Polyhexamethylene biguanide for treatment of external genital warts: a prospective, double-blind, randomized study

Abstract. – Genital human papillomavirus infection is one of the most common sexually transmitted diseases. Polyhexamethylene biguanide is a new agent, that has been demonstrated to have potent in vivo antiviral effects in animal and in human models

Introduction
Human papillomaviruses (HPVs) belong to a family of small (8-kb pairs) double-conate (CHG), a bis-biguanide (two bi-guanide groups), has been used as a safe, general vaginal disinfectant for over thirty years and has more recently been evaluated as a microbicidal agent effective against chlamydial infection. The PEG compound polyhexamethyl-ene biguanide (PHMB) is used as the broad-spectrum active ingredient in anti-bacterial contact lens solutions as a treatment for Acanthamoeba keratitis, as a potential antiĀ¬septic mouthrinse, as a topical wound disinfectant, and as an environmental biocide. PBGs such as PHMB have many characteristics that are consistent with the attributes of an ideal microbicide, including (1) ease of synthesis and preparation, (2) the absence of odor, and (3) chemical stability. The antibacterial activity of PHMB is attributed to interactions with cellular membrane components, specifically anionic phospholipids and perhaps proteins and lipopolysaccharides. To ability to interact with membranes suggests that PHMB may also be effective against HIV-1, since infection of cells susceptible to HIV-1 is mediated by components in both the cellular membrane and viral envelope. Indeed, PHMB was demonstrated to be effective in vitro against herpes simplex virus type 1 (HSV-1) at concentrations as 0.01%.
The mechanism by which polyhexamethylene biguanide produces wart regression is probably dependent on the interactions with cellular membrane components, specifically anionic phospho-lipids and perhaps proteins and lipopoly-saccharides. Prior to polyhexamethylene biguanide, all topical treatments for external genital warts were either caustic, cytotoxic, or antimitotic. The efficacy of polyhexamethylene biguanide represents a positive indication of the importance in controlling these infections.

G. MARELLI, E. PAPALEO, M. ORIGONI, L. CAPUTO, A. FERRARI
Department of Obstetrics and Gynecology Vita-Salute, University, San Raffaele Scientific Institute -Milan (Italy)

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