Increasing Incidence of Anogenital Warts with an Urban–Rural Divide among Males in Manitoba, Canada, 1990–2011

Background

Anogenital warts (AGW) are caused by the most common sexually transmitted infection, human papillomavirus. The objective of this study was to examine AGW incidence from 1990 to 2011 by sex, age, income quintile, and residential area category (urban/rural). The study period included the initiation of school-based HPV vaccination for girls in the sixth grade, which began in 2008. The data presented in this paper may also be useful for establishing baseline rates of AGW incidence which may be used to evaluate the success of the school-based HPV immunization program.

Methods

Cases of anogenital warts were identified using Manitoba’s administrative databases of Physician Claims and Hospital Discharge Abstracts. Annual age-standardized incidence in Manitoba from 1990 to 2011 was calculated. Incident AGW rates were compared by sex, age group, residential area category (urban/rural), and household income quintile using logistic regression. Joinpoint regression analyses were used to evaluate the time trends of AGW.

Results

Prior to 2000, AGW incidence was higher among females than males. However, from 2000 to 2011 the incidence was higher among males and increased steadily over time. AGW incidence tended to peak in younger age groups among females compared to males. Females and males living in urban areas had nearly twice the odds of AGW occurrence compared to those in rural areas.

Conclusions

There is a need for education about AGW in male population. The upcoming initiation of HPV vaccination among boys may reduce the incidence and should be evaluated.

Below: Age-Standardized Incidence (per 100,000 persons) of AGW in Manitoba, 1990 – 2011

Below:  Sex Stratified Age-Specific 5-year Average AGW Incidence (per 100,000 persons) in Manitoba, 1990 – 2011

Below:  The Trends of Age-Standardized Incidence (per 100,000 persons) of AGW by Sex and Geographic Residential Area in Manitoba, 1990 - 2011

Full article at:   http://goo.gl/keXH9u

By:  Laura H. Thompson, Zoann Nugent, James F. Blanchard, Carla Ens, and Bo Nancy Yu*

Epidemiology and Surveillance Unit, Public Health and Primary Health Care Division, Manitoba Health, Healthy Living & Seniors, Winnipeg, R3B 3 M9 Manitoba Canada

Centre for Global Public Health, University of Manitoba, Winnipeg, Canada

Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada

Bo Nancy Yu, Email: ac.abotinamu@uy.ycnan.

*Corresponding author.

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Demographic Characteristics and Risk Factors in Turkish Patients with Anogenital Warts

Anogenital warts (AGW) are one of the most common sexually transmitted diseases worldwide. The determination of groups vulnerable to contracting anogenital warts (AGW) leads to the development of policies for disease control and of prevention programs. The aim of our study was to investigate the demographical features and risk factors of Turkish patients with AGW. 

This study included 200 patients with AGW and 200 healthy individuals as a control group. The age, gender, education and marital status, age of first sexual intercourse, number of sexual partners, sexual orientation, and smoking status were recorded in both groups. In this study, 88% of the patients were male, and 12% were female. The mean age of the patients was 35.21±0.77 years, and the majority of patients were below 35 years old (63%). Furthermore, 46.0% of the patients were educated at the university level, and 33.5% had graduated high school. 

No significant differences were found based on sexual orientation or condoms between the patient and control groups. In the patient group, the mean age of first sexual intercourse was significantly earlier, and the number of single individuals and sexual partners were significantly higher. Also, 61% of the patients were current smokers, which was significantly higher than the control group. The duration of smoking and the duration of AGW were found to be correlated. All patients were tested for anti-HIV antibodies, and only one patient was found to be infected. AGW were more common in patients younger than 35 years old, among men, and among those who had graduated from high school or university. 

Early age of first sexual intercourse, a high number of sexual partners, being single, and smoking were also risk factors for the development of anogenital warts.

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By:  Tamer E1, Çakmak SK2, İlhan MN3, Artüz F4.

• 1Ankara Numune Education and Research Hospital, Dermatology Clinic, Turkey. Electronic address: eminettamer@yahoo.com.tr.
• 2Ankara Numune Education and Research Hospital, Dermatology Clinic, Turkey.
• 3Gazi University Faculty of Medicine, Public Health & Occupational Health, Turkey. Electronic address: mnilhan@gazi.edu.tr.
• 4Ankara Numune Education and Research Hospital, Dermatology Clinic, Turkey. Electronic address: ferdaartuz@yahoo.com 

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Human Papillomavirus and Genital Warts: A Review of the Evidence for the 2015 Centers for Disease Control and Prevention Sexually Transmitted Diseases Treatment Guidelines

To provide updates for the 2015 Centers for Disease Control and Prevention sexually transmitted diseases treatment guidelines on human papillomavirus (HPV) and anogenital warts (AGWs), a review of the literature was conducted in key topic areas: 

epidemiology and burden of disease; 

1. transmission and natural history; 
2. diagnosis and management of AGWs; 
3. occupational exposure of healthcare workers; 
4. anal cancer screening among men who have sex with men (MSM); and 
5. HPV vaccine recommendations. 

Most sexually active persons will have detectable HPV at least once in their lifetime; 14 million persons are infected annually, and 79 million persons have prevalent infection. HPV is transmitted frequently between partners; more frequent transmission has been reported from females to males than from males to females. 

A new formulation of imiquimod (3.75% cream) is recommended for AGW treatment. Appropriate infection control, including performing laser or electrocautery in ventilated rooms using standard precautions, is recommended to prevent possible transmission to healthcare workers who treat anogenital warts, oral warts, and anogenital intraepithelial neoplasias (eg, cervical intraepithelial neoplasia). 

Data are insufficient to recommend routine anal cancer screening with anal cytology in persons living with human immunodeficiency virus (HIV)/AIDS or HIV-negative MSM. An annual digital anorectal examination may be useful for early detection of anal cancer in these populations. HPV vaccine is recommended routinely for 11- or 12-year-olds, as well as for young men through age 21 years and young women through age 26 years who have not previously been vaccinated. HPV vaccine is also recommended for MSM, people living with HIV/AIDS, and immunocompromised persons through age 26 years.

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By:  Park IU1, Introcaso C2, Dunne EF2.

• 1Sexually Transmitted Diseases Control Branch, Division of Communicable Disease Control, California Department of Public Health, Richmond Department of Family and Community Medicine, School of Medicine, University of California, San Francisco.
• 2Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia. 

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Associations of Anogenital Low-Risk Human Papillomavirus Infection with Cancer and Acquisition of HIV

α-Mucosal human papillomavirus (HPV) types are implicated in a range of clinical conditions and categorized as "low-risk" (LR) and "high-risk" (HR) types according to their degree of association with cervical cancers. 

The causative role of LR HPV infection in the development of anogenital warts and in low-grade squamous intraepithelial lesions is well established. In addition, there is a growing body of evidence that infection with LR HPV types may be associated with an elevated risk of cancers and potentiation of coinfections. Prospective and case-control studies consistently report a higher risk of anogenital cancers in men and women with a history of anogenital warts. 

Based on currently available evidence, this higher risk may be due to shared exposure to HR HPV types or an underlying immune impairment, rather than a direct role of LR HPV types in subsequent cancer risk. Data also suggest that infection with LR HPV, HR HPV, or both may increase the risk of HIV acquisition, although the relative contribution of different HPV types is not yet known. There is also evidence implicating HPV clearance, rather than HPV infection, in increased risk of HIV acquisition.

Via:  http://ht.ly/Sybhc Purchase full article at: http://goo.gl/OrIwsI

By: Bennetts LE1, Wagner M, Giuliano AR, Palefsky JM, Steben M, Weiss TW.

• 1From the *LASER Analytica, Montréal, Québec, Canada; †H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; ‡Department of Medicine, University of California San Francisco, San Francisco, CA; §Direction des Risques Biologiques et de la Santé au Travail, Institut National de Santé Publique du Québec, Montréal, Québec, Canada; and ¶Merck & Co, Inc, Global Health Outcomes, West Point, PA. 
  
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Giant Condyloma Acuminatum of Vulva: A Frustrating Treatment Challenge

Below:  Patient with giant condyloma prior to reconstructive surgery

Below:  Patient following the healing process

Giant condylomata are not usually seen nowadays in developed nations, but such cases are still seen in the under-resourced countries. Condylomata acuminata are commonly transmitted through sexual intercourse. Generally diagnosed based on their appearance. Giant condyloma acuminata also named Buschke- Löwenstein tumour (BLT) is a slow growing cauliflower-like tumor, locally aggressive and destructive, with possible malignant transformation. Common clinical treatment of anogenital warts is conservative, however, in extreme cases conservative therapy is insufficient and surgical excision is required. A case of common presentation of giant condylomata in a 50 years old, divorced, multiparous woman is presented and the literature is reviewed. She presented with 15 years history of slowly progressive vulval lesion and associated itching, contact bleeding, malodorous vaginal discharge and difficulty in walking. She had previously been treated with podophyllin and cryosurgery without success. The growth measured 30×10 cm in each side and was successfully excised with no evidence of malignancy concomitant and reconstruction also done.

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