Combination of Circumcision and Microwave in Treatment of Genital Warts in Uncircumcised Patients

Objective: To investigate the efficacy of combina-tion of circumcision and microwave on genital wartsin uncircumcised men. Methods: A randomized, prospective study of 109uncircumcised adult men with genital warts was con-ducted in a STD clinic in Zhanjiang, Guangdong. Onegroup (n=54) received microwave therapy only, whilethe other group (n=55) was taken the combination ofcircumcision and microwave therapy. The recurrenceswere observed at the end of months 3, 6 and 12, andoperative complications were also recorded. Results: There were no significant differences inthe mean age and duration of the disease between twogroups (P>0.05). No serious operative complicationswere documented. The recurrence rate in circumci-sion plus microwave group was markedly lower thanthat in microwave group (12.7% vs 29.6%, P<0.05),while the differences in early and late recurrencesbetween two groups showed no statistical significance(P>0.05). Conclusion: Circumcision can be safely performedunder local anesthesia in an outpatient setting. Com-bination of circumcision and microwave can produceexcellent effect as well as less tissue damage,therefore, it may be ideal for uncircumcised patientswith extensive condylomas.

Detection of HPV Types and Neutralizing Antibodies in Women with Genital Warts in Tianjin City,China

The serum samples and corresponding cervical swabs were collected from 50 women with genital warts from Tianjin city, China. The neutralizing antibodies against HPV-16, -18, -58, -45, -6 and -11 in serum samples were tested by using pseudovirus-based neutralization assays and HPV DNAs in cervical swabs were also tested by using a typing kit that can detect 21 types of HPV. The results revealed that 36% （18/50） of sera were positive for type-specific neutralizing antibodies with a titer range of 160-2560, of which 22%（11/50）, 12%（6/50）, 10%（5/50）, 4%（2/50）, 4%（2/50） and 2%（1/50） were against HPVs -6, -16, -18, -58, -45 and -1 l, respectively. Additionally, 60% （30/50） of samples were HPV DNA-positive, in which the most common types detected were HPV-68（18%）, HPV-16（14%）, HPV-58（12%）, HPV-33（8%） and HPV-6, HPV-11, HPV-18 and HPV-52 （6% each）. The concordance between HPV DNA and corresponding neutralizing antibodies was 56% （28/50） with a significant difference （P〈0.05）. The full-length sequences of five HPV types （HPV -42, -52, -53, -58 and -68） were determined and exhibited 98%-100% identities with their reported genomes. The present data may have utility for investigating the natural history of HPV infection and promote the development of HPV vaccines.

A Correlative Analysis of Cervical Lesions in Patients with Vulva Condyloma Acuminatum

OBJECTIVE To analyze the relation ship among vulva condyloma acuminatum, high-risk human papillomavirus （HPV） infections and cervical epithelium lesions. METHODS From May 2002 to April 2004 patients with vulva condyloma acuminatum were examined employing vulva biospy, colposcopy, highrisk HPV-DNA test and cervical bioscopy. RESUTS In 418 cases of vulva condyloma acuminatum, verified by pathologic analysis, high-risk HPV （＋） infections were detected in 68.7% （287/418） of the cases. Among those patients, 20,6% （59/287） had concurrent subclinical cervical intraepithelial neoplastic （CIN） lesions. Among the high-risk HPV（-） 31.3 % （131）, patients 7,6% （10/131） had concurrent subclinical CIN lesions, Pathological examination results： cervicitis, 167 （40.0%）; cervical HPV infection, 182 （43.5%）; CIN-Ⅰ, 51（12.2%）; CIN- Ⅱ, 16 （3.83%）; CIN-Ⅲ, 2 （0,5%）; cervical cancer, none. Another patient had vulva condyloma acuminatum with valva intraepithelial neoplasia （VIN） Ⅱ-Ⅲ, CONCLUSION It was concluded that simultaneous cervical HPV infection of many types,was rather common in patients with vulva condyloma acuminatum. Vulva condyloma acuminatum is the chief clinical symptom which hints at a high possibility of infection with high-risk HPV. The patients are at high-risk for CIN and cervical cancer. We must pay more attention to the cervix in cases with vulva condyloma acuminatum.

Relationship between circumcision and human papillomavirus infection： a systematic review and meta-analysis

Male circumcision （MC） is reported to reduce human papillomavirus （HPV） prevalence in men. However, the efficacy remains imprecise. The aim of this study was to conduct a systematic review and meta-analysis to assess the relationship between MC and genital HPV infection and genital warts. PUBMED, EMBASE, and Web of Science were searched from inception to March 22, 2015. We identified 30 papers, including a total of 12149 circumcised and 12252 uncircumcised men who were evaluated for the association of circumcision with genital HPV or genital warts. Compared with men who were not circumcised, circumcised men may have had significantly reduced odds of genital HPV prevalence （odds ratio [OR]： 0.68; 95% confidence interval [95% CI]： 0.56-0.82）. There was no significant association between MC and genital HPV acquisition of new infections （OR： 0.99; 95% CI： 0.62-1.60）, genital HPV clearance （OR： 1.38; 95% Ch 0.96-1.97）, and prevalence of genital warts （OR： 1.17; 95% CI： 0.63-2.17）. This meta-analysis suggests that circumcision reduces the prevalence of genital HPV infections. However, no clear evidence was found that circumcision was associated with decreased HPV acquisition, increased HPV clearance, or decreased the prevalence of genital warts. More studies are required to evaluate adequately the effect of MC on the acquisition and clearance of HPV infections and prevalence of genital warts.

Development and optimization of nanoemulsion gel for topical delivery of imiquimod

In the present study,we aimed to formulate,optimize and characterize nanoemulsion-based gel of imiquimod for its topical administration and to improve the drug permeation.Nanoemulsions were prepared by the aqueous phase titration method and spontaneously formed by mixing specific fractions of oil phase:Smix:water.The nanoemulsion formulations were optimized by response surface methodology(RSM) using mixture design,Scheffe model.The formulated nanoemulsion was incorporated into 0.5% Carbopol 934(w/v) to enhance convenience in superficial application of the drug.The nanoemulsions were characterized in terms of droplet size,zeta potential,TEM,DSC and in vitro drug permeation.The vesicle size was 113.6 nm with polydispersity index of 0.251.The zeta potential was 34 m V.The spherical droplet shape was confirmed by TEM analysis.The drug permeation from the diffusion membrane was 73.67% in 6 h for the optimized formulation.An optimized nanoemulsion gel formulation of imiquimod was successfully developed with improved permeation using experimental design technique.The developed formulation could be further explored as a potential alternate to currently available topical formulations for the treatment of genital warts.