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  2. 2. Condyloma acuminataHPV
  3. 3. Human Papilloma Virus Condyloma Acuminata represents the most common STI Caused by a DNA virus that is a member of the Papovirus group- HPV Most Commonly seen in Homosexual Male population
  4. 4. Human Papilloma Virus 19 % of patients with HIV have been found to have anal condyloma It is recommended that all patients with anal condyloma undergo HIV testing
  5. 5. Genital Warts (HPV) There is NO cure for the virus. can spread the virus to anyone you have sex with.. can still get HPV even when you use a condom.
  6. 6. HPV Human Papillomavirus Many types of Human Papillomavirus (HPV), some of which infect the genital area Incubation period unclear Can infect men, women, and newborns The person can easily pass it on to sex partners 6
  7. 7. HPV Genital HPV: Two Types The types of HPV that infect the genital area are labeled “low-risk” or “high-risk” depending on whether they can cause cancer or not. Low-risk HPV types can cause genital warts. High-risk HPV types can cause serious cervical lesions, cervical cancer, and other genital cancers. 7
  8. 8. Condylomata Acuminata Over 40 subtypes of HPV Most common 6 and 11 16, 18, 31, and 32 are associated with squamous cell carcinoma
  9. 9. TRANSMISSION Genital warts are very contagious. Infection is Acquired oral, vaginal, or anal sex .
  10. 10. Epidemiology· Genital warts caused by HPV 6and 11 are the most common· Direct contact with the lesion isbelieved to result in spread of thedisease.
  11. 11.  HPV Histology Hyperplastic Epithelial Growth with irregular acanthosis and marked Hyperkeratosis
  12. 12. Epithelial Hyperplasia in a CondylomaWhen epithelia cells are infected byHPV, they undergo a transformation inwhich they divide continuously causing abuildup of abnormal tissue thateventually becomes a wart
  13. 13. Perinuclear Halos = Koilocytosis
  14. 14. Features of CONDYLOMATAsoft, moist, or flesh colored appear in clusters that resemblecauliflower-like bumps,either raised or flat, small or large
  15. 15. cauliflower-like lesions
  16. 16. Symptoms of HPV discharge, pruritis, difficulty with defecation, anal pain, tenesmus, foul odor, and rectal bleeding
  17. 17. ManifestationsWarts are usually, small,discrete, elevated pink to grey vegetativeexcrescences · Soft, fleshy, cauliflower-like lesions on the skin, genitalia, perineum, and perianal regions .
  18. 18. DiagnosisFor the cauliflower-like lesions, clinicalpresentation is enough.These must be differentiated from condylomalata and molluscum contagiosum.cytology PCR immunofluorescence electron microscopy
  19. 19.  COMPLICATIONSCancer cervical cancer. vulvar cancer, anal cancer, and cancer of the penis (a rare cancer)..
  20. 20. LOCATION of GENITAL WARTS Although genital warts are most often found on or inside the genitals, they can also be found on the mouth, eyelid, lip, nipple, and around the anus.
  21. 21. Male locations: Genital Warts: Anal verge/canaljust inside the opening of the urethra, frenulum, head of the penis, coronal ridge, inner surface of the foreskin,along the penile shaft.
  22. 22. Female locations: GenitalWarts Opening to the vagina, inner third of the vagina, and cervix. .
  23. 23.
  24. 24. Condyloma Acuminata
  25. 25. Condyloma Acuminata
  26. 26. Condyloma Acuminata
  27. 27. Perianal Condyloma Acuminata
  28. 28. HPV Warts on the Thigh 32
  29. 29. Possible HPV on the Tongue 33
  30. 30. Condyloma on Tongue
  31. 31. HPV HPV Penile WartsSource: Cincinnati STD/HIV Prevention Training Center 35
  32. 32. HPV Genital Warts in a WomanSource: CDC/NCHSTP/Division of STD, STD Clinical Slides 36
  33. 33. HPV Perianal WartSource: Cincinnati STD/HIV Prevention Training Center 37
  34. 34. Condylomata Acuminata
  35. 35. Condylomata Acuminata
  36. 36. Condylomata Acuminata
  37. 37. Condylomata Acuminata
  38. 38. Condylomata Acuminata
  39. 39. Condylomata Acuminata Successful therapy requires accurate diagnosis and eradication of all warts All patients undergo anoscopy and genital examination Once identified, there are many different treatments depending on disease progression Each treatment has advantages and disadvantages
  40. 40. Treatment Modalities 1. Podophyllin- cytotoxic chemical agent very toxic to normal skin. Can only be used on external warts.. Local complications include necrosis, fistula, and anal stenosis Multiple treatments are usually required Other caustic agents are available Eg. Bichloracetic Acid
  41. 41. Immunotherapy 2. A Vaccine is created and the patient is vaccinated with six consecutive weekly injections
  42. 42. HPV Vaccine - Gardisil Approved for use in women only, 9-26  Recommended at ages 11-12  Catch-up older patients  3 vaccine series (0,2,6 mo) Efficacy varies, outcomes studied vary  But efficacy in the 90+ percentile for reduction of type-specific dysplasia Targets HPV 6/11,16/18  Based on primary capsid proteins
  43. 43. Immunomodulators (Imiquimod/Aldara) 3. Imidazoquinolines- a new class of immune-response modulators Mechanism of action unknown, but thought to play a role in cytokine-induced activation of the immune system Application 3/week qhs x 16weeks
  44. 44. Condylomata Acuminata Two therapies that are more commonly practiced today are interferon injections and Aldara (imiquimod) cream Both therapies are very potent with many side-effects LFT’s should be checked routinely with interferon injections Aldara should be used every other day, because it can burn normal tissue and make it necrotic
  45. 45. Topical Cytostatics 4. Chemotherapeutic agents such as 5-FU, Thiotepa and Bleomycin Bleomycin is given as an intra-lesional injection q2-3weeks 70% success rate reported
  46. 46. Cryotherapy and Laser Therapy 5. Cryotherapy- topical application of Liquid Nitrogen commonly used by dermatologists for the treatment of conventional warts 6. Laser Therapy- work through thermonecrosis Success rate from 88-95% Higher rate of recurrence seen than electrocoagulation No difference in healing time, pain or scarring reported
  47. 47. Fulgaration/Electrocoagu lation 7. Fulgaration with excision of a portion to send to pathology Gold Standard Very Painful if done too deeply, should not be into the dermis or fat Risk of stricture formation if a large area is to be treated Less than 50% have full resolution after one treatment
  48. 48. Anal Condylomata Summary External Condylomata without evidence of Internal Warts can usually be effectively treated by chemical means If the response is unsatisfactory, physical destruction by electrocoagulation is the preferred approach Obtaining tissue for pathologic confirmation, especially with respect to premalignant or malignant change is a a prudent philosophy
  49. 49. Sores Secondary Syphilis - Clinical Manifestations Represents hematogenous dissemination of spirochetes Usually 2-8 weeks after chancre appears Findings:  rash - whole body (includes palms/soles)  mucous patches  condylomata lata - HIGHLY INFECTIOUS  constitutional symptoms Sn/Sx resolve in 2-10 weeks 53
  50. 50. Sores Secondary Syphilis – Condylomata LataSource: Florida STD/HIV Prevention Training Center 54
  51. 51. MOLLUSCUM CONTAGIOSUM Molluscum contagiosum (MC) is a common, self-limited, benign viral infection of the skin caused by a member of the pox-virus group. MC is transmitted by close personal contact including sexual contact
  52. 52. DIAGNOSIS Diagnosis is usually done on clinical grounds alone by the typical appearance of the lesions. Expression of materials stained with Giemsa, Wright or Gram stain reveals molluscum bodies. Biopsy, which shows characteristic features of epidermal hyperplasia.
  53. 53. Complications: Secondary infections Eczematization Conjunctivitis/keratitis from eyelid infection
  54. 54. DIFFERENTIAL DIAGNOSIS Acne whiteheads Warts Pyoderma Cryptococcosis
  55. 55. Questions?