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Genital Warts.PROF:AKMAL JAMAL
This document discusses genital warts (condyloma acuminata) caused by human papillomavirus (HPV). It notes that HPV is commonly seen in the homosexual male population and 19% of HIV patients have anal HPV. There is no cure for HPV and it can be transmitted even with condom use. Treatment options discussed include podophyllin, immunotherapy, imiquimod cream, cryotherapy, laser therapy, and electrocoagulation. Recurrence is common and regular screening is important due to HPV's link to cervical and other cancers.
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Genital Warts.PROF:AKMAL JAMAL
- 1. GENITAL WARTS PROF:AKMAL JAMAL FCPS;FRCSEd: 30 APRIL 2012
- 2.
- 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. 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. 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. 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. 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. Condylomata Acuminata Over 40 subtypes of HPV Most common 6 and 11 16, 18, 31, and 32 are associated with squamous cell carcinoma
- 9. TRANSMISSION Genital warts are very contagious. Infection is Acquired oral, vaginal, or anal sex .
- 10. Epidemiology · Genital warts caused by HPV 6 and 11 are the most common · Direct contact with the lesion is believed to result in spread of the disease.
- 11. HPV Histology Hyperplastic Epithelial Growth with irregular acanthosis and marked Hyperkeratosis
- 12. Epithelial Hyperplasia ina Condyloma When epithelia cells are infected by HPV, they undergo a transformation in which they divide continuously causing a buildup of abnormal tissue that eventually becomes a wart
- 13. Perinuclear Halos =Koilocytosis
- 14. Features of CONDYLOMATA soft, moist, or flesh colored appear in clusters that resemble cauliflower-like bumps, either raised or flat, small or large
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- 16. Symptoms of HPV discharge, pruritis, difficulty with defecation, anal pain, tenesmus, foul odor, and rectal bleeding
- 17. Manifestations Warts are usually,small, discrete, elevated pink to grey vegetative excrescences · Soft, fleshy, cauliflower-like lesions on the skin, genitalia, perineum, and perianal regions .
- 18. Diagnosis For the cauliflower-likelesions, clinical presentation is enough. These must be differentiated from condyloma lata and molluscum contagiosum. cytology PCR immunofluorescence electron microscopy
- 19. COMPLICATIONS Cancer cervical cancer. vulvar cancer, anal cancer, and cancer of the penis (a rare cancer). .
- 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. Male locations: GenitalWarts : Anal verge/canal just inside the opening of the urethra, frenulum, head of the penis, coronal ridge, inner surface of the foreskin, along the penile shaft.
- 26. Female locations: Genital Warts Opening to the vagina, inner third of the vagina, and cervix. .
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- 32. HPV Warts onthe Thigh 32
- 33. Possible HPV onthe Tongue 33
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- 35. HPV HPV Penile Warts Source: Cincinnati STD/HIV Prevention Training Center 35
- 36. HPV Genital Warts in a Woman Source: CDC/NCHSTP/Division of STD, STD Clinical Slides 36
- 37. HPV Perianal Wart Source: Cincinnati STD/HIV Prevention Training Center 37
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- 43. Condylomata Acuminata Successfultherapy 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
- 44. 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
- 45. Immunotherapy 2. A Vaccine is created and the patient is vaccinated with six consecutive weekly injections
- 46. 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
- 47. 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
- 48. Condylomata Acuminata Twotherapies 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
- 49. 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
- 50. 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
- 51. 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
- 52. 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
- 53. 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
- 54. Sores Secondary Syphilis – Condylomata Lata Source: Florida STD/HIV Prevention Training Center 54
- 56. 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
- 57. 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.
- 61. Complications: Secondary infections Eczematization Conjunctivitis/keratitis from eyelid infection
- 62. DIFFERENTIAL DIAGNOSIS Acne whiteheads Warts Pyoderma Cryptococcosis
- 63.