今日の臨床サポート

尖圭コンジローマ(婦人科)

著者: 川名敬 日本大学医学部 産婦人科学系 産婦人科学分野

監修: 小林裕明 鹿児島大学大学院医歯学総合研究科生殖病態生理学

著者校正/監修レビュー済:2021/03/10
参考ガイドライン:
  1. 日本性感染症学会:性感染症 診断・治療ガイドライン 2020年版
患者向け説明資料

概要・推奨   

  1. 臨床症状・所見により診断は可能であるが、症例によっては組織診により確定診断する(推奨度2)
  1. 外性器または肛門周囲に病変を有する患者を対象としたイミキモド5%クリームの有効性を調べた試験では、4週間塗布で病変面積の約80%が消失する(推奨度2)
  1. 難治性の病変ではまれに外陰癌に変化することがある。病変の所見が変化したら、生検による組織検査を行う(推奨度1
  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契
  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となり
  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧には
  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契
  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約
  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧には
薬剤監修について:
オーダー内の薬剤用量は日本医科大学付属病院 薬剤部 部長 伊勢雄也 以下、林太祐、渡邉裕次、井ノ口岳洋、梅田将光による疑義照会のプロセスを実施、疑義照会の対象については著者の方による再確認を実施しております。
※薬剤中分類、用法、同効薬、診療報酬は、エルゼビアが独自に作成した薬剤情報であり、
著者により作成された情報ではありません。
尚、用法は添付文書より、同効薬は、薬剤師監修のもとで作成しております。
※薬剤情報の(適外/適内/⽤量内/⽤量外/㊜)等の表記は、エルゼビアジャパン編集部によって記載日時にレセプトチェックソフトなどで確認し作成しております。ただし、これらの記載は、実際の保険適用の査定において保険適用及び保険適用外と判断されることを保証するものではありません。また、検査薬、輸液、血液製剤、全身麻酔薬、抗癌剤等の薬剤は保険適用の記載の一部を割愛させていただいています。
(詳細はこちらを参照)
著者のCOI(Conflicts of Interest)開示:
川名敬 : 特に申告事項無し[2021年]
監修:小林裕明 : 講演料(中外製薬株式会社,アストラゼネカ株式会社),奨学(奨励)寄付など(中外製薬株式会社)[2021年]

改訂のポイント:
  1. 梅毒の流行期には、扁平コンジローマ(梅毒第2期)との鑑別のため、梅毒抗体検査を行うことを追記した。
  1. 4価HPVワクチンの男性への接種が国内で承認されたことを追記した。

病態・疫学・診察

疾患情報(疫学・病態)  
  1. 尖圭コンジローマは10万対で30人程度が罹患する。男女比は1:1で、女性は20歳代、男性は30歳代がピークとなる[1]
 
尖圭コンジローマの年齢別の男女患者数

全国971の定点医療機関から尖圭コンジローマと診断、報告された男女別年齢分布

 
  1. ヒトパピローマウイルス(HPV)6型もしくは11型が性行為によって生殖器に感染することによって発症する。
  1. HPV6型もしくは11型感染者の75%以上は発症する。感染から発症までの潜伏期間は3週~8カ月(平均2.8カ月)である[2][3]
  1. 生殖器粘膜もしくは皮膚に性交時にできた微細な傷からHPVが侵入し、重層扁平上皮の基底細胞に到達することによって感染が成立する。良性乳頭腫であり、有茎性のイボ(疣贅)を形成する。
  1. 出血、疼痛、痒みを伴うことは原則的にはないが、疣贅の茎が裂ける場合は出血・疼痛を伴う[3]
  1. 病変の好発部位は、女性では外陰、腟壁、子宮頸部、腟前庭、男性では外陰、陰茎、会陰、陰嚢、男女ともに会陰、肛門内、尿道口である。
  1. 治療は、イミキモド5%クリームの外用が第1選択である。外科的治療法として凍結療法、外科切除、焼灼、レーザー蒸散も有効である[3]
  1. 外科的治療法では治療が奏効しても再発率が高い(治療後3カ月で10~30%再発する)。治療後も再発のチェックが必要である[3][4]
  1. 悪性化することはきわめてまれである。他の腫瘍性病変との鑑別のため生検による組織診断が必要である。
  1. 梅毒流行期では、2期梅毒である扁平コンジローマとの鑑別を行うために、梅毒抗体検査を行う。
  1. 妊娠に伴って発症することがあり、妊婦では薬物療法は慎重投与であるため外科的治療が望ましい。ただし再発率が高いのでフォローが重要である。
  1. 尖圭コンジローマ合併妊婦から生まれた児にまれに母子感染症(再発性呼吸器乳頭腫症)を発症する[5]
  1. 4価HPVワクチンによって予防し得る疾患である[6]
 
  1. 尖圭コンジローマ患者では、ハイリスク型HPVの子宮頸部への感染にも注意する。
  1. 尖圭コンジローマがある女性では、ない女性に比べて子宮頸部細胞診異常が約2倍となる[7]。したがって尖圭コンジローマ患者では必ず子宮頸がんの癌検診も必要である。
  1. 当科を受診して尖圭コンジローマと診断された女性のうち53%には子宮頸部にハイリスク型HPVが検出された。HPV6型もしくは11型で悪性腫瘍を発症することはきわめてまれであるが、それ以外にハイリスク型HPVが混合感染している可能性があることを患者に説明する必要がある。
  1. 女性の尖圭コンジローマ患者では、子宮頸がん検診が不可欠である。
 
  1. 尖圭コンジローマはHPVワクチンによって予防できる性感染症である(推奨度1)
  1. 4価HPVワクチン(ガーダシル)の16~26歳を対象にした3つの大規模臨床試験(世界数十カ国)を統合して解析した[8][9][10]。表(<図表>)では、14タイプのHPV-DNAが陰性かつワクチンタイプ(6/11/16/18)の抗体が陰性である集団を“未感染者の集団”(per-protocol efficacy: PPE群)と記している。PPE群では、HPV6/11/16/18のいずれかに起因する各臓器の前癌病変(CIN2/3、AIS、VIN2/3、VaIN2/3)の発症をほぼ100%予防していることがわかる。すなわち3.5~4年の追跡期間中にプラセボ群では各評価疾患がある程度発生しているが、ワクチン群ではほとんど疾患が発生していない(<図表>)。この結果から、絶対的なHPV未感染者である学童女子にHPVワクチンを接種すれば、HPV6/11による尖圭コンジローマ、HPV16/18による子宮頸がん、外陰癌、腟癌はほぼ撲滅できると推察される。一方、ワクチンタイプの既感染者、有病者などを含む一般集団(intention-to-treat: ITT群)では、ワクチン群にも評価疾患が発生しているため、予防効果としては子宮頸部疾患で約50%、外陰、腟疾患で70~80%と低下するが、それでも集団として考えると有意差を持って患者数が減少することが証明されている(<図表>)。特に外陰、腟疾患、尖圭コンジローマではITT群としては高い予防効果が示され、成人女性に対する有効性が期待される。
  1. 豪州では、国家プロジェクトとして2007年からHPV4価ワクチン(ガーダシル)の集団接種を12~13歳の学童女子に行い、さらに13~26歳の女性に2年間の無料接種キャンペーンを実施した。その間ビクトリア州では、学童児で80~90%、13~26歳女性でも70%前後の接種率を得た。その結果、豪州ではすでに尖圭コンジローマ患者が減少していることが報告されている。2007年のワクチンプログラム開始後、28歳以下のワクチン接種を受けていると思われる世代の女性の尖圭コンジローマ患者数だけが減少しはじめ、たった4年間で患者数が1/4になっている[11]
  1. 尖圭コンジローマは予防ワクチンによって根絶できる性感染症である。HPVワクチン接種は性交未経験者である学童女子が最も有効である。
  1. 日本では2011年から、中1~高1女子に対して全自治体でHPVワクチンの公的助成(多くは無料)による接種が始まっている。さらに定期接種化の方向で進んでいる。国内でも2020年12月に4価HPVワクチンは男性への接種が承認された。
 
4価HPVワクチンによるHPV6/11/16/18に起因する疾患予防効果

16-26歳女性における4価HPVワクチン(ガーダシル)接種群とプラセボ群の疾患発生数と疾患予防効果。PPE群はウイルス学的に未感染者と考えられる集団。ほぼ100%疾患が予防されている。ITT群は全接種対象の集団で、既感染者や有病者を含む集団。尖圭コンジローマは70-80%に近い予防効果が期待できる。

出典

img1:  The mitochondrial chaperonin hsp60 is required for its own assembly.
 
 Nature. 1990 Nov 29;348(6300):455-8. doi・・・
img2:  Impact of human papillomavirus (HPV)-6/11/16/18 vaccine on all HPV-associated genital diseases in young women.
 
 J Natl Cancer Inst. 2010 Mar 3;102(5):32・・・
問診・診察のポイント  
問診:
  1. イボを自覚した時期を確認し、新しいパートナーの有無とそのパートナーとの性交開始時期は診断の参考となる。

これより先の閲覧には個人契約のトライアルまたはお申込みが必要です。

最新のエビデンスに基づいた二次文献データベース「今日の臨床サポート」。
常時アップデートされており、最新のエビデンスを各分野のエキスパートが豊富な図表や処方・検査例を交えて分かりやすく解説。日常臨床で遭遇するほぼ全ての症状・疾患から薬剤・検査情報まで瞬時に検索可能です。

まずは15日間無料トライアル
本サイトの知的財産権は全てエルゼビアまたはコンテンツのライセンサーに帰属します。私的利用及び別途規定されている場合を除き、本サイトの利用はいかなる許諾を与えるものでもありません。 本サイト、そのコンテンツ、製品およびサービスのご利用は、お客様ご自身の責任において行ってください。本サイトの利用に基づくいかなる損害についても、エルゼビアは一切の責任及び賠償義務を負いません。 また、本サイトの利用を以て、本サイト利用者は、本サイトの利用に基づき第三者に生じるいかなる損害についても、エルゼビアを免責することに合意したことになります。  本サイトを利用される医学・医療提供者は、独自の臨床的判断を行使するべきです。本サイト利用者の判断においてリスクを正当なものとして受け入れる用意がない限り、コンテンツにおいて提案されている検査または処置がなされるべきではありません。 医学の急速な進歩に鑑み、エルゼビアは、本サイト利用者が診断方法および投与量について、独自に検証を行うことを推奨いたします。

文献 

著者: Tim R H Read, Jane S Hocking, Marcus Y Chen, Basil Donovan, Catriona S Bradshaw, Christopher K Fairley
雑誌名: Sex Transm Infect. 2011 Dec;87(7):544-7. doi: 10.1136/sextrans-2011-050234. Epub 2011 Oct 4.
Abstract/Text BACKGROUND: Australia provided free quadrivalent human papillomavirus vaccines to 12-18-year-old girls and women aged ≤26 years from mid-2007 until the end of 2009. After this time, only girls aged 12-13 years had access to free vaccines.
METHODS: Before and after the study, of the proportion of new patients attending Melbourne Sexual Health Centre from mid-2004 to mid-2011, diagnosed with genital warts (GW) by risk group.
RESULTS: From July 2004 to June 2011, 52 454 new patients were seen at Melbourne Sexual Health Centre and 5021 (9.6%, 95% CI 9.3% to 9.8%) were diagnosed with GW. From July 2004 to June 2007, the proportions with GW either increased or did not change in all groups. Comparing the two 12-month periods of 2007/2008 and 2010/2011, GW declined in women under 21 years from 18.6% to 1.9% and in heterosexual men under 21 years from 22.9% to 2.9%. The ORs per year for diagnosis of GW adjusted for number of sexual partners from July 2007 until June 2011 in women and heterosexual men <21 years were 0.44 (95% CI 0.32 to 0.58) and 0.42 (95% CI 0.31 to 0.60), respectively. There was no significant change in GW in women ≥30 years (OR 0.97, 95% CI 0.84 to 1.12), heterosexual men ≥30 years (OR 0.97, 95% CI 0.89 to 1.06) or in homosexual men (OR 0.95, 95% CI 0.85 to 1.07).
CONCLUSION: The dramatic decline and near disappearance of GW in women and men under 21 years of age, 4 years after commencing this programme, suggest that the basic reproductive rate has fallen below one.

PMID 21970896  Sex Transm Infect. 2011 Dec;87(7):544-7. doi: 10.1136/s・・・
著者: C Munk, E I Svare, P Poll, J E Bock, S K Kjaer
雑誌名: Sex Transm Dis. 1997 Nov;24(10):567-72.
Abstract/Text BACKGROUND AND OBJECTIVES: The most important risk factor for cervical neoplasia is genital infection with certain types of human papillomavirus (HPV). Genital warts (GW) are an easily recognizable condition caused by HPV. Although only a fraction of HPV infections are clinical, a history of ever having had GW could serve as a marker for exposure to HPV.
GOALS: To study the risk factors for ever having had GW. The association of GW with abnormal Papanicolaou (Pap) smear and relation to cervical neoplasia is also discussed.
STUDY DESIGN: A case-control study among 10,838 women aged 20 to 29 years and reporting at least one lifetime sexual partner. The women were participants in a prospective cohort study on the relationship between HPV and cervical neoplasia in Copenhagen, Denmark. Data were obtained by means of personal interviews using structured questionnaires.
RESULTS: In all, 1,820 women (17%) reported ever having had GW. The most important risk factor was the number of lifetime of sexual partners (adjusted odds ratio 5.2; 95% confidence interval: 3.4-8.0) for at least 40 partners vs. 1 to 2 partners). The number of regular partners, sexually active years, a history of chlamydial infection, and smoking were also associated with the risk of ever having had GW. Women who had had GW were 1.9 times more likely than other women to report an abnormal Pap smear.
CONCLUSIONS: The study confirms the sexual transmission of the infection. There is also good concordance between risk factors for ever having had GW and cervical neoplasia. A close relationship between having had GW and an abnormal Pap smear was observed.

PMID 9383844  Sex Transm Dis. 1997 Nov;24(10):567-72.
著者: J Paavonen, P Naud, J Salmerón, C M Wheeler, S-N Chow, D Apter, H Kitchener, X Castellsague, J C Teixeira, S R Skinner, J Hedrick, U Jaisamrarn, G Limson, S Garland, A Szarewski, B Romanowski, F Y Aoki, T F Schwarz, W A J Poppe, F X Bosch, D Jenkins, K Hardt, T Zahaf, D Descamps, F Struyf, M Lehtinen, G Dubin, HPV PATRICIA Study Group
雑誌名: Lancet. 2009 Jul 25;374(9686):301-14. doi: 10.1016/S0140-6736(09)61248-4. Epub 2009 Jul 6.
Abstract/Text BACKGROUND: The human papillomavirus (HPV)-16/18 AS04-adjuvanted vaccine was immunogenic, generally well tolerated, and effective against HPV-16 or HPV-18 infections, and associated precancerous lesions in an event-triggered interim analysis of the phase III randomised, double-blind, controlled PApilloma TRIal against Cancer In young Adults (PATRICIA). We now assess the vaccine efficacy in the final event-driven analysis.
METHODS: Women (15-25 years) were vaccinated at months 0, 1, and 6. Analyses were done in the according-to-protocol cohort for efficacy (ATP-E; vaccine, n=8093; control, n=8069), total vaccinated cohort (TVC, included all women receiving at least one vaccine dose, regardless of their baseline HPV status; represents the general population, including those who are sexually active; vaccine, n=9319; control, n=9325), and TVC-naive (no evidence of oncogenic HPV infection at baseline; represents women before sexual debut; vaccine, n=5822; control, n=5819). The primary endpoint was to assess vaccine efficacy against cervical intraepithelial neoplasia 2+ (CIN2+) that was associated with HPV-16 or HPV-18 in women who were seronegative at baseline, and DNA negative at baseline and month 6 for the corresponding type (ATP-E). This trial is registered with ClinicalTrials.gov, number NCT00122681.
FINDINGS: Mean follow-up was 34.9 months (SD 6.4) after the third dose. Vaccine efficacy against CIN2+ associated with HPV-16/18 was 92.9% (96.1% CI 79.9-98.3) in the primary analysis and 98.1% (88.4-100) in an analysis in which probable causality to HPV type was assigned in lesions infected with multiple oncogenic types (ATP-E cohort). Vaccine efficacy against CIN2+ irrespective of HPV DNA in lesions was 30.4% (16.4-42.1) in the TVC and 70.2% (54.7-80.9) in the TVC-naive. Corresponding values against CIN3+ were 33.4% (9.1-51.5) in the TVC and 87.0% (54.9-97.7) in the TVC-naive. Vaccine efficacy against CIN2+ associated with 12 non-vaccine oncogenic types was 54.0% (34.0-68.4; ATP-E). Individual cross-protection against CIN2+ associated with HPV-31, HPV-33, and HPV-45 was seen in the TVC.
INTERPRETATION: The HPV-16/18 AS04-adjuvanted vaccine showed high efficacy against CIN2+ associated with HPV-16/18 and non-vaccine oncogenic HPV types and substantial overall effect in cohorts that are relevant to universal mass vaccination and catch-up programmes.
FUNDING: GlaxoSmithKline Biologicals.

PMID 19586656  Lancet. 2009 Jul 25;374(9686):301-14. doi: 10.1016/S014・・・
著者: Susanne K Kjaer, Kristján Sigurdsson, Ole-Erik Iversen, Mauricio Hernandez-Avila, Cosette M Wheeler, Gonzalo Perez, Darron R Brown, Laura A Koutsky, Eng Hseon Tay, Patricia García, Kevin A Ault, Suzanne M Garland, Sepp Leodolter, Sven-Eric Olsson, Grace W K Tang, Daron G Ferris, Jorma Paavonen, Matti Lehtinen, Marc Steben, F Xavier Bosch, Joakim Dillner, Elmar A Joura, Slawomir Majewski, Nubia Muñoz, Evan R Myers, Luisa L Villa, Frank J Taddeo, Christine Roberts, Amha Tadesse, Janine Bryan, Roger Maansson, Shuang Lu, Scott Vuocolo, Teresa M Hesley, Alfred Saah, Eliav Barr, Richard M Haupt
雑誌名: Cancer Prev Res (Phila). 2009 Oct;2(10):868-78. doi: 10.1158/1940-6207.CAPR-09-0031. Epub 2009 Sep 29.
Abstract/Text Quadrivalent human papillomavirus (HPV) vaccine has been shown to provide protection from HPV 6/11/16/18-related cervical, vaginal, and vulvar disease through 3 years. We provide an update on the efficacy of the quadrivalent HPV vaccine against high-grade cervical, vaginal, and vulvar lesions based on end-of-study data from three clinical trials. Additionally, we stratify vaccine efficacy by several baseline characteristics, including age, smoking status, and Papanicolaou (Pap) test results. A total of 18,174 females ages 16 to 26 years were randomized and allocated into one of three clinical trials (protocols 007, 013, and 015). Vaccine or placebo was given at baseline, month 2, and month 6. Pap testing was conducted at regular intervals. Cervical and anogenital swabs were collected for HPV DNA testing. Examination for the presence of vulvar and vaginal lesions was also done. Endpoints included high-grade cervical, vulvar, or vaginal lesions (CIN 2/3, VIN 2/3, or VaIN 2/3). Mean follow-up time was 42 months post dose 1. Vaccine efficacy against HPV 6/11/16/18-related high-grade cervical lesions in the per-protocol and intention-to-treat populations was 98.2% [95% confidence interval (95% CI), 93.3-99.8] and 51.5% (95% CI, 40.6-60.6), respectively. Vaccine efficacy against HPV 6/11/16/18-related high-grade vulvar and vaginal lesions in the per-protocol and intention-to-treat populations was 100.0% (95% CI, 82.6-100.0) and 79.0% (95% CI, 56.4-91.0), respectively. Efficacy in the intention-to-treat population tended to be lower in older women, women with more partners, and women with abnormal Pap test results. The efficacy of quadrivalent HPV vaccine against high-grade cervical and external anogenital neoplasia remains high through 42 months post vaccination.

PMID 19789295  Cancer Prev Res (Phila). 2009 Oct;2(10):868-78. doi: 10・・・
著者: Nubia Muñoz, Susanne K Kjaer, Kristján Sigurdsson, Ole-Erik Iversen, Mauricio Hernandez-Avila, Cosette M Wheeler, Gonzalo Perez, Darron R Brown, Laura A Koutsky, Eng Hseon Tay, Patricía J Garcia, Kevin A Ault, Suzanne M Garland, Sepp Leodolter, Sven-Eric Olsson, Grace W K Tang, Daron G Ferris, Jorma Paavonen, Marc Steben, F Xavier Bosch, Joakim Dillner, Warner K Huh, Elmar A Joura, Robert J Kurman, Slawomir Majewski, Evan R Myers, Luisa L Villa, Frank J Taddeo, Christine Roberts, Amha Tadesse, Janine T Bryan, Lisa C Lupinacci, Katherine E D Giacoletti, Heather L Sings, Margaret K James, Teresa M Hesley, Eliav Barr, Richard M Haupt
雑誌名: J Natl Cancer Inst. 2010 Mar 3;102(5):325-39. doi: 10.1093/jnci/djp534. Epub 2010 Feb 5.
Abstract/Text BACKGROUND: The impact of the prophylactic vaccine against human papillomavirus (HPV) types 6, 11, 16, and 18 (HPV6/11/16/18) on all HPV-associated genital disease was investigated in a population that approximates sexually naive women in that they were "negative to 14 HPV types" and in a mixed population of HPV-exposed and -unexposed women (intention-to-treat group).
METHODS: This analysis studied 17 622 women aged 15-26 years who were enrolled in one of two randomized, placebo-controlled, efficacy trials for the HPV6/11/16/18 vaccine (first patient on December 28, 2001, and studies completed July 31, 2007). Vaccine or placebo was given at day 1, month 2, and month 6. All women underwent cervicovaginal sampling and Papanicolaou (Pap) testing at day 1 and every 6-12 months thereafter. Outcomes were any cervical intraepithelial neoplasia; any external anogenital and vaginal lesions; Pap test abnormalities; and procedures such as colposcopy and definitive therapy. Absolute rates are expressed as women with endpoint per 100 person-years at risk.
RESULTS: The average follow-up was 3.6 years (maximum of 4.9 years). In the population that was negative to 14 HPV types, vaccination was up to 100% effective in reducing the risk of HPV16/18-related high-grade cervical, vulvar, and vaginal lesions and of HPV6/11-related genital warts. In the intention-to-treat group, vaccination also statistically significantly reduced the risk of any high-grade cervical lesions (19.0% reduction; rate vaccine = 1.43, rate placebo = 1.76, difference = 0.33, 95% confidence interval [CI] = 0.13 to 0.54), vulvar and vaginal lesions (50.7% reduction; rate vaccine = 0.10, rate placebo = 0.20, difference = 0.10, 95% CI = 0.04 to 0.16), genital warts (62.0% reduction; rate vaccine = 0.44, rate placebo = 1.17, difference = 0.72, 95% CI = 0.58 to 0.87), Pap abnormalities (11.3% reduction; rate vaccine = 10.36, rate placebo = 11.68, difference = 1.32, 95% CI = 0.74 to 1.90), and cervical definitive therapy (23.0% reduction; rate vaccine = 1.97, rate placebo = 2.56, difference = 0.59, 95% CI = 0.35 to 0.83), irrespective of causal HPV type.
CONCLUSIONS: High-coverage HPV vaccination programs among adolescents and young women may result in a rapid reduction of genital warts, cervical cytological abnormalities, and diagnostic and therapeutic procedures. In the longer term, substantial reductions in the rates of cervical, vulvar, and vaginal cancers may follow.

PMID 20139221  J Natl Cancer Inst. 2010 Mar 3;102(5):325-39. doi: 10.1・・・
著者: Basil Donovan, Neil Franklin, Rebecca Guy, Andrew E Grulich, David G Regan, Hammad Ali, Handan Wand, Christopher K Fairley
雑誌名: Lancet Infect Dis. 2011 Jan;11(1):39-44. doi: 10.1016/S1473-3099(10)70225-5. Epub 2010 Nov 8.
Abstract/Text BACKGROUND: Quadrivalent human papillomavirus (HPV) vaccine has high efficacy in clinical trials but no reports describe its effects at a population level. From July, 2007, Australia was the first country to fund a vaccination programme for all women aged 12-26 years. We established a national surveillance network in Australia and aimed to identify trends in diagnoses of genital warts in 2004-09.
METHODS: We obtained standardised data for demographic factors, frequency of genital warts, HPV vaccination status, and sexual behaviour for new patients attending eight sexual health services in Australia between January, 2004, and December, 2009. We used χ² analysis to identify significant trends in proportions of patients diagnosed with warts in periods before and after vaccination began. Our primary group of interest was female Australian residents who were eligible for free vaccination, although data were assessed for patients ineligible for free vaccination, including women older than 26 years of age, non-resident women, and men.
FINDINGS: Among 112 083 new patients attending sexual health services, we identified 9867 (9%) cases of genital warts. Before the vaccine programme started, there was no change in proportion of women or heterosexual men diagnosed with genital warts. After vaccination began, a decline in number of diagnoses of genital warts was noted for young female residents (59%, p(trend)<0·0001). No significant decline was noted in female non-residents, women older than 26 years in July, 2007, or in men who have sex with men. However, proportionally fewer heterosexual men were diagnosed with genital warts during the vaccine period (28%, p(trend)<0·0001), and this effect was more pronounced in young men. By 2009, 65·1% of female Australian residents who were eligible for free vaccine reported receipt of quadrivalent or unknown HPV vaccine.
INTERPRETATION: The decrease in frequency of genital warts in young Australian women resulting from the high coverage of HPV vaccination might provide protective effects in heterosexual men through herd immunity.
FUNDING: CSL Biotherapies.

Copyright © 2011 Elsevier Ltd. All rights reserved.
PMID 21067976  Lancet Infect Dis. 2011 Jan;11(1):39-44. doi: 10.1016/S・・・
著者: S M Garland, J W Sellors, A Wikstrom, C S Petersen, C Aranda, S Aractingi, R D Maw, Imiquimod Study Group
雑誌名: Int J STD AIDS. 2001 Nov;12(11):722-9.
Abstract/Text Our objective was to determine the efficacy and safety of imiquimod 5% cream in the treatment of external genital/perianal warts in an open-label Phase IIIB trial. Patients applied imiquimod 5% cream 3 times per week, for up to 16 weeks. Those who cleared their warts were monitored during a 6-month follow-up period. If their warts recurred, or new warts developed during this time, patients could be re-treated for up to 16 additional weeks. Patients who experienced partial clearance during the initial treatment period entered an extended treatment period of up to an additional 16 weeks. A total of 943 patients from 114 clinic sites in 20 countries participated in this study. Complete clinical clearance was observed in 451/943 (47.8%) patients (intent-to-treat (ITT) analysis) during the initial treatment period, with clearance in an additional 52 (5.5%) patients during the extended treatment period beyond 16 weeks. The overall clearance rate for the combined treatment periods was 53.3%. In a treatment failure analysis, the overall clearance rate was 65.5%; a greater proportion of female patients (75.5%) experienced complete clearance than male patients (56.9%). Low recurrence rates, of 8.8% and 23.0%, were observed at the end of the 3- and 6-month follow-up periods, respectively. The sustained clearance rates (patients who cleared during treatment and remained clear at the end of the follow-up period) after 3 and 6 months were 41.6% and 33.0% (ITT analysis), respectively. Local erythema occurred in 67% of patients. In the majority of patients local skin reactions were of mild to moderate severity. In conclusion, imiquimod 5% cream is an effective self-applied treatment for external genital/perianal warts when applied for up to 16 weeks and is well tolerated for up to 32 weeks.

PMID 11589811  Int J STD AIDS. 2001 Nov;12(11):722-9.
著者: Helmut Schöfer, Arndt Van Ophoven, Ulrike Henke, Tamara Lenz, Angelika Eul
雑誌名: Eur J Dermatol. 2006 Nov-Dec;16(6):642-8.
Abstract/Text Conventional ablative treatments for external anogenital warts are affected by high recurrence rates. This study compared sustained clearance after ablation vs. treatment with imiquimod 5% cream vs. the combination of both methods. This was a 3-arm, open-label, randomized clinical study comparing ablation alone (Group A), imiquimod 5% cream monotherapy (Group B), or combined ablation followed by topical imiquimod (Group C). Subjects whose anogenital warts were completely cleared entered a 6-month follow-up to evaluate sustained clearance. After 3 months follow-up, 83.9% (73/87), 93.8% (90/96) and 91.7% (66/72) of subjects in Groups A, B, C, respectively, remained free of recurrent anogenital warts. After 6-months follow-up, 73.6% (64/87), 93.7% (89/95) and 91.5% (65/71) of subjects presented free of recurrence (Group A vs. B & C p-values each p < 0.004 in favour of the imiquimod-treated groups). Imiquimod 5% cream, as monotherapy or in combination with ablation, was superior to ablation alone in reducing the recurrence of successfully treated anogenital warts.

PMID 17229604  Eur J Dermatol. 2006 Nov-Dec;16(6):642-8.
著者: Keerti V Shah
雑誌名: J Infect Dis. 2014 May 1;209(9):1307-9. doi: 10.1093/infdis/jit611. Epub 2013 Nov 21.
Abstract/Text Juvenile-onset recurrent respiratory papillomatosis (JORRP) is a rare disease caused by intrapartum or perinatal transmission of human papillomavirus (HPV) types 6 and 11 from an infected mother to the newborn. Immunization of a pregnant woman who has condyloma or HPV-6/11 infection with the quadrivalent HPV vaccine will result in a high neutralizing antibody response to HPV 6 and HPV 11 in her serum, and these antibodies transferred to the newborn will likely protect the child against the development of JORRP. Because of the low incidence of disease in at-risk children, it may be difficult to test the effectiveness of maternal immunization for prevention of JORRP.

PMID 24265442  J Infect Dis. 2014 May 1;209(9):1307-9. doi: 10.1093/in・・・
著者: Kimberly A Workowski, Stuart Berman, Centers for Disease Control and Prevention (CDC)
雑誌名: MMWR Recomm Rep. 2010 Dec 17;59(RR-12):1-110.
Abstract/Text These guidelines for the treatment of persons who have or are at risk for sexually transmitted diseases (STDs) were updated by CDC after consultation with a group of professionals knowledgeable in the field of STDs who met in Atlanta on April 18-30, 2009. The information in this report updates the 2006 Guidelines for Treatment of Sexually Transmitted Diseases (MMWR 2006;55[No. RR-11]). Included in these updated guidelines is new information regarding 1) the expanded diagnostic evaluation for cervicitis and trichomoniasis; 2) new treatment recommendations for bacterial vaginosis and genital warts; 3) the clinical efficacy of azithromycin for chlamydial infections in pregnancy; 4) the role of Mycoplasma genitalium and trichomoniasis in urethritis/cervicitis and treatment-related implications; 5) lymphogranuloma venereum proctocolitis among men who have sex with men; 6) the criteria for spinal fluid examination to evaluate for neurosyphilis; 7) the emergence of azithromycin-resistant Treponema pallidum; 8) the increasing prevalence of antimicrobial-resistant Neisseria gonorrhoeae; 9) the sexual transmission of hepatitis C; 10) diagnostic evaluation after sexual assault; and 11) STD prevention approaches.

PMID 21160459  MMWR Recomm Rep. 2010 Dec 17;59(RR-12):1-110.
著者: Constance Mao, James P Hughes, Nancy Kiviat, Jane Kuypers, Shu-Kuang Lee, Diane E Adam, Laura A Koutsky
雑誌名: Am J Obstet Gynecol. 2003 Mar;188(3):677-84.
Abstract/Text OBJECTIVE: The purpose of this study was to identify clinical signs and symptoms associated with detection of human papillomavirus (HPV) DNA in the female genital tract.
STUDY DESIGN: A total of 516 university students (18 to 24 years old) enrolled in a cohort study that included the collection of genital specimens for HPV DNA testing every 4 months for up to 4 years. Reported symptoms and objective clinical findings of women with and without HPV DNA were compared by multivariate analysis.
RESULTS: Acute and persisting HPV infections were not associated with discharge, itching, burning, soreness, or fissures. Clinical evidence of genital warts was statistically associated only with HPV types 6 and 11. Detection of any HPV DNA was associated with bacterial vaginosis (BV). Furthermore, a time lag analysis suggests that HPV infection usually precedes detection of BV.
CONCLUSION: Most women who acquire genital HPV infection are asymptomatic; some, however, are at increased risk for BV.

PMID 12634640  Am J Obstet Gynecol. 2003 Mar;188(3):677-84.
著者: T V Ellerbrock, M A Chiasson, T J Bush, X W Sun, D Sawo, K Brudney, T C Wright
雑誌名: JAMA. 2000 Feb 23;283(8):1031-7.
Abstract/Text CONTEXT: Women infected with human immunodeficiency virus (HIV) are at increased risk for cervical squamous intraepithelial lesions (SILs), the precursors to invasive cervical cancer. However, little is known about the causes of this association.
OBJECTIVES: To compare the incidence of SILs in HIV-infected vs uninfected women and to determine the role of risk factors in the pathogenesis of such lesions.
DESIGN: Prospective cohort study conducted from October 1,1991, to June 30, 1996.
SETTING: Urban clinics for sexually transmitted diseases, HIV infection, and methadone maintenance.
PARTICIPANTS: A total of 328 HIV-infected and 325 uninfected women with no evidence of SILs by Papanicolaou test or colposcopy at study entry.
MAIN OUTCOME MEASURE: Incident SILs confirmed by biopsy, compared by HIV status and risk factors.
RESULTS: During about 30 months of follow-up, 67 (20%) HIV-infected and 16 (5%) uninfected women developed a SIL (incidence of 8.3 and 1.8 cases per 100 person-years in sociodemographically similar infected and uninfected women, respectively [P<.001]). Of incident SILs, 91% were low grade in HIV-infected women vs 75% in uninfected women. No invasive cervical cancers were identified. By multivariate analysis, significant risk factors for incident SILs were HIV infection (relative risk [RR], 3.2; 95% confidence interval [CI], 1.7-6.1), transient human papillomavirus (HPV) DNA detection (RR, 5.5; 95% CI, 1.4-21.9), persistent HPV DNA types other than 16 or 18 (RR, 7.6; 95% CI, 1.9-30.3), persistent HPV DNA types 16 and 18 (RR, 11.6; 95% CI, 2.7-50.7), and younger age (<37.5 years; RR, 2.1; 95% CI, 1.3-3.4).
CONCLUSIONS: In our study, 1 in 5 HIV-infected women with no evidence of cervical disease developed biopsy-confirmed SILs within 3 years, highlighting the importance of cervical cancer screening programs in this population.

PMID 10697063  JAMA. 2000 Feb 23;283(8):1031-7.

ページ上部に戻る

戻る

さらなるご利用にはご登録が必要です。

こちらよりご契約または優待日間無料トライアルお申込みをお願いします。

(※トライアルご登録は1名様につき、一度となります)


ご契約の場合はご招待された方だけのご優待特典があります。

以下の優待コードを入力いただくと、

契約期間が通常12ヵ月のところ、14ヵ月ご利用いただけます。

優待コード: (利用期限:まで)

ご契約はこちらから