Human Papillomavirus Infection and Disease in the HIV+ Individual

Abstract

The following abstracts are taken from journals of interest to our readers and are reviewed by Thomas M. Julian (TMJ) and L. Steward Massad (LSM). Streptococcus pyogenesPharyngeal Colonization Resulting in Recurrent, Prepubertal Vulvovaginitis MT Hansen, VT Sanchez, K Eyster, KA Hansen J Pediatr Adolesc Gynecol 2007;20(5):315Y7This report is a case of a 4-year-old girl with culture-proven recurrent Streptococcus pyogenes vulvovaginitis from vaginal reinoculation from pharyngeal colonization. Symptoms repeatedly resolved with penicillin therapy but recurred after antibiotic therapy. Evaluation included physical examination, transabdominal pelvic ultrasound, and vaginoscopy. Both the patient and her mother demonstrated culture-proven group A Streptococcus pharyngeal colonization. Because of repeated inoculations of the vaginal area from the colonized pharynx, both were treated for decolonization with a regimen of amoxicillin and rifampin for 10 days. After this therapy, there was resolution of vaginal symptoms with no further recurrence. Follow-up pharyngeal culture done on mother and child were negative for group A Streptococcus. The authors conclude that this case demonstrated an unusual specific cause of recurrent vaginitis from group A A-hemolytic Streptococcus from pharyngeal colonization. Group A A-hemolytic Streptococcus are consistently sensitive to penicillin, but up to 25% of acute pharyngitis cases treated with penicillin have continued asymptomatic bacterial carriage within the nasopharynx. This case stresses the importance of considering reinfection through this route in the patient with recurrent group A A-hemolytic Streptococcus vulvovaginitis. Comment: This case is interesting in that it provides evidence for streptococcal vaginitis and shows what steps may be necessary in its eradication. (TMJ)

Prevalence of Anal HPV Infection Among HIV-Positive Men Who Have Sex With Men in India

“…Again, because of our high anal HPV prevalence, we may not have had the power to evaluate the association of ARVS and anal HPV infection. A reduction in prevalence with ARV use is consistent with findings of a reduction in other opportunistic infections following initiation of ARVs 26,27 . However, the relationship between ARVs and HPV is not as clear as the relationship with other opportunistic infections.…”

Prevalence of Genital Human Papillomavirus among Men in Europe: Systematic Review and Meta-Analysis

“…Nevertheless, we had no information on lifetime number of sexual partners and age‐specific prevalence estimates were available in very few studies. The prevalence of genital HPV is increased in HIV‐positive men [69,70]. We included one study of HIV‐positive men only [59].…”

Human papillomavirus–related genital disease in the immunocompromised host

“…In some cases, it may be unclear whether vulvovaginal lesions are arising as an extension of cervical disease or whether the lesions represent a separate HPV infection localized to the vulvovaginal skin. 87 In either case, if vulvar neoplasia is confirmed by a biopsy specimen, referral for colposcopic evaluation is indicated, 88 and these women should continue to receive careful cervical cancer screening and follow-up throughout their lives (level IV evidence).…”