Klinik und Therapie anogenitaler Warzen und papillomvirusassoziierter Krankheitsbilder

Abstract

There is a series of different therapies for the treatment of anogenital warts. Home therapy should be reserved only for initial therapy of simple cases. Such approaches include podophyllotoxin solution, podophyllotoxin cream,imiquimod cream and adjuvant interferon gel. Recurrent disease and disseminated disease must be treated by the physician. Choice of therapy depends on the morphology, the extent of the disease and also on the immunological status of the patient. Therapy should be discussed between the physician and the patient. Whatever therapy will be chosen, HPV DNA can persist latently in surrounding tissue and may lead to recurrence of visible lesions. Long-standing warts can undergo malignant conversion; intraepithelial neoplasias such as Bowen's disease, erythroplasia of Queyrat and bowenoid papulosis are especially prone to develop into squamous-cell carcinoma. Thus adequate therapy and thorough follow-up are mandatory in such cases. In the future therapies directed against HPV specifically will be available. They should lead both to destruction and complete clearance of visible lesions and also should prevent recurrences. Ideally HPV should be eliminated completely from the treated tissue.

Sexually transmitted papillomavirus infections: epidemiology pathogenesis, clinic, morphology, important differential diagnostic aspects, current diagnostic and treatment options

“…4 The positive finding in PAN-staining must be obligatorily accompanied by an exact determination of the type of the virus strains. 4,15,26 Direct immunofluorescence is successfully applied to decode group-specific antigens in highly differentiated cells having a highly concentrated viral content. 2 Due to its low sensibility and specificity its application is limited.…”

“…4 Their side effects, such as intrauterine death and the appearance of different malformations (podophyllotoxin) are the basis of this contraindication. 26 The application of highly concentrated (85%) trichloracetic acid is a good therapeutic alternative during pregnancy. 26 In case of strong pains and concerns of overdosing, rapid neutralization is possible with sodium bicarbonate.…”

“…26 The application of highly concentrated (85%) trichloracetic acid is a good therapeutic alternative during pregnancy. 26 In case of strong pains and concerns of overdosing, rapid neutralization is possible with sodium bicarbonate. 4 The second problematic group are children infected during birth by HPV-6, -11, and, in rarer occasions, by HPV-16, -18, -31, and -35 viral strains.…”

“…4 The second problematic group are children infected during birth by HPV-6, -11, and, in rarer occasions, by HPV-16, -18, -31, and -35 viral strains. 4,26 The location of warts in the ano1genital area reveals the possibility of sexual abuse. 13 Cryosurgery, electrodessication, and laser ablation under a short incubation narcosis are suitable options for this group of patients.…”

“…29 Some intra-epithelial neoplasias, such as Bowen's disease, bowenoid papulosis and Queyrat's erythroplasia, are an exception and need surgical removal and, occasionally, a primary closure of the operative wound edges. 1,4,26,29 Circumcision in some cases provides good results. 26,50 The primary therapy of bowenoid papulosis (i.e.…”