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DipGUM > Anogenital warts > Flashcards

Anogenital warts Flashcards

1
Q

What organism causes anogenital warts?

A

Human papilloma virus (HPV)

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2
Q

How many genotypes of HPV are there?

A

over 100

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3
Q

What are the typical HPV genotypes in anogenital warts?

A

6 & 11

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4
Q

What percentage of anogenital warts are due to HPV 6 or 11?

A

90%

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5
Q

What genotype of HPV cause hand warts?

A

HPV type 2

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6
Q

Can HPV type 2 occur on the genitals?

A

Reported cases in children of HPV 2 transferred from hands to genitals

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7
Q

Can HPV infection occur through contact with fomites?

A

No

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8
Q

Oncogenic HPV is most common to be found in what lesions?

A

Anogenital dysplastic lesions

Cancer

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9
Q

Most HPV infection does not result in visible lesions, how quick does infection resolve?

A

Resolve spontaneously within a year

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10
Q

HPV bi-valent vaccine - against which HPV types?

A

High risk types 16 & 18

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11
Q

HPV quadrivalent vaccine - against which HPV types?

A

6/11/16/18

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12
Q

Anogenital warts - describe their typical presentation

A 
Benign epithelial skin tumours
Single or multiple
Soft and non-keratinised on moist, non-hair bearing skin
Firm and keratinised on dry hairy skin
Broad based or pedunculated
sometimes pigmented
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13
Q

Where are HPV lesions most likely to arise?

A

Site of trauma during sexual intercourse

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14
Q

Who more commonly get perianal HPV lesions?

A

Men who have sex with men

Common in BOTH sexes and not necessarily associated with anal sex

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15
Q

If warts occur inside anal canal what is this associated with?

A

Penetrative anal sex

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16
Q

Where do extra genital HPV lesions occur?

A

Oral cavity
Larynx
Conjunctivae
Nasal cavity

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17
Q

What are the symptoms of anogenital warts?

A 
Asymptomatic
Lumps/growths
local irritation 
bleeding
discomfort
secondary infection or maceration
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18
Q

What is the incubation period of HPV?

A

3 weeks to 8 months, but can be up to 18 months

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19
Q

What is the most common appearance of a genital wart?

A

Soft, cauliflower-like growths of varying size

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20
Q

Rarely a wart may grow rapidly and infiltrate local tissue/local erosion, what are they called?

A

Buschke-lowenstein lesion

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21
Q

When should biopsy of the HPV-type lesion be considered?

A

If do not respond to treatment

22
Q

When should proctoscopy be performed for HPV disease?

A

Unable to visualise upper limit of warts

Irritation, bleeding or rectal discharge

23
Q

How effective are condoms at reducing risk of HPV acquisition?

A

30-60% reduction

24
Q

What patient specific factors may mean they respond poorly to treatment for HPV lesions?

A

Current Smoker

25
Q

Soft, non keratinised warts respond well to which treatments?

A

Podophyllotoxin

Trichloracetic acid

26
Q

Keratinised warts may require what alternative treatments?

A

Cryotherapy

Excision

27
Q

For what type of warts can imiquimod be used?

A

BOTH keratinised and non-keratinised

28
Q

If there is only a small number of warts what is the best first line therapy?

A

Cryotherapy
or
Podophyllotoxin

29
Q

What proportion of warts will clear spontaneously within 6 months?

A

30%

30
Q

HPV treatment - podophyllotoxin - regimen?

A

0.5% solution OR 0.15% cream twice daily 3 days, rest 4 days
Similar efficacy
Cream easier to apply
Often used on all anogenital sites, licensed for external genitalia

31
Q

Imiquimod - mechanism of action

A

immune response modifier
acts as a toll-like receptor-7 (TLR7) agonist
stimulation of local tissue macrophages to release interferon-alpha and other cytokines part of a local cell-mediated response

32
Q

HPV treatment - imiquimod - regimen?

A

5% cream
apply 3 times weekly, wash off 10 hours later
Trial up to 16 weeks, can extend if working

33
Q

What is catephen?

A

extract of the leaf of the green tea plant Camellia sinensis

containing epigallocatechingallate

34
Q

HPV treatment - catephen - regimen?

A

10% ointment 3 times a day

Trial up to 16 weeks

35
Q

Trichloroacetic acid (TCA) - mechanism of action

A

caustic agent resulting in cellular necrosis

36
Q

When can TCA be used for treatment of genital warts?

A

in specialistic clinic, not for self application

37
Q

HPV treatment - TCA - regimen?

A

80-90%

Weekly application

38
Q

How may surrounding skin be protected when using TCA?

A

Petroleum jelly
+
neutralising agent (sodium bicarbonate) in event of excess application

39
Q

When using liquid nitrogen to treat HPV how should this be performed?

A

Apply until a ‘halo’ of freezing established
Single freeze or a double freeze
Aim 15-30 seconds of freezing

40
Q

What is the main limiting factor to cryotherapy?

A

Patient tolerability

41
Q

How often should cryotherapy be repeated for anogenital warts?

A

Weekly

Review at 4 weeks if no improvement

42
Q

What are the 3 types of electrosurgery?

A

Electrocautery
Hyfrecation
Monopolar surgery

43
Q

HPV excision - describe electrocautery

A

burning of the treatment site and surrounding tissue

44
Q

HPV excision - describe hyfrecation

A

electrofulguration resulting in superficial charring and limited dermal damage
can be followed by curettage

45
Q

HPV excision - describe monopolar surgery

A

different waveforms can be generated, allowing desiccation, cutting, or coagulation
cleaner cut and less damage to surrounding tissue

46
Q

When might laser treatment be considered for anogenital warts?

A

Large volume warts

47
Q

What is the main limitation to laser treatment for HPV?

A

Expensive

48
Q

What treatment can be offered for intravaginal warts?

A 
Cryotherapy
Electrosurgery
TCA
or 
Podophyllotoxin off license
49
Q

What treatment can be offered for urethral meatus warts?

A 
If base of wart can be seen:
cryotherapy
electrosurgery
laser ablation
podophyllotoxin
Imiquimod
50
Q

When should urethral meatal warts be referred to urology?

A

If unable to see base of wart

51
Q

What treatment can be offered for intra-anal warts?

A

cryotherapy
topical Imiquimod (unlicensed indication) electrosurgery
laser ablation
trichloroacetic acid

52
Q

What treatment should be avoided in pregnancy?

A

Podphyllotoxin
Imiquimod
5-FU

DipGUM (39 decks)

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