Re: [Fwd: vinegar for screenings]
From: Patti Tessler (tessler@frontiernet.net)
Sat Mar 27 19:48:47 1999
At 10:27 AM 3/24/99 -0600, Linda Morrison-Boczar, MD, MBA wrote:
>Actually, in our area, by university trained urologists, one from Boston, one
>from Univ. of Florida, one from Michigan, etc.; all use the vinegar soak
>method to look for condyloma or dysplasia in men. I know of two CIS of the
>penile skin found in this way. My understanding is that this is a standard
>method in men.
And my understanding is quite different (see below).
So the urologists do this as a general health screening for all of their
patients, or only those with a history of condyloma? Take samples of each
area with acetowhitening? Treat the acetowhite areas? Use a colposcope?
I'm also wondering how many clinicians on the list use routine application
of acetic acid to evaulate the vulva, and how those doing so followup on
their findings.
--
Patti Tessler, RN, CS, Family Nurse Practitioner (ANCC certified)
Orange County, NY
mailto:tessler@frontiernet.net
>From the latest CDC STD Guidelines:
"Subclinical genital HPV infection occurs more frequently than visible
genital warts among both men and women. Infection often is indirectly
diagnosed on the cervix by Pap smear, colposcopy, or biopsy and on the
penis, vulva, and other genital skin by the appearance of white areas after
application of acetic acid. However, the routine use of acetic acid soaks
and examination with light and magnification, as a screening test, to
detect "subclinical" or "acetowhite" genital warts is not recommended.
Acetowhitening is not a specific test for HPV infection. Thus, in
populations at low risk for this infection, many false-positives may be
detected when this test is used for screening. The specificity and
sensitivity of this procedure has not been defined. In special situations,
experienced clinicians find this test useful for identification of flat
genital warts. A definitive diagnosis of HPV infection depends on detection
of viral nucleic acid (DNA or RNA) or capsid protein. Pap smear diagnosis
of HPV does not always correlate with detection of HPV DNA in cervical
cells. Cell changes attributed to HPV in the cervix are similar to those of
mild dysplasia and often regress spontaneously without treatment. Tests
that detect several types of HPV DNA or RNA in cells scraped from the
cervix are available, but the clinical utility of these tests for managing
patients is unclear. Management decisions should not be made on the basis
of HPV tests. Screening for subclinical genital HPV infection using DNA or
RNA tests or acetic acid is not recommended."
and...
"Examination of sex partners is not necessary for the management of genital
warts because the role of reinfection is probably minimal and, in the
absence of curative therapy, treatment to reduce transmission is not
realistic. However, because self- or partner-examination has not been
evaluated as a diagnostic method for genital warts, sex partners of
patients who have genital warts may benefit from examination to assess the
presence of genital warts and other STDs. Sex partners also might benefit
from counseling about the implications of having a partner who has genital
warts."
Also please note:
Title Clinical and molecular evaluation of acetowhite genital lesions in men.
Author Schultz RE; Miller JW; MacDonald GR; Auman JR; Peterson NR; Ward BE;
Crum CP
Source J Urol, 143(5):920-3 1990 May
Abstract
A total of 108 male partners of women with cervical condyloma and/or
dysplasia underwent evaluation for gross and subclinical condyloma via
acetic acid screening with a magnified examination. Biopsies of acetowhite
genital skin were obtained for histological and deoxyribonucleic acid
hybridization analysis. Of the men 52 (49%) had acetowhite lesions and
underwent biopsies, 44 of which were evaluable by histological and
deoxyribonucleic acid analyses. Of the lesions 12 had features of condyloma
or penile intra-epithelial neoplasia, among which 7 (58%) contained human
papillomavirus deoxyribonucleic acid. The remaining 32 lesions revealed
minimal histological changes sometimes suggesting condyloma. However, only
5 of the 32 biopsies (16%) contained human papillomavirus deoxyribonucleic
acid. A tendency to overdiagnose condyloma based on histological findings
is suggested. Criteria by which to identify best human
papillomavirus-related morphology are presented. Acetowhite genital
epithelia with minor (nonspecific) histological changes correlate poorly
with human papillomavirus nucleic acids and in most cases do not represent
disease involving common viral types. The application of appropriate
histological criteria appears to be particularly relevant to management
strategies that avoid overtreatment of minor epithelial abnormalities. It
remains unclear whether acetowhite genital epithelia positive for human
papillomavirus require treatment given the high tendency for recurrence and
lack of demonstrated effect on the natural history of cervical carcinoma.
