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The relation between genital wart and multiple sclerosis
Maryam Aghaei1, Mohammad Ali Nilforoushzadeh2, Mehdi Azami1, Seyed Hossein Hejazi3
1 Skin Diseases and Leishmaniasis Research Centre, Isfahan University of Medical Sciences, Isfahan, Iran
2 Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran
3 Skin Diseases and Leishmaniasis Research Centre, Isfahan University of Medical Sciences; Department of Parasitology and Mycology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| Date of Web Publication | 27-Jan-2017 |
Correspondence Address:
Seyed Hossein Hejazi
Skin Diseases and Leishmaniasis Research Center, Isfahan University of Medical Sciences, Isfahan
Iran
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/1735-1995.199097
How to cite this article:
Aghaei M, Nilforoushzadeh MA, Azami M, Hejazi SH. The relation between genital wart and multiple sclerosis. J Res Med Sci 2017;22:9 |
Sir,
Human papillomavirus (HPV) is a contagious virus which is transmitted via sexual contact and cause genital warts in both genders. Infection persists for months and as a skin disease has a relationship with the prevalence of psychological disorders.[1],[2]
Multiple sclerosis (MS) is chronic inflammation of central nervous system. Cause of MS is unknown, but hypotheses have proposed possible roles of viral agents and vaccines in its pathogenesis, as studies have shown that viral infections are short-term risk factors for MS onset or relapses to occur in established MS.[3] Because of host's hormonal or cellular immune response is responsible for the progression of HPV and hence MS and both are more common in early to middle adulthood of females, we studied two woman patients for searching this relation.[1],[3] Case-1 was a 25-year-old married woman from Iran that experienced genital wart after marriage. After confirming HPV infection by Pap smear test and curing with podophyllin, she afflicted to clinically isolated syndrome with symptoms such as left side numbness of the body after 4 months. Her personal history was significant for sever measles as a child, and strict chicken pox later in school but she had not medical history of MS among her first-degree relative.
In immunology tests of the patient, only the level of cardiolipin IgM was higher than normal range, [Table 1]. Furthermore, C-reactive protein, rheumatoid factor, rapid plasma reagin, and complete blood count (CBC) tests were normal. In neurologic test, abnormal upper and lower limbs somatosensory evoked potential demonstrated cortical somatosensory pathways conduction delay [Figure 1]. In brain magnetic resonance imaging (MRI), hyperintense lesion of the paraventricular regions and centrum semi-oval were seen [Figure 2]. | Figure 1: Upper and lower limbs somatosensory evoked potential report of Case-1
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 | Figure 2: Magnetic resonance imaging study of the brain without contrast of Case-1: The desired lesions marked with arrow
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Case-2 was a 30-year-old daughter that had afflicted to relapsing-remitting MS for 6 years and had not any sign of relapse. She was infected by HPV during relation with a sexual partner. After confirming HPV infection by Pap smear test and curing with podophyllin and in despite consuming immune modulator drugs, interferon beta, she experienced relapses and secondary-progressive MS form with signs such as temporary palsy of body total after 2 months. Cancer, heart and autoimmune diseases were observed in her first-rate family, but there was not history of MS among them. Her personal history was significant for mumps and chicken pox in a child, and anemia later in life.
CBC and immunology tests were normal, but her active disease was shown by evolving neurologic deficits or MRI evidence of new gadolinium-enhanced lesions. So that in cervical spine MRI with and without contrast, focal hyperintense lesion of the cervical cord at C2–C3 level was seen that showed no sign of enhancement after injection of contrast media [Figure 3]. | Figure 3: The cervical spine magnetic resonance imaging with and without contrast of Case-2: The desired lesions marked with arrow
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Although our study suggested onset or exacerbation of MS disease following genital wart, in according to our laboratory tests, some studies did not provide diagnostic or experimental evidence including the time frame between administration of HPV vaccine and development of MS symptoms.[4] Hence, more studies are needed for surveying association MS with HPV in different population in the future.
Financial support and sponsorship
Nil.
Conflicts of interest
The authors have no conflicts of interest.
| References | |  |
| 1. | Jaffary F, Musini V, Nilforoushzadeh MA, Bassett K. Systematic review of imiquimod for the treatment of external genital wart. Int J Pharmacol 2007;3:1-10.  |
| 2. | Neshat Doust HT, Nilforoush Zadeh MA, Dehghani F, Molavi H. Effectiveness of cognitive-behavioral stress management therapy on patients' quality of life with alopecia areata in Skin Disease and Leishmaniasis Research Centre of Isfahan. Arak Med Univ J 2009;12:125-33. |
| 3. | Buljevac D, Flach HZ, Hop WC, Hijdra D, Laman JD, Savelkoul HF, et al. Prospective study on the relationship between infections and multiple sclerosis exacerbations. Brain 2002;125(Pt 5):952-60. |
| 4. | Sutton I, Lahoria R, Tan I, Clouston P, Barnett M. CNS demyelination and quadrivalent HPV vaccination. Mult Scler 2009;15:116-9. |
[Figure 1], [Figure 2], [Figure 3]
[Table 1]
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