patients with inflammatory bowel disease (IBD) are at elevated risk of developing anal cancer. However, it remains unclear whether the increased risk manifests from immunosuppressant use or location of the disease (inflammation). We aimed to examine whether the risk of anal cancer in IBD patients is attributable to immunosuppression or the disease’s location by comparing IBD patients with rheumatoid arthritis (RA) and diverticulitis patients, respectively. Methods We conducted a retrospective cohort study using the US Optum® commercial claims database (2008–2018). We estimated the risk of anal cancer in the IBD cohort compared to the RA cohort (to examine risk attributable to immunosuppressant use) and the diverticulitis cohort (to examine risk attributable to similar disease location). Disease cohorts and index dates were identified using a combination of ICD diagnosis codes and prescription drug use. Patients 18 years and older and with a minimum of 12 months of continuous insurance enrollment were included. All three cohorts were mutually exclusive; we excluded persons with HIV/AIDS or organ transplant. We estimated hazard ratios (HRs) using Cox proportional regression, adjusting for age at diagnosis, comorbidity, risk factors for HPV infection (smoking, obesity, genital wart, substance abuse, alcoholism), and prescription drug use. Analyses were stratified by sex. Results The study included 70,314 patients with IBD, 164,991 with RA, and 129,558 with diverticulitis. In men, the adjusted hazard ratio (aHR) of developing anal cancer was 6.78 (95% CI, 3.40–13.55) comparing IBD to RA, and was 2.68 (95% CI, 0.99–7.30) comparing IBD to diverticulitis. Among women, the risk of developing anal cancer was significantly higher in IBD compared to RA (aHR 2.70; 95% CI, 1.36–5.35), but not different compared to diverticulitis (aHR 0.70; 95% CI, 0.20–2.44). The factors associated with a higher risk of anal cancer in both men and women were age at diagnosis, history of genital wart, corticosteroid use, and immunosuppressant use. Conclusion We found a significantly elevated risk of anal cancer in IBD patients than RA patients. However, anal cancer risk was not significantly different when comparing IBD patients to diverticulitis patients. These results indicate that the location of the disease is more strongly associated with anal cancer incidence than the treatment of autoimmune disease.

Giant genital wart in pregnancy: cryotherapy as a spray of hope

<p>Giant genital warts are caused by (HPV) type 6 and 11. Genital warts in pregnancy pose a treatment challenge. Here we report a case of 19 years pregnant patient treated with cryotherapy. A 19 years mid-term pregnant female presented with complaints of mild itchy increasing growth over the genitalia, in the past 20 days. Examination revealed a pinkish solitary cauliflower like growth over labia majora. The patient was treated with liquid nitrogen cryotherapy with each cycle of freeze and thawing for 15 seconds each for 12 weeks, the lesion almost regressed. Cryotherapy is a safe, easy and effective treatment modality in pregnancy.</p>