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A - MSRA Gynaecology [8] > [5] Genital Warts > Flashcards

[5] Genital Warts Flashcards

1
Q

What are genital warts?

A

Benign epithelial growths or mucosal outgrowths

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2
Q

What causes genital warts?

A

Human Papilloma Virus (HPV)

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3
Q

What sort of virus is HPV?

A

DNA virus

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4
Q

How common are genital warts?

A

The most commonly diagnosed STI in the UK

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5
Q

What has affected the prevalence of genital warts?

A

Widespread vaccination for HPV

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6
Q

When was vaccination for HPV started?

A

2008

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7
Q

What was the prevalence of genital warts in 14-24 year olds undergoing chlamydia screening prior to 2008?

A

35%

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8
Q

What is expected to happen to the prevalence of genital warts?

A

Fall

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9
Q

How many types of HPV are there?

A

> 100

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10
Q

What varies with the type of HPV?

A

Type of warts

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11
Q

What number of HPV types have been associated with anogenital warts?

A

> 40

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12
Q

What is another name for anogenital warts?

A

Condyloma acuminatum

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13
Q

What are the most important types of HPV?

A
  • HPV 6

- HPV 11

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14
Q

What % of anogenital warts are caused by HPV 6 and 11?

A

~90%

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15
Q

How are infections of HPV causing genital warts spread?

A

Skin-to-skin contact in sex

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16
Q

What types of sex can cause genital wart transmission?

A
  • Vaginal
  • Anal
  • Non-penetrative
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17
Q

Do condoms stop the spread of genital warts?

A

Not 100%

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18
Q

Why don’t condoms fully prevent genital warts spreading?

A

They do not cover all areas of skin e.g. inner thighs

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19
Q

How can genital warts be spread more rarely?

A
  • Hand to genitals
  • Oral sex
  • To neonate during delivery
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20
Q

How does the HPV virus infect the host?

A

Penetrates the epithelial barrier and infects basal keratinocytes

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21
Q

What happens once HPV infects basal keratinocytes?

A

Replicates causing keratinocyte multiplication and rapid growth manifesting as lesions

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22
Q

Why is the main concern with HPV infection?

A

Some types are high-risk oncogenic

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23
Q

What can high-risk oncogenic types of HPV lead to?

A

Precancerous lesions

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24
Q

What can persistent infection with high-risk oncogenic HPV types lead to?

A

Cancer of the cervix, vulva, vagina and anus (and penis)

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25
Q

What cancer is HPV most commonly associated with?

A

Cervical cancer

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26
Q

What types of HPV are most commonly associated with cervical cancer?

A
  • HPV 16

- HPV 18

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27
Q

What % of cases of cervical cancer are associated with HPV 16/18 infection?

A

70%

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28
Q

How are most cases of HPV 16/18 infection detected?

A

Abnormal cervical screening result

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29
Q

Are HPV 6 and 11 associated with cancer?

A

No

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30
Q

What are the risk factors for genital warts?

A
  • Early age at first sexual experience
  • Multiple partners
  • Immunosuppression
  • Smoking
  • Diabetes associated with persistence of warts
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31
Q

What happens in most cases of HPV infection?

A

Asymptomatic with spontaneous resolution

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32
Q

Where can genital warts affect?

A
  • Penis
  • Scrotum
  • Vulva
  • Vagina
  • Cervix
  • Perianal skin
  • Inside the anus
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33
Q

How long can HPV infections take to present?

A

Weeks - years after initial infection

34
Q

What is the typical nature of HPV warts?

A

Painless fleshy growths that can be soft or hard and singular or multiple

35
Q

When can HPV warts be a problem for the patients?

A

They can cause irritation or inflammation

36
Q

Where else can HPV types associated with infection cause lesions?

A

Some can cause lesions in the oral cavity, larynx, conjunctivae and nasal cavity

37
Q

What are some differentials for genital warts?

A
  • Vestibular papillomatosis

- Molluscum contagiosum

38
Q

What is vestibular papillomatosis?

A

Projections of the vestibular epithelium or labia minor

39
Q

How is vestibular papillomatosis spread?

A

Non-sexual viral transmission

40
Q

How can HPV genital warts be differentiated from vestibular papillomatosis?

A

Application of acetic acid does not change the colour of vestibular papillomatosis lesions

41
Q

What colour do HPV genital warts turn with acetic acid?

42
Q

What is molluscum contagiosum?

A

Viral infection causing small, firm, raised papules on the skin

43
Q

What should patients with anogenital warts be offered at diagnosis?

A

Full STI screen

44
Q

How is diagnosis of genital warts made?

A

Examination alone and sometimes magnifaction

45
Q

When may proctoscopy be required in diagnosis of genital warts?

A

When warts are around the anal margin or present with irritation or bleeding

46
Q

What further examination may females with genital warts require?

A

Speculum to look for internal warts

47
Q

What may be required for atypical genital warts and suspected intraepithelial neoplastic lesions?

48
Q

What happens to most genital warts?

A

Spontaneous resolution

49
Q

How long may treatment of genital warts take?

A

Several months

50
Q

What does treatment option for genital warts depend on?

A

Morphology, number and location

51
Q

What are some topical treatments for genital warts?

A
  • Podophyllotoxin
  • Imiquimod
  • Catephan
  • Trichloroacetic acid
52
Q

How often is podophyllotoxin used?

A

BD for 3 days followed by 4 days rest for 4-5 weeks

53
Q

When is podophyllotoxin the topical treatment of choice for genital warts?

A

Clusters of small warts - better for non-keratinised

54
Q

How often is imiquimod used for genital warts?

A

3 times weekly and wash off after 6-10 hours (up to 16 weeks)

55
Q

When is imiquimod the topical treatment of choice for genital warts?

A

Larger warts, particularly keratinised warts

56
Q

Are catephan and trichloroacetic acid used in the UK?

A

No so don’t remember :)

57
Q

What are the disadvantages of topical genital warts treatments?

A
  • Can weaken latex condoms
  • Contra-indicated in pregnancy and breastfeeding
  • Can cause inflammation
58
Q

What are the physical ablation options for treatment of genital warts?

A
  • Excision
  • Cryotherapy
  • Electrosurgery
  • Laser surgery
59
Q

What is excision of genital warts?

A

Surgical removal under local anaeasthetics

60
Q

What type of genital warts are better for excision?

A

Pedunculated/large warts or small inaccessible warts

61
Q

What is cryotherapy for genital warts?

A

Using liquid nitrogen to freeze warts

62
Q

How often is cryotherapy required for genital warts?

A

Repeated weekly for up to 4 weeks

63
Q

What type of genital warts is cryotherapy better for?

A

Multiple small warts

64
Q

What is electrosurgery for genital warts?

A

Excision removes most of the wart and then electric current is passed through metal loop to remove any remaining wart

65
Q

What type of warts is electrosurgery better for?

A

Large warts that fail to respond to topical treatment

66
Q

What is laser surgery for genital warts?

A

Laser burns the warts under local or general anaesthetic

67
Q

What type of genital warts is laser surgery best for?

A

Difficult to access warts e.g. inside the anus

68
Q

When is a change in therapy for genital warts recommended?

A

If there is a <50% response after 4-5 weeks (8-12 for imiquimod)

69
Q

What group of people in the UK receive the HPV vaccine?

A

Girls aged 12-13

70
Q

When was the HPV vaccine introduced?

71
Q

What types of HPV did the vaccine initially protect against?

72
Q

What HPV vaccine was introduced in 2012?

73
Q

What types of HPV are protected for by Gardasil?

A

6, 11, 16 and 18

74
Q

When is the HPV vaccine of most benefit?

A

If administered before first sexual contact

75
Q

What is the argued problem with only giving HPV vaccination to girls?

A

Will not protect males and herd immunity will not apply to MSM

76
Q

Is HPV in pregnancy associated with miscarriage, premature birth or other pregnancy complications?

77
Q

What effect can pregnancy have on HPV infection?

A

Hormonal changes can cause genital warts to enlarge or multiply

78
Q

What is the aim of treatment of genital warts in pregnancy?

A

Reduce the burden if lesions so that during childbirth the neonate’s exposure is reduced

79
Q

What type of genital wart therapy is preferred in pregnancy?

A

Physical ablation

80
Q

What is the risk of transmission of genital warts to neonate during delivery?

81
Q

What can happen if the neonate contracts HPV during delivery?

A
  • Usually clears

- May develop respiratory papillomatosis

82
Q

What is respiratory papillomatosis?

A

Development of warts in the throat

A - MSRA Gynaecology [8] (52 decks)

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