Diagnosis of vulvar condyloma acuminatum: clinical and molecular genetic aspects

Apolikhina I.A., Gasanova G.F., Trofimov D.M., Donnikov A.E.

1) Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of the Russian Federation, Moscow, Russia; 2) Department of Obstetrics, Gynecology, Perinatology, and Reproductology, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
Objective. To optimize the diagnosis of vulvar condyloma acuminatum (CA), by expanding the possibilities of using the polymerase chain reaction (PCR) in clinical practice.
Subjects and methods. Ninety patients with vulvar CA were examined. All the examined women underwent vulvoscopy with a vinegar test, high-frequency ultrasound of the skin and vulvar mucosa, human papillomavirus (HPV) typing in the samples of the cervical canal epithelium, scrapes from CA, and its biopsy specimens. Biopsies (n = 90) were performed in AC measuring more than 3 mm in diameter.
Result. Analyzing the identification of HPV types revealed that HPV 6 and HPV 44 were statistically significantly more common in the biopsy specimens of CA than in those of the cervical canal and in the CA scrapes; HPV 11 was found statistically significantly more frequently in the scrapes from CA than in those from the cervical canal and in the biopsy specimens. High-risk HPV types were also detected in the CA biopsy specimens, while the viral load was more often found to be statistically significantly higher in the samples of the cervical canal epithelium. The viral load in the scrapes from CA on the vulvar mucosa turned out to be statistically significantly higher than that in those on the vulvar skin.
Conclusion. CAs on the vulvar mucosa, even with small sizes, are a reservoir of HPV infection and have a more pronounced viral potential than those located on the skin, therefore CAs absolutely require timely and effective treatment.

Keywords

polymerase chain reaction
condyloma acuminatum
human papillomavirus

References

  1. Федеральные клинические рекомендации. Дерматовенерология. Болезни кожи. Инфекции, передаваемые половым путем. М.: Российское общество дерматовенерологов и косметологов; 2016. [Federal clinical guidelines. Dermatovenereology. Skin diseases. Sexually transmitted infections. Russian Society of Dermatovenerologists and Cosmetologists. Moscow. 2016. (In Russian)]
  2. Park I.U., Introcaso C., Dunne E. F. Human papillomavirus and genital warts: a review of the evidence for the 2015 centers for disease control and prevention sexually transmitted diseases treatment guidelines. Clin. Infect. Dis. 2015; 61(Suppl. 8): S849-55.
  3. Лопухов П.Д., Брико Н.И., Цапкова Н.Н., Халдин А.А., Жукова О.В., Исаева Д.Р., Лупашко О.В. Злокачественные и доброкачественные новообразования, обусловленные вирусом папилломы человека, в Российской Федерации и в Москве. Эпидемиология и инфекционные болезни. Актуальные вопросы. 2016; 4: 52-6. [Lopukhov P.D., Briko N.I., Tsapkova N.N. et al. Malignant and benign neoplasms caused by the human papillomavirus in the Russian Federation and in Moscow. Epidemiology and infectious diseases. Current issues. 2016. (In Russ.)]
  4. Кубанова А.А., Кубанов А.А., Мелехина Л.Е., Богданова Е.В. Дерматовенерология в Российской Федерации. Итоги 2014 года. Успехи, достижения. Основные пути развития. Вестник дерматологии и венерологии. 2015; 4: 13-26. [Kubanova A.A., Kubanov A.A., Melekhina L.E., Bogdanova E.V. Dermatovenereology in the Russian Federation. Results of 2014 Successes, achievements. The main ways of development. Bulletin of dermatology and venereology. 2015; 4: 13-26. (In Russ.)]
  5. Grayson W. Infections diseases of the skin. In: Calonje E., BrennT., Lazar T.A., McKee P.H., eds. Mckee’s skin pathology with clinical correlations. 4th ed. Toronto: Elsevier; 2012. Р. 760-95.
  6. Workowski K.A., Bolan G.A.; Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm. Rep. 2015; 64(RR-03): 1-137.
  7. Роговская С.И. Папилломавирусная инфекция гениталий. Клиника и лечение. Заболевания шейки матки. Клинические лекции. М.; 1997. С. 46-51. [Rogovskaya S.I. Papillomavirus infection of the genitals. Clinic and treatment. Diseases of the cervix. Clinical lectures. M.: 1997. Р. 46-51. (In Russian)]
  8. Bosch F.X., Broker T.R., Forman D., Moscicki A.B., Gillison M.L., Doorbar J. et al. Comprehensive сontrol of human papillomavirus infections and related diseases. Vaccine. 2013; 31(Suppl. 7): H1-31.
  9. Garland S.M., Steben M., Sings H.L., James M., Lu S., Railkar R. et al. Natural history of genital warts: analysis of the placebo arm of 2 randomized phase III trials of a quadrivalent human papillomavirus (types 6, 11, 16, and 18) vaccine. J. Infect. Dis. 2009; 199(6): 805-14.
  10. Гасанова Г.Ф., Аполихина И.А., Додова Е.Г., Горбунова Е.А. Комбинированные подходы к терапии остроконечных кондилом наружных половых органов у женщин. Эпидемиология и инфекционные болезни. Актуальные вопросы. 2017; 3: 65-71. [Hasanova G.F., Apolikhina I.A., Dodova E.G., Gorbunova E.A. Combined approaches to the treatment of genital warts of the external genital organs in women. Epidemiology and infectious diseases. Topical issues. 2017; 3: 65-71. (In Russ.)]
  11. Гасанова Г.Ф., Аполихина И.А., Додова Е.Г., Горбунова Е.А., Саидова А.С., Белков П.А., Баширова Л.К. Высокочастотное ультразвуковое исследование в диагностике остроконечных кондилом наружных половых органов у женщин. Акушерство и гинекология. 2017; 11: 141-7. [Hasanova G.F., Apolikhina I.A., Dodova E.G., Gorbunova E.A., Saidova A.S., Belkov P.A., Bashirova L.K. High-frequency ultrasound in the diagnosis of genital warts of the external genital organs in women. Akusherstvo i ginekologiya/Obstetrics and Gynecology. 2017; 11: 141-147. (In Russ.)]
  12. Гасанова Г.Ф., Аполихина И.А. Современные подходы к диагностике кожных проявлений вируса папилломы человека. Акушерство и гинекология. 2015; 11: 11-5. [Hasanova G.F., Apolikhina I.A. Modern approaches to the diagnosis of cutaneous manifestations of human papillomavirus. Akusherstvo i ginekologiya/Obstetrics and gynecology. 2015; 11: 11-15. (In Russ.)]
  13. Ван Крог Г., Лейси С.Н., Гросс Г., Баррассо Р., Шнайдер А. Европейский клуб по заболеваниям, ассоциированным с ВПЧ: рекомендации для врачей общей практики по диагностике и лечению аногенитальных бородавок. Инфекции, передаваемые половым путем. 2001; 1: 5-13. [Van Krog G., Lacey S.N., Gross G., Barrasso R., Schneider A. European Club for HPV-associated diseases: recommendations for general practitioners in the diagnosis and treatment of anogenital warts. Sexually transmitted infections. 2001; 1: 5-13. (In Russ.)]
  14. Европейские стандарты диагностики и лечения заболеваний, передаваемых половым путем. М.: Медлит; 2004. 272 с. [European standards for the diagnosis and treatment of sexually transmitted diseases. M.: Medlit; 2004.272 p.(In Russ.)]
  15. Шипулин Г.А., Шипулина О.Ю. Разработка и апробация ПЦР-тестов для проведения скрининговых исследований на наличие папилломавирусной инфекции и предраковых заболеваний шейки матки. Информационное письмо № 2. – Департамент здравоохранения г. Москвы. М.: ФГУН «Центральный НИИ эпидемиологии» Роспотребнадзора; 15 марта 2006. [Shipulin G.A., Shipulina O.Yu. Development and testing of PCR tests for screening studies for the presence of human papillomavirus infection and precancerous diseases of the cervix. Information letter No. 2. – Moscow Department of Health, Central Research Institute of Epidemiology, Federal Service for Health and Social Development, Rospotrebnadzor, Moscow, 15 March 2006. (In Russ.)]
  16. Molijn A., Kleter B., Quint W., van Doom L.J. Molecular diagnosis of human papillomavirus (HPV) infections. J. Clin. Virol. 2005; 32(Suppl.1): 43-51.
  17. Lin P.R., ShaoM.F., Liu J.Y. One-tube, nested PCR assay for the detection Trichomonasvaginalis in the vaginal discharges. Ann Trop. Med. Parasitol. 1997; 91(1): 61-5.
  18. Moberg M., Gustavsson I., Wilander E., Gyllensten U. High viralloads of human papillomavirus predict risk of invasive cervical carcinoma. Br. J. Cancer. 2005; 92(5): 891-4.
  19. Snijders J., van den Brule A., Meijer C. Clinical relevance of HPV testing: relationship between analytical and clinical sensitivity. J. Pathol. 2003; 201(1): 1-6.
  20. Van Duin M., Snijders P., Schrijnemakers H. Human papillomavirus 16 load in normal and abnormal cervical scrapes: an indicator of CIN II/III and viral clearance. Int. J. Cancer. 2002; 98(4): 590-5.
  21. Прилепская В.Н., ред. Патология шейки матки и генитальные инфекции. М.: МЕДпресс-информ; 2008. 383 с. [Pathology of the cervix and genital infections. Еd. V.P. Prilepsky. M.: Medpress-inform; 2008. 383 p.(In Russian)]
  22. Шипицына Е.В., Оржесковская Е.А., Бабкина К.А., Савичева A.M., Микая Н.А., Орлова О.О., Юркова И.К. Определение вирусной нагрузки и статуса ДНК вируса папилломы человека 16 типа методом ПЦР в реальном времени. Журнал акушерства и женских болезней. 2004; 53(4): 26-32. [Shipitsyna E.V., Orzheskovskaya E.A., Babkina K.A., Savicheva A.M., Mikaya N.A., Orlova O.O., Yurkova I.K. Determination of viral load and DNA status of human papillomavirus type 16 by real-time PCR. Journal of Obstetrics and Women’s Diseases. 2004; 53 (4): 26-32. (In Russ.)]
  23. Garland S.M.,Tabrizi S. In: J. Monsonego Emerging issues on HPV infection. Basel: Karger; 2006. Available at: www.carger.com.
  24. Anic G.M., Messina J.L., Stoler M.H., Rollison D.E., Stockwell H., Villa L.L. et al. Concordance of human papillomavirus types detected on the surface and in the tissue of genital lesions in men. J. Med.Virol. 2013; 85(9): 1561-6.
  25. Meyer T., Arndt R., Christophers E., Beckmann E.R., Schroder S., Gissmann L. et al. Association of rare human papillomavirus types with genital premalignant and malignant lesions. J. Infect. Dis. 1998; 178(1): 252-5.
  26. Brown D.R., Schroeder J.M., Bryan J.M., Stoler M.H., Fife K.H. Detection of multiple human papillomavirus types in Condylomata acuminata lesions from otherwise healthy and immunosuppressed patients. J. Clin. Microbiol. 1999; 37(10): 3316-22.
  27. Lacey C.J., Woodhall S.C., Wikstrom A., Ross J. 2011 European guideline for the management of anogenital warts. IUSTI 2011.GW guidelines V7 13.09.11.
  28. Lacey C.J., Lowndes C.M., Shah KV. Chapter 4: Burden and management of non-cancerous HPV-related conditions: HPV-6/11 disease. Vaccine. 2006; 24(Suppl. 3): S35-41.
  29. Pista A., Oliveira A., Verdasca N., Ribeiro F. Single and multiple human papillomavirus infections in cervical abnormalities in Portuguese women. Clin. Microbiol. Infect. 2011; 17(6): 941-6.
  30. Hawkins M.G., Winder D.M., Ball S.L., Vaughan K., Sonnex C., Stanley M.A. et al. Detection of specific HPV subtypes responsible for the pathogenesis of condylomata acuminata. Virol. J. 2013; 10: 137.
  31. Yaghoobi R., Makvandi M., Afshar N., Pazyar N., Hamidifard M., Sharifpour C. High frequency of human papillomavirus genotype 16 among patients with anogenital warts. Jundishapur J. Microbiol. 2015; 8(11): e25882.
  32. Bhageerathy P.S., Cecilia M., Sebastian A., Raghavendran A., Abraham P., Thomas A., Peedicayil A. Human papilloma virus-16 causing giant condyloma acuminata. J. Surg. Case Rep. 2014; 2014 (1).

Received 11.01.2019

Accepted 22.02.2019

About the Authors

Apolikhina Inna A., MD, Professor, Head of aesthetical gynecology and rehabilitation department, Federal budget state institution V. I. Kulakov National Research Centre
for Obstetrics Gynecology and Perinatology, e-mail: apolikhina@inbox.ru, tel.+79854100811, ORCHID iD 0000-0002-4581-6295
Gasanova Gulnar F., graduent student of the Federal budget state institution “National Research Centre for Obstetrics Gynecology and Perinatology n. a. V. I. Kulakov”, e-mail: ice8507@rambler.ru, tel.+79256366822
Trofimov Dmitriy Y., MD, Professor, Head of clinical and molecular genetics Department of V. I. Kulakov Russian National Medical Research Centre for Obstetrics Gynecology and Perinatology, e-mail: d_trofimov@oparina4.ru
Donnikov Andrey E., PhD, Head of Laboratory of molecular-genetic methodsof V. I. Kulakov Russian National Medical Research Centre for Obstetrics Gynecology and Perinatology, e-mail: a_donnikov@oparina4.ru

For citation: Apolikhina I.A., Gasanova G.F., Trofimov D.M., Donnikov A.E. Diagnosis of vulvar condyloma acuminatum: clinical and molecular genetic aspects.
Akusherstvo i ginekologiya/Obstetrics and Gynecology. 2019;(8):112-18 (in Russian)
https://dx.doi.org/10.18565/aig.2019.8.
By continuing to use our site, you consent to the processing of cookies that ensure the proper functioning of the site.