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Purpose: To investigate the prevalence of anogenital warts (AGW) caused by human papillomavirus in men and the characteristics and changes of the disease in Korea. Materials and Methods: From 2007 to 2018, male AGW corresponding to the International Classification of Disease-10 A63.0 were targeted. Through a big data analysis of the Health Insurance Review & Assessment Service, data of patients diagnosed with AGW as either the main or secondary diagnosis were extracted. The overall prevalence and prevalence by age were calculated through the population by year and the population by 5-year-old unit of the National Statistical Office. Additionally, the amount accrued through the disease code was confirmed and compared as AGW-related medical expenses. Results: The annual number of patients increased by 3.5 times from 32,709 in 2007 to 114,734 in 2018. Additionally, the annual prevalence increased by 3.34 times from 132.83 per 100,000 to 443.57. The age-specific prevalence was the highest among the 25-to 29-year age group. The highest prevalence was observed in the 25- to 29-year age group in 2018 (1,492.15 per 100,000), and the lowest was noted in the 10- to 14-year age group in 2014 (7.28 per 100,000). AGW-related medical expenses increased by approximately 9.76 times from US$ 2,789,215.1 in 2007 to US$ 27,227,254.9 in 2018. Conclusions: In Korea, cases of male AGW are increasing yearly, with the 25- to 29-year age group having the highest prevalence. Medical costs related to AGW are also increasing tenfold. For male AGW, further studies and national interventions are needed. [ABSTRACT FROM AUTHOR]

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Purpose Perianal Buschke-Löwenstein tumor (BLT) is characterized by an exophytic cauliflower-like mass surrounding the perianal region. Its tendency to infiltrate the adjacent tissues, its massiveness, and its high recurrence rate cause difficulties in treatment. The aim of this study is to report our strategy with wide local excision and flap reconstruction for BLT. Methods From November 2002 to June 2019, 11 patients (9 men) with a mean age of 33.45 years (range, 19–54 years) were operated on for BLT. All patients underwent wide local excision and V-Y flap reconstruction, supplemented with other flaps whenever needed. No additional modalities were used. Results Two patients had a history of anal intercourse while all patients were human immunodeficiency virus-negative. The mean tumor length was 15.54±1.34 cm (range, 10–26 cm). Human papillomavirus 6 was the most common type identified. Partial wound dehiscence developed in 3 patients, while anal stenosis, mucosal ectropion, or local recurrence was not observed during the mean follow-up period of 50.45±1.75 months (range, 10–196 months). Conclusion In patients with perianal BLT, wide local excision and flap reconstruction result in a high healing rate without significant complications.

Background and Objective: Condyloma acuminata is treated in different ways, each of which may have advantages and disadvantages. The present study aimed to evaluate the effective factors in response to cryotherapy treatment in women with condyloma acuminata. Materials and Methods: This case-control study was conducted on 200 women with condyloma acuminata who were candidates for cryotherapy and were referred to Farshchian Hospital (Sinai) in 2021-2022. Before starting cryotherapy, a biopsy sample was taken from the lesions to perform a polymerase chain reaction (PCR) and determine the genotype of the human papillomavirus. Based on the extracted subtype, the lesions were classified into three high-risk, medium- and low-risk groups. Cryotherapy was performed for each lesion once every two weeks and up to six sessions at most. Patients were examined one month after the last cryotherapy session in terms of recovery with no recovery. Non-response to treatment was considered the case group, and response was regarded as the control group. Results: In terms of genotype, 43% were high risk, 24.5% were intermediate, and 32.5% were low risk. The frequency of response to treatment was 37%. A response to cryotherapy of condyloma acuminata in the anogenital area of participating showed a significant correlation with age (P=0.008), lesion size (P=0.001), duration of disease (P=0.001), genotype (P=0.001), and lesion location (P =0.014). Conclusion: Response to cryotherapy treatment in anogenital condyloma acuminata warts is relatively low. Lesions in the vaginal area, younger age, the smaller size of lesions, and shorter duration of infection had a better prognosis after cryotherapy

In 2009, Norway initiated routine quadrivalent HPV (qHPV) vaccination for girls at 12–13 years of age to protect against virus types causing cervical cancer, HPV16/18, and HPV6/11 which cause anogenital warts (AGW). We wanted to investigate qHPV vaccine effectiveness (VE) against AGW in females before and after first AGW episode and to assess the impact of female vaccination in males. QHPV vaccination and AGW episodes were collected for the time period 2006–2016 for birth cohorts 1975–2003. Cox models were applied to age at first, as well as at second AGW episode. Finally, we estimated the impact of the female vaccination program on unvaccinated males. The VE against the first episode of AGW was strongly dependent on vaccination age, with hazard ratios (HRs) compared to unvaccinated individuals of 0.2, 0.2, 0.3, 0.5, 1.0, 1.3, and 2.7, for age groups of ⩽13, 14–15, 16–17, 18–19, 20–24, 25–29, and 30+ years at first vaccination, respectively. Among women who had suffered a first episode of AGW, subsequent qHPV vaccination did not protect against a second episode, with HRs of 0.8, 1.0, and 1.4, for age groups of ⩽17, 18–24, and 25+ years at first vaccination. A gradually decreasing AGW risk was seen in unvaccinated male cohorts neighboring the first routinely vaccinated female 1997 cohort. When administered before 14 years of age, qHPV vaccination reduced the probability of AGW about fivefold. The effect decreased sharply with vaccination age, and was not significant among women vaccinated after age 20 years. QHPV administered after the first AGW episode did not protect against a second AGW episode. Herd effects were indicated in unvaccinated males, as we observed a gradual decrease in AGW rates from the 1993 male birth cohort and onwards. [ABSTRACT FROM AUTHOR]

IFN-ε is essential in combating viral infections, particularly in epithelial cells and protected mucosal tissues. Its protective effects have been demonstrated against HSV2, Zika virus, HIV and SARS-COV2. However, the specific expression and role of IFN-ε in skin keratinocytes and HPV infection are still not fully understood and require further investigation. In this study, we aimed to investigate the functions and expression mechanism of IFN-ε in keratinocytes during HPV infection and the progression of condyloma acuminata. Keratinocytes isolated from biopsied CA warts and normal skins samples were analyzed by MeRIP-seq analysis. IFN-ε and WTAP in CA warts and normal skins were analyzed by immunostaining and qPCR. In this study, we identified IFN-ɛ was markedly upregulated in CA warts and HPV-infected keratinocytes. IFN-ɛ expression also showed negatively correlation with the size of CA warts (R=−0.4646, P = 0.009). IFN-ɛ suppressed the susceptibility of HPV infection directly. m6A analysis reveals WTAP is a key m6A writer promoting the m6A modification of IFNE mRNA. Our research suggests that IFN-ɛ is an important Type I IFN cytokine involved in the development of genital warts. Furthermore, we found that HPV infection affects the m6A modifications of IFNE through a mechanism dependent on WTAP. This study provides insights into the innate immune response of the host to HPV infection and may contribute to the development of future strategies for regulating innate immunity to treat genital warts. • HPV infection induces IFN-ɛ expression in keratinocytes. • IFN-ɛ shows negative correlation with the development of condyloma acuminata. • IFN-ɛ suppressed the susceptibility of HPV infection. • WTAP regulates the expression of IFN-ɛ by m6A modification. [ABSTRACT FROM AUTHOR]

Erythema nodosum (EN) is a form of septal panniculitis, which is believed to represent a delayed hypersensitivity reaction activated by infectious agents, drugs, granulomatous and autoimmune diseases, pregnancy, and malignancies. There are only four reported cases of EN during oral isotretinoin therapy to our knowledge, all of them occurring in patients with severe acne. Since acne itself can trigger EN, the question as to whether there is indeed a causative relationship between isotretinoin and EN in the reported cases remains to be elucidated. We present herein a 20-year-old woman with multiple vulvar condylomata acuminata who developed EN two weeks after onset of oral isotretinoin therapy. To the best of our knowledge, this is the first report of EN occurring during isotretinoin treatment in a patient without acne and strongly indicates that the pathogenesis of EN can be directly related to the biological actions of isotretinoin. Erythema nodosum should be regarded as a rare side effect of oral isotretinoin therapy, regardless of the underlying disease. Physicians should be aware of this rare side effect.

Condylomata acuminata is the most common sexually transmitted disease in the world. Physical treatments include excision, cryotherapy, electrocautery and ablative CO2, and Nd:YAG laser ablation, while topical treatments include imiquimod immunotherapy and antimitotic podophyllotoxin or sinecatechins. Efficacies of all methods are low, and recurrences are very common. A new combined method is presented as a single case in a 25-year-old male patient diagnosed with numerous condylomas on the penis, scrotum, and lower abdomen. The treatment consisted of a 7-week topical monotherapy using 5% imiquimod cream followed by local treatment with 20 MHz high-intensity focused ultrasound on remaining recalcitrant lesions. Results showed resolution of approximately 70% of the condylomas after imiquimod treatment, and full resolution of all recalcitrant condylomas treated subsequently with high-intensity focused ultrasound. The method is concluded to be safe and effective and, furthermore, presents a new physical method that does not generate airborne infectious human papillomavirus particles that pose a health risk for the medical team performing therapy. Further studies in larger populations are recommended to confirm the combined efficacy of the proposed method.

ObjectiveTo observe the stability and therapeutic effect of chloroquine phosphate gel on human condylomata acuminata (CA) caused by low-risk human papillomavirus (HPV).MethodsThe appearance, viscosity, pH, chloroquine concentration, deethylchloroquine concentration and content uniformity of chloroquine phosphate gel were examined for 24 months, the gel met the quality standards throughout the 24-month observation. A nude mouse model harboring CA xenografts was used to observe the therapeutic effect of this gel on CA in vivo.ResultsAfter 14 days of gel administration, compared with the control group, the treatment group had significantly smaller warts and significantly reduced DNA copy numbers of HPV6 and HPV11 in the wart tissues. Immunohistochemistry analysis of p53 protein expression in the wart tissues of the treatment group was significantly increased.ConclusionChloroquine phosphate gel was stable and effective against CA, possibly through the promotion of p53 protein expression to induce apoptosis, leading to the involution of warts.

High recurrence rate and adverse effects were common shortcomings in treatments for genital warts, but a number of clinical studies have found that photodynamic therapy (PDT) had some unique superiority compared to other treatments. This study aims to evaluate the efficacy and safety of PDT for genital warts in comparison to alternative treatments. Seven databases and ClinicalTrials.gov were searched and seven randomized controlled trials were finally included. There was no significant difference in clearance rate of urethral lesions between the PDT group and the CO2 laser therapy (CO2‐LT group) (Odds ratio [OR] 0.676, 95% confidence interval [CI] 0.071–6.426, P = 0.734), but the overall clearance rate of all genital warts was slightly lower for PDT (OR 0.574, CI 0.335–0.985, P = 0.044). The recurrence rate after PDT was significantly lower than after CO2‐LT (OR 0.318, CI 0.220–0.460, P < 0.001), and adverse effects were also slighter after PDT (OR 0.015, CI 0.003–0.074, P < 0.001). In addition, a modification of parameters of light irradiation provides the potential to alleviate pain. This study shows that PDT is an effective treatment for genital warts with good tolerability and safety, especially for cavitary lesions. Some modified protocols probably have the potential to reduce adverse effects, but still need further investigation. High recurrence rate and adverse effects were common shortcomings in treatments for genital warts, but a number of clinical studies have found that photodynamic therapy (PDT) had some unique superiority compared to other treatments. This study aims to evaluate the efficacy and safety of PDT for genital warts in comparison to alternative treatments. Seven databases and ClinicalTrials.gov were searched and seven randomized controlled trials were finally included. The study shows that PDT is an effective treatment for genital warts with good tolerability and safety, especially for cavitary lesions. Some modified protocols probably have the potential to reduce adverse effects, but still need further investigation. [ABSTRACT FROM AUTHOR]

Purpose: One of the most known sexually transmitted diseases is Condylomata acuminata (CA), a skin lesion occurring due to infection from Human Papilloma Virus (HPV). CA has a typical appearance of raised, skin-colored papules ranging in size from 1 mm to 5 mm. These lesions often form cauliflower-like plaques. Depending on the involved HPV-subtype (either high-risk or low-risk) and its malignant potential, these lesions are likely to lead to malignant transformation when specific HPV subtypes and other risk factors are present. Therefore, high clinical suspicion is required when examining the anal and perianal area. Methods: In this article, the authors aim to present the results of a five-year case series (2016–2021) of anal and perianal cases of CA. Results: A total of 35 patients were included in this study. Patients were categorized based on specific criteria, which included gender, sex preferences, and human immunodeficiency virus infection. All patients underwent proctoscopy and excision biopsies were obtained. Based on dysplasia grade patients were further categorized. The group of patients where high-dysplasia squamous cell carcinoma was present was initially treated with chemoradiotherapy. Abdominoperineal resection was necessary in five cases after local recurrence. Conclusions: CA remains a serious condition where several treatment options are available if detected early. Delay in diagnosis can lead to malignant transformation, often leaving abdominoperineal resection as the only option. Vaccination against HPV poses a key role in eliminating the transmission of the virus, and thus the prevalence of CA. [ABSTRACT FROM AUTHOR]