Dermatology Power point slides Useful, Important & Easy Way To Understand The Chapter for the medical students aswell as others

1. GENITAL WARTS
DR. BIJAY KR.YADAV
Holly vision technical campus
Shankhamul, Kathmandu
3/14/2019
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2. VIRAL STDS
 Viral STDs are chronic and incurable. Diseases are:
 HIV infection and AIDS
 Genital Herpes.
 Genital warts (Condyloma acuminatum)
 Hepatitis B and C.
 Genital Molluscum contagiosum.
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5. GENITAL WARTS :
 The most common STD.
 Only 1-2 % of HPV infected persons have visible
clinical lesion.
 Synonyms: Condyloma accuminata, Human
Papillomavirus infection, venereal warts.
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9. ETIOLOGY :
 HPV is a DNA papovavirus.
 More than 20 types of HPV. Type 6 and 11 most
common.
 Types 16,18, 31 ,33 strongly associated with
genital dysplasia and carcinoma.
 Subclinical infection very common.
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10. TRANSMISSION :
 Sexual contact.-
 Homo or hetero
 Mother to neonate, at time of delivery.
 Microabrasion on epithelial surface allows virus to
enter basal cells.
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11. PATHOGENESIS :
 HPV infection persists throughout a patients lifetime
in a dormant state and becomes infectious
intermittently.
 Immune suppression from any cause results in
more lesions of HPV.
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12. HISTORY :
 Incubation period : Weeks to months.
 Skin symptoms :Asymptomatic ,except for
cosmetic appearance .Obstruction if large.
 Psychosexual impact –Fear of transmission,
Depression, Low self esteem, Breakdown of
relationship.
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13. MUCOCUTANEOUS LESIONS :
Four clinical types seen:
 Papular lesions
 Cauliflower - floret lesions
 Keratotic warts.
 Plaque type – common in cervix
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16. SITES :
 Male : Frenulum, corona, glans penis, prepuce,
shaft, scrotum.
 Female: Labia, clitoris, periurethral, vagina. Cervix,
perineum.
 Both sexes :Perianal, anal canal, urethra, bladder,
oropharynx.
 Infants –Laryngeal pappilomas
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17. LABORATORY EXAMINATION :
 Pap Smear : All women with HPV infection to have
annual Pap smear as HPV infection is the major
cause of cancer cervix.
 HIV testing is mandatory plus tests for syphilis-
concomittent other sti may be present.
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18. COURSE AND PROGNOSIS :
 Spontaneous regression in 10 to 30 % of patients
within 3 months.
 Sub clinical infection persists for life.
 Recurrence may occur in normal or
immunosuppressed persons.
 Even after therapy recurrence is common
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19. PREGNANCY :
 Genital warts may increase in size and number.
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20. HPV AND CANCER :
 HPV types 16,18, 31 and 33 are the major
etiologic factors for cervical cancer, carcinoma
of the vulva , penis and anal canal.
 Pap test must be stressed for women with
genital warts.
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21. MANAGEMENT :
No treatment shown to eradicate infection.
Prevention :
 Sexual abstinence.
 Single partner.
 Condom use.
Indications for therapy :
 Cosmetic
 Reduce Transmissibility
 Improve self esteem.
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22. MANAGEMENT :
 Podophyllin : (10 to 25%)in compound tincture of
benzoin. Very irritant substance. Use < 0.5 ml. each
time.
 Wash off after 2hrs.
 Repeat weekly if necessary-max 6 applications.
 Contraindicated during pregnancy
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23. MANAGEMENT :
 Cryosurgery with liquid nitrogen. Repeat weekly if
necessary.
 Trichloroacetic acid (TCA). Apply only to warts.
Repeat weekly
 Electrocautery.
 Co2 Laser.
 Imiquimod 5%cream. Applied 3 times a week.
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24. TREATMENT DURING PREGANCY :
 Genital warts can proliferate and become more
friable during pregnancy
 Cytotoxic agents : ( Podophyllin, Podofilox,
Imiquimod ) should not be used
 Cryotherapy, Trichloroacetic acid (TCA),
Bichloroacetic acid (BCA) and surgical removal
may be used.
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