Discriminating high-risk cervical Human Papilloma Virus infections with urinary biomarkers via non-targeted GC-MS-based metabolomics

Genital human papillomavirus (HPV) is the world’s most commonly diagnosed sexually transmitted infection, and high-risk HPV types are strongly linked to cervical dysplasia and carcinoma. Puerto Ricans are among the US citizens with higher HPV prevalence and lower screening rates and access to treatment. This bleak statistic was as a motivation to detect biomarkers for early diagnosis of HPV in this population. We collected both urine and cervical swabs from 43 patients attending San Juan Clinics. Cervical swabs were used for genomic DNA extractions and HPV genotyping with the HPV SPF10-LiPA25 kit, and gas chromatography-mass spectrometry (GC-MS) was employed on the urine-derived products for metabolomics analyses. We aimed at discriminating between patients with different HPV categories: HPV negative (HPV-), HPV positive with simultaneous low and high-risk infections (HPV+B) and HPV positive exclusively high-risk (HPV+H). We found that the metabolome of HPV+B is closer to HPV- than to HPV+H supporting evidence that suggests HPV co-infections may be antagonistic due to viral interference leading to a lower propensity for cervical cancer development. In contrast, metabolites of patients with HPV+H were significantly different from those that were HPV-. We identified three urinary metabolites 5-Oxoprolinate, Erythronic acid and N-Acetylaspartic acid that discriminate HPV+H cases from negative controls. These metabolites are known to be involved in a variety of biochemical processes related to energy and metabolism and may likely be biomarkers for HPV high-risk cervical infection. However, further validation should follow using a larger patient cohort and diverse populations to confirm our finding.

Genital Human Papilloma Virus Infection in Males. A Clinico-Pathologic Study

From March 1987 to December 1988, 402 male sexual partners of 317 women with human papilloma virus (HPV) infection of the lower genital tract and 85 with HPV-associated cervical and/or vulvar intraepithelial neoplasia (CIN and/or VIN) were submitted to clinical examination and peniscopy. The latter was performed at a 6-15 X magnification after a 3 min exposure to 5% acetic acid solution. Visible lesions were biopsied. Thirty-one patients had clinical evidence of HPV infection in the glans, penile shaft or urethra, and 222 had peniscopic evidence of subclinical aceto-white lesions. Of 31 patients with clinical lesions, 11 showed also aceto-white subclinical lesions. Of 253 peniscopically positive males, 237 were biopsied and 191 of these were histologically ascertained. Three patients had penile intraepithelial neoplasia, one with clinical appearance of a Buschke-Löwenstein tumor. The incidence of HPV infection in male sexual partners of women affected by HPV infection of the lower genital tract associated or not with intraepithelial neoplasia is lower than expected. However, clinically negative males should not be considered disease free; in fact, 12 patients, negative at the first examination, showed histological evidence of HPV infection at subsequent controls. Therefore, follow-up of at least 6 months should be allowed to Identify HPV bearing males. The reported low frequency of HPV infection may be due to the fact that the males may harbour the virus in the urethra, prostate or seminal vesicles or penis without any clinical evidence of disease. Although research for HPV-DNA in intraurethral and penile scraping material might be useful for diagnosis, peniscopy with a 5% acetic acid application remains the clinical test for evaluating HPV Infection in males. The importance of peniscopy should be viewed with respect to the prevention of infection or reinfection of the female sexual partners, in addition to the specific diagnostic purpose in male patients.

Ebselen alleviates testicular pathology in mice with Zika virus infection and prevents its sexual transmission

Despite the low case fatality, Zika virus (ZIKV) infection has been associated with microcephaly in infants and Guillain-Barré syndrome. Antiviral and vaccine developments against ZIKV are still ongoing; therefore, in the meantime, preventing the disease transmission is critical. Primarily transmitted by Aedes species mosquitoes, ZIKV also can be sexually transmitted. We used AG129 mice lacking interferon-α/β and -γ receptors to study the testicular pathogenesis and sexual transmission of ZIKV. Infection of ZIKV progressively damaged mouse testes, increased testicular oxidative stress as indicated by the levels of reactive oxygen species, nitric oxide, glutathione peroxidase 4, spermatogenesis-associated-18 homolog in sperm and pro-inflammatory cytokines including IL-1β, IL-6, and G-CSF. We then evaluated the potential role of the antioxidant ebselen (EBS) in alleviating the testicular pathology with ZIKV infection. EBS treatment significantly reduced ZIKV-induced testicular oxidative stress, leucocyte infiltration and production of pro-inflammatory response. Furthermore, it improved testicular pathology and prevented the sexual transmission of ZIKV in a male-to-female mouse sperm transfer model. EBS is currently in clinical trials for various diseases. ZIKV infection could be on the list for potential use of EBS, for alleviating the testicular pathogenesis with ZIKV infection and preventing its sexual transmission.

Pathogenesis and sexual transmission of Spondweni and Zika viruses

The Spondweni serogroup of viruses (Flaviviridae, Flavivirus) is comprised of Spondweni virus (SPONV) and Zika virus (ZIKV), which are mosquito-borne viruses capable of eliciting human disease. Numerous cases of ZIKV sexual transmission in humans have been documented following the emergence of the Asian genotype in the Americas. The African ZIKV genotype virus was previously implicated in the first reported case of ZIKV sexual transmission. Reports of SPONV infection in humans have been associated with non-specific febrile illness, but no association with sexual transmission has been reported. In order to assess the relative efficiency of sexual transmission of different ZIKV strains and the potential capacity of SPONV to be sexually transmitted, viral loads in the male reproductive tract and in seminal fluids were assessed in interferon α/β and –γ receptor deficient (AG129) mice. Male mice were inoculated subcutaneously with Asian genotype ZIKV strains PRVABC59 (Puerto Rico, 2015), FSS13025 (Cambodia, 2010), or P6-740 (Malaysia, 1966); African genotype ZIKV strain DakAr41524 (Senegal, 1984); or SPONV strain SAAr94 (South Africa, 1955). Infectious virus was detected in 60–72% of ejaculates collected from AG129 mice inoculated with ZIKV strains. In contrast, only 4% of ejaculates from SPONV-inoculated AG129 males were found to contain infectious virus, despite viral titers in the testes that were comparable to those of ZIKV-inoculated mice. Based on these results, future studies should be undertaken to assess the role of viral genetic determinants and host tropism that dictate the differential sexual transmission potential of ZIKV and SPONV.

The Spondweni serogroup of viruses, which includes Zika virus and Spondweni virus, are mosquito-borne viruses that can cause disease in humans. During the recent outbreak of Zika virus in the Americas, sexual transmission and in utero transmission have also been described. Due to the close genetic identity of Zika and Spondweni viruses, the herein reported study used a mouse model to assess the sexual transmission capacity of Spondweni virus in comparison to recent outbreak Zika strains and older Zika virus strains. In this model, all Zika strains were shed in seminal fluids from infected males. However, the percentage of ejaculates that contained infectious virus was significantly lower for Spondweni-infected males than Zika-infected males. Thus, sexual transmission potential is conserved among Zika viruses and not likely to fully explain the magnitude and dynamics of the recent outbreak in the Americas. In addition, sexual transmission potential should be further evaluated for Spondweni virus. Virus-specific differences in rates of shedding in seminal fluids will inform future studies on the viral determinants of sexual transmission.

Severe acute pharyngotonsillitis due to herpes simplex virus type 2 in a young woman

Whereas herpes simplex virus type 1 (HSV-1) is a recognized cause of acute oropharyngeal infection in young adults, HSV-2 infections are mostly associated with genital symptoms. We report a case of acute and prolonged febrile ulcerative pharyngotonsillitis with inflammatory syndrome which persisted despite antibiotic therapy for 8 days and required hospitalization in an 18-year old immune competent and sexually active female patient. HSV-2 was evidenced in tonsillar samples and blood by real time PCR, and HSV type-specific serology showed HSV-2 primary infection. Despite delayed diagnosis, acyclovir treatment led to rapid clinical improvement. This case highlights HSV-2 as an unusual cause of pharyngotonsillitis that should be reminded in sexually active patients.

[Analysis of tongue figure features in 990 cases of sexually transmitted and intravenous drug use spread HIV infected population in Xinjiang]

OBJECTIVE

To investigate the tongue manifestation features of sexually transmitted and intravenous drug use spread HIV infected population in Xinjiang.

METHODS

Recruited were 990 HIV infected subjects in Xinjiang from May 2011 to March 2012, who were assigned to the intravenous drug use spread HIV infected (498 cases) and the sexually transmitted (492 cases). By using tongue figure shoot combined with analyses of experts, tongue manifestations were analyzed and compared between the sexually transmitted and the intravenous drug use spread from four aspects, i.e., the tongue color, the tongue shape, the fur color, and the fur property.

RESULTS

Compared with the sexually transmitted population, red tongue, fissured tongue, yellow fur, thick fur, eroded fur, deficiency of fur fluid were more often seen, showing statistical difference (P < 0.05). Compared with the intravenous drug use spread population, pale tongue, white fur, and thin fur were more often seen, showing statistical difference (P < 0.05).

CONCLUSIONS

The tongue manifestations of the intravenous drug use spread HIV population reflected inner exuberance of evil toxin and heat impairing qi and yin. Compared with the intravenous drug use spread population, the attack of HIV infection was more hiding in the sexually transmitted population, with milder internal injury. Their Wei-qi was not damaged and no obvious change occurred in the tongue figure.

Human papillomavirus infections of the oral mucosa and upper respiratory tract

Human papillomaviruses (HPVs) are frequently detected in a variety of lesions in the oral mucosa and upper respiratory tract. The pathogenesis in these areas is not as clearly elucidated as in other anatomical regions, but most experts agree that HPVs are responsible for the commonly observed benign lesions, such as squamous papillomas, verruca vulgaris and recurrent respiratory papillomatosis. Transformation of these benign lesions is well described, but it is not clear what role the virus plays, if any, in carcinogenesis. HPV types 6 and 11 are most frequently detected in oral cavity and respiratory tract lesions, though several other types have also been reported. Despite an opaque understanding of these lesions' pathogeneses, it is essential for the clinician to recognize these diseases, to provide appropriate treatment and to promote patient awareness of potential oral transmission. In this paper, we review the major HPV-associated diseases of the oral mucosa and upper respiratory tract, focusing specifically on clinical features, histopathological characteristics and disease management.

Genitoanal human papillomavirus infection and associated neoplasias

Human papillomavirus (HPV) infection is the most common sexually transmitted virus infection; about 40 out of 150 known HPV genotypes have been associated with genitoanal lesions in the female and male. They have been divided into low-risk (LR) and high-risk (HR) HPV types according to the association of each HPV genotype with genitoanal benign warts, genitoanal cancer and precursor lesions. For the most part, genitoanal HPV infection is equally common in men and in women. Genitoanal HPVs are predominantly transmitted by sexual intercourse. In a minor number of individuals where HR HPV infection has persisted, malignant squamous-cell tumors may develop. There are 15 mucosal oncogenic HPV types which are the etiological factor of cervical cancer and other genitoanal cancers. DNAs of HR HPV types are present in 100% of all cervical carcinomas and in 100% of the precursor lesions, the cervical intraepithelial neoplasias 2 and 3. HPV-16 and -18 alone account for 70% of the oncogenic mucosal HPV types identified. HR HPV types, mostly HPV-16 and -18, are the causes of vaginal and vulvar cancers in females, anal cancers in both genders and cancer of the penis in men. While anal cancers are linked to HR HPVs in more than 80% of cases, only 40% of vulvar cancers and 50% of penile cancers are HPV positive. Genitoanal cancers have a similar anatomy, histology and similar risk factors as well as natural histories. About 60% of vulvar and 50% of penile cancers are HPV negative, but associated with chronic inflammatory disorders, mainly lichen sclerosus. Clinical manifestations of LR HPVs in both sexes are genitoanal warts (condylomata acuminata), which are benign highly infectious tumors. The highest rate of warts is observed in females 16-24 years of age. In males the peak is at the age of 20-24 years. Diagnosis of genitoanal warts should exclude other sexually transmitted infections and diseases. A high number of genitoanal dermatoses, benign tumors, malignant squamous-cell neoplasias and cancer precursors may mimic condylomata acuminata. These malignant counterparts have to be ruled out by biopsy and a thorough histological workup. Therapy of manifest genitoanal HPV-associated lesions has profited from the development of local immunotherapy with imiquimod and local therapy with green tea derivatives (sinecatechin) 10% (Europe) and 15% (USA). Disease recurrence is a crucial problem with treatment, one that could potentially be reduced with the use of immunomodulating agents such as immuquimod and sinecatachins. Recently primary prevention of genitoanal clinical manifestations associated with HPV-6, -11, -16 and -18 including cancer precursors (intraepithelial neoplasias) has become true by the release of prophylactic quadrivalent (HPV-6, -11, -16, -18) and bivalent (HPV-16, -18) vaccines. These vaccines consist of HPV L1 virus-like particles which induce high anti-L1 serum-neutralizing antibody concentrations. Dermatologists and venereologists, general practitioners and pediatricians should cooperate with gynecologists to vaccinate young women and men in order to increase vaccination rates. In Australia and Scotland, an immense efficacy has been observed both regarding the prevention of benign genitoanal warts and cancer precursors caused by the vaccine HPV types. An absolute prerequisite of such a successful prevention against HPV-associated neoplasias is the administration of the vaccine before the first sexual contact.

Clinical manifestations of adolescents with HIV/AIDS in Jamaica

OBJECTIVE

To characterize the clinicopathological manifestations and outcomes of a cohort of HIV-infected Jamaican adolescents.

METHODS

This is a retrospective cohort study to determine demographic, clinical, immunological characteristics, antiretroviral uptake and mortality in 94 adolescents aged 10-19 years followed in the Kingston Paediatric and Perinatal HIV/AIDS Programme (KPAIDS) between September 2002 and May 2007. Parametric and non-parametric tests are used to compare variables.

RESULTS

The median age at initial presentation was 10.0 years (interquartile range (IQR) 7.0-12.0 years), 54.3% (51) were female (p = 0.024), transmission was primarily mother-to-child (70, 73.4%), with 87% (61) of the latter presenting as slow progressors. Sexual transmission accounted for 19.1% and there was significant female predominance (n=15; p = 0.024). At most recent visit, perinatally infected adolescents were more likely (p < 0.0001) to reside with a non-parent (n=42) than a biological parent (n=19) and most had Centers for Disease Control and Prevention (CDC) category C (35/50%) disease, whereas the majority of non-perinatally infected children were classified CDC category A. Mean z scores for height-for-age was -1.47 +/- 1.21 (n=77), weight-for-age -1.06 +/- 1.44 (n=80) and BMI-for-age -0.34 +/- 1.21 (n=76) respectively; females (n=41) were taller than males (n=36) at their current height (p = 0.031). Lymphadenopathy (82%), dermatitis (72.0%), hepatomegaly (48%) and parotitis (48%) were the most common clinical manifestations, with significant predilection for lymphadenopathy (p < or = 0.0001), dermatitis (p = 0.010), splenomegaly (p = 0.008), hepatomegaly (p = 0.001) and parotitis (p = 0.007) among perinatally infected children. Median baseline CD4+ cell count was 256.0/microL (IQR 71.0 - 478.0 cells/microL); median most recent CD4+ cell count was 521/microL (IQR 271.0 - 911.0 cells/microL). Seventy-six per cent (n=71) were initiated with highly active antiretroviral therapy (HAART) and 62 (87.3%) were currently receiving first-line therapy. Six behaviourally infected females became pregnant, resulting in five live births. There were seven deaths (7.4%).

CONCLUSION

This study comprehensively characterizes HIV infection among perinatally infected teens with predominantly slow-progressor disease and an increasing population of sexually-infected adolescents. As the cohort transitions to adulthood, adolescent developmental, mental health and life planning issues must be urgently addressed.

Predictors of condom use among young adults in South Africa: the Reproductive Health and HIV Research Unit National Youth Survey

OBJECTIVES

We examined correlates of condom use among a national random probability sample of sexually experienced young adults aged 15 to 24 years (n = 7686) in South Africa.

METHODS

Using data from the Reproductive Health and HIV Research Unit National Youth Survey, we conducted gender-stratified bivariate and multivariate logistic regression analyses to determine predictors of whether respondents had used a condom during their most recent sexual intercourse.

RESULTS

Condom use at sexual debut and talking with one's first sexual partner about condoms were the most significant predictors of condom use at most recent intercourse. Other significant predictors included high condom use self-efficacy, optimism about the future, and reported behavior change attributable to HIV/AIDS. Young adults who were married or had been involved in a relationship for 6 months or more were significantly less likely to have used a condom during their most recent sexual intercourse.

CONCLUSIONS

Our findings point to the importance of exposing youths to sexuality education before their sexual debut as well as voluntary counseling and testing and programming that supports young adults, particularly young women, in making informed decisions about sexual intercourse and condoms.

Risk factors and histological outcome of abnormal cervix with human papilloma infection in northeastern Thai-women

This study aimed to investigate the histological outcome of cervix with human papillomavirus (HPV) infection and the association of risk factors with cervical intraepithelial neoplasia (CIN) and invasive cervical carcinoma (ICC) development in Northeast Thai women. The study population (n=210) comprised 71 cases of normal cervix, 71 cases of CIN and 68 cases of ICC. The histological outcome of HPV infection was determined for 9.5% of the study population. Increased risk factors for CIN were observed for more than one partner (odds ratio (OR)=3.75, p<0.05), history of sexually transmitted disease (STD) (OR=2.28, p<0.05), menarche under 14 years of age (OR=0.31, p<0.05) and partners' smoking history (OR=3.98, p<0.01). Increased risk for ICC was observed for those with a history of STDs (OR=0.14, p<0.01) and multiparity (OR=2.53, p<0.01). Age at first sexual intercourse was not a risk factor in this study population. Further studies with HPV-DNA tests should more precisely quantify the risks.

Prevalence of acetowhite areas in male partners of women affected by HPV and squamous intra-epithelial lesions (SIL) and their prognostic significance. A multicenter study

BACKGROUND

Estimates for the prevalence of cervical HPV infection vary and are only available for a few populations with regard to male partners. Attention has been drawn to the male role in cancer progression from cervical intra-epithelial neoplasia, but most of the male lesions are subclinical and only visible after acetowhite staining. The prognostic significance of acetowhite areas, of male partners of women affected by HPV and preneoplastic lesions, was evaluated.

MATERIALS AND METHODS

A cohort of 3210 male partners of women affected by HPV infection and/or preneoplastic lesion of the lower genital tract was observed from 1987 to 2001. Acetowhite changes were assessed 5 min after the application of 5% solution of acetic acid and biopsies were tested for HPV-DNA by PCR. Patients with HPV lesions underwent CO2 laser surgery and follow-up.

RESULTS

Of the 3210 male partners, 39.12% exhibited clinical HPV lesions and 3.64% subclinical lesions identified as acetowhite areas. In the group of 117 male partners with acetowhite areas, the HPV-DNA test was positive (HPV 6-11) in 36.75% and negative in 63.24% (p<0.001). No statistical differences were observed between HPV+/- groups regarding their sexual habits. The HPV-positive infection group compared to the HPV-negative group showed a statistically significant difference for CO2 laser surgery (p<0.001).

CONCLUSION

The acetic acid test can give false-positives and is not a specific indicator of HPV infection, and thus the limited efficacy of tests for acetowhite areas was confirmed. The treatment of clinical lesions is necessary. Follow-up represents the major route to the diagnosis of preneoplastic lesions in men and for the prevention of cervical carcinoma in their female partners.

Interactions of the female hormonal environment, susceptibility to viral infections, and disease progression

Sex hormones influence susceptibility and disease predisposition for many genital tract infections. This review describes the mechanisms by which sex steroids affect mucosal immunity, with particular reference to human immunodeficiency virus (HIV) and genital herpes, and the stage-specific effects of hormonal contraception on human papillomavirus (HPV) infection. Estrogen's role is important in the early stages of several infections as it stimulates antibody- and cell-mediated immune responses. There is increased expression of some cytokines in peripheral blood and vaginal fluids during the follicular phase of the menstrual cycle and with use of hormonal contraception. Whether estrogen exerts a protective or deleterious influence depends on the infecting organism and stage of infection or disease. Estrogen apparently reduces susceptibility to primary HPV infection but in the event of persistent HPV infection, sex steroid hormones (estrogen and/or progesterone) are associated with progression to cervical cancer. It is important that these stage-specific effects are better described because most vaccines will try to prevent either infection or disease. Clinicians with patients at high risk of sexually transmitted infections, especially HIV, require better information on the risks associated with different hormonal contraceptive regimes.

[Human papillomaviruses (HPV) in urology. I: 10 years results of interdisciplinary HPV diagnosis]

Human papillomaviruses play a pre-eminent role as the most frequent sexually transmitted virus in urology. However, a pathogenetic connection between these viruses and urological cancers has not been proved so far, in contrast to the correlation with cervical cancer. Our 10-year experience with urological partner diagnostics and therapy surveillance in 788 patients form the empirical basis for the detection of clinical and subclinical HPV efflorescences, rates of partner infection and the benefit of laboratory techniques for HPV detection. Commercial HPV test methods only detect a fraction of the HPV types affecting the external genitals and the urethra that are demonstrated in a reference laboratory. HPV analyses are not appropriate for routine diagnostics, but should be used solely in research projects.

[Imiquimod: a new treatment possibility in bowenoid papulosis?]

Bowenoid papulosis is a highly characteristic condition of the anogenital region which is histologically similar to bowenoid carcinoma in situ. Some evidence suggests a viral origin on the basis of infection with high-risk oncogenic genotypes of human papilloma viruses (HPV 16/18 and others) and an association with cervical carcinoma. Malignant transformation is rare in bowenoid papulosis. The condition usually shows a good response to immuno-modulatory treatment. In the following we present our first case of successful treatment with imiquimod, a topical immune response modifier which is successfully used in the USA for local treatment of condylomata acuminata. Imiquimod creme (Aldara) proved to be a safe, efficious and practical patient-applied therapeutic option for the treatment of bowenoid papulosis. In view of the oncogenic potential of high-risk HPV infections, irrespective of the treatment used, all patients with bowenoid papulosis and their sexual partners must be included in long-term follow-up and regularly examined for malignant transformation.

[Incidence and risk factors of papillomavirus infection and cervical dysplasia in sexually active adolescent girls]

A cytological examination of 425 sexually active females aged 13-17 established cervical HPV infection incidence at 30.3 +/- 2.2% while that of cervical dysplasia--4.5 +/- 1.0%. The risk factors for HPV infection included low education and income level (p < 0.05), number of sexual partners exceeding three (p < 0.05), poor hygienic standards of woman (p < 0.05) and those of partner (p < 0.001) and smoking of more than 5 cigarettes per day (p < 0.001). The risk factors of cervical epithelial dysplasia were number of partners of 5 or more (p < 0.001), poor hygienic standards of male partner (p < 0.001) and smoking of 10 cigarettes and more per day (p < 0.001), etc.

HHV-8 and multiple myeloma

Recently, a new member of the gamma-herpesvirus family, human herpesvirus 8 (HHV-8), was identified in a case of Kaposi's sarcoma. This virus has also been found in the nonmalignant dendritic cells of the bone marrow from myeloma patients. In addition, HHV-8 is also detectable in the peripheral blood of most patients although its absence suggests earlier stage disease. By contrast, this virus is undetectable in the blood of family members and sexual partners of myeloma patients. Sequencing of HHV-8 open reading frames from myeloma patients show interpatient differences as well as consistent differences in the myeloma samples compared to HHV-8 in other malignancies associated with HHV-8 infection. Consistent expression of both the viral homologues of interferon regulatory factor and IL-8 receptor suggest a possible role for these transforming viral genes in the pathogenesis of myeloma. The latter gene is known to induce angiogenesis and preliminary studies show the abundance of vascular endothelial cells in the bone marrow of myeloma patients.

Human papillomavirus identification and typing of both sexual partners

OBJECTIVE

To investigate the efficacy of diagnostic methods for human papillomavirus (HPV) infection.

STUDY DESIGN

The diagnostic methods were morphologic and immunohistochemical techniques and in situ hybridization. The first ones consisted of (1) a cytologic smear on the females, (2) cytologic examination of a urethral brushing on the males, (3) colposcopy on the females, and (4) histologic examination of the uterine cervix.

RESULTS

A synchronous HPV infection was found in 50% of the sexual partners. HPV was detected also in 30% of cervical biopsies by immunohistochemistry. In situ hybridization was performed on both the cervical biopsies and urethral samples from the males. By this method the same subtype of the virus was observed in both sexes. The types of HPV were identified in 45% of 20 females and 80% of 20 males. Analytically, in men, 7 cases of HPV 6/11 types, 3 cases of 16/18, 5 cases of 31/33/35 and 1 case each of 16/18 and 31/33/35 were observed. In women, in 4 cases subtypes 6/11, in 2 cases types 16/18 and in 3 cases types 31/33/35 were identified.

CONCLUSION

Male partners of women with HPV infection should be investigated in order to produce greater insight into HPV prevalence and the mechanisms of viral transmission.

Replication of equid herpesvirus-1 (EHV-1) in the testes and epididymides of ponies and venereal shedding of infectious virus

Six Welsh Mountain pony colts were infected intranasally with the Ab4 isolate of EHV-1. Clinical and virological monitoring demonstrated mild upper respiratory tract disease, with nasal shedding of virus and establishment of a cell-associated viraemia. Detailed pathological examination of the urogenital tract was performed post mortem on days 4-9 post-infection (PI). EHV-1 was isolated from the epididymis on day 8 and the testis on day 9 PI, with viral replication in endothelial cells of these organs and an associated necrotizing vasculitis and thrombosis. Productive viral infection of germinal epithelium was not observed. In a further study, three Welsh Mountain pony stallions were infected intranasally with Ab4, which again resulted in mild upper respiratory tract disease and the establishment of a cell-associated viraemia. Semen samples were collected up to day 60 PI. Two stallions showed a decrease in the proportion of morphologically normal sperm. Significant numbers of inflammatory cells were observed in the sperm-rich fraction of ejaculates collected from one stallion between days 16 and 28 PI; infectious virus was recovered from the semen of this animal between days 17 and 25 PI, after the cessation of viraemia. The affected stallion appeared clinically normal over the period of venereal EHV-1 shedding.

[The enigma of Kaposi sarcoma]

The epidemiology of AIDS-associated Kaposi's sarcoma (KS) points to a sexually transmittable disease. Despite the fact that a recently discovered new herpesvirus has been detected in all forms of KS (Aids, classic, african and immunosuppressed--KS) its role remains to be further established, since a simple infection cannot account for all epidemiologic findings in KS. Various cytokines seem to play an important role also. The effect of human chorionic gonadotropin on KS can explain the different incidence of KS in males and females. Whether all forms of KS indeed have common causes, today, seems doubtful.

Prevalence of genital human papillomavirus infection in Wellington women

OBJECTIVES

To determine prevalence of human papillomavirus (HPV) in Wellington women, to identify risk factors for HPV infection, to correlate presence of HPV with cervical cytology, and to identify characteristics of women infected with HPV but with normal cytology.

DESIGN

Demographic, social, personal and clinical data were collected by a confidential self-administered coded questionnaire. The presence of DNA from HPV types 6/11, 16 + 18 and 31 + 33 in cervical scrapes was determined by dot-blot DNA hybridisation. All data were correlated with cervical cytology results.

SETTING AND SUBJECTS

Two thousand and twenty one women attending family planning clinics in the Wellington region participated in the study. The mean age of participants was 26 years, 33.3% currently smoked, 72.3% used hormonal contraceptives, 31.4% were married, and 91.4% were of European origin.

RESULTS

We found 10.9% of the study group infected with HPV. HPV types 16 and/or 18 predominated, being detected in 71.5% of HPV-positive women either alone or with other types. Of those infected 26.2% had multiple infections. Dysplasia (n = 87) or atypia (n = 84) were observed in 26.7% of infected women (n = 221) and 6.25% of uninfected women (n = 1792). Over 8% of women with normal smears were HPV positive, and types 16/18 were most common in these women.

CONCLUSIONS

Women with cervical dysplasia or atypia were six times more likely to have HPV infection than other women. The main risk factor for HPV infection, particularly with types 16 and/or 18, was multiple (> 5) sexual partners in the last year independent of other variables. Multivariate analysis of data showed no independent association between HPV infection and ethnicity, educational background, smoking history, marital status, contraceptive use, age at first sexual intercourse, or number of lifetime sexual partners.

Management of human papillomavirus-associated genital lesions in men

A total of 155 men with human papillomavirus (HPV)-associated genital lesions were studied to evaluate therapy for obvious and subclinical lesions. The treatment methods were selected according to type, location, size, and number of lesions. Seventy-three percent of all patients were successfully treated by the initial therapy. Eighty men with minimal disease had a significantly lower treatment failure rate than 75 men with multiple lesions (15 versus 40%; P less than .001). The type of lesions (classical condyloma versus other HPV-associated lesions), visibility (obvious condylomata versus subclinical lesions), and location did not significantly influence the cure rate (P greater than .05). Seventy-six percent of treatment failures were evident at the first follow-up examination. After a follow-up time of 1 year, 95% of men with obvious condylomata and 93% of men with subclinical lesions were disease-free. The results indicate that obvious and subclinical HPV-associated lesions in men may be successfully controlled by one or more treatment modalities adapted to the particular needs of the patient.