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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
Soft, non keratinised warts respond well to which treatments?
Podophyllotoxin | Trichloracetic acid
26
Keratinised warts may require what alternative treatments?
Cryotherapy | Excision
27
For what type of warts can imiquimod be used?
BOTH keratinised and non-keratinised
28
If there is only a small number of warts what is the best first line therapy?
Cryotherapy or Podophyllotoxin
29
What proportion of warts will clear spontaneously within 6 months?
30%
30
HPV treatment - podophyllotoxin - regimen?
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
Imiquimod - mechanism of action
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
HPV treatment - imiquimod - regimen?
5% cream apply 3 times weekly, wash off 10 hours later Trial up to 16 weeks, can extend if working
33
What is catephen?
extract of the leaf of the green tea plant Camellia sinensis | containing epigallocatechingallate
34
HPV treatment - catephen - regimen?
10% ointment 3 times a day | Trial up to 16 weeks
35
Trichloroacetic acid (TCA) - mechanism of action
caustic agent resulting in cellular necrosis
36
When can TCA be used for treatment of genital warts?
in specialistic clinic, not for self application
37
HPV treatment - TCA - regimen?
80-90% | Weekly application
38
How may surrounding skin be protected when using TCA?
Petroleum jelly + neutralising agent (sodium bicarbonate) in event of excess application
39
When using liquid nitrogen to treat HPV how should this be performed?
Apply until a 'halo' of freezing established Single freeze or a double freeze Aim 15-30 seconds of freezing
40
What is the main limiting factor to cryotherapy?
Patient tolerability
41
How often should cryotherapy be repeated for anogenital warts?
Weekly | Review at 4 weeks if no improvement
42
What are the 3 types of electrosurgery?
Electrocautery Hyfrecation Monopolar surgery
43
HPV excision - describe electrocautery
burning of the treatment site and surrounding tissue
44
HPV excision - describe hyfrecation
electrofulguration resulting in superficial charring and limited dermal damage can be followed by curettage
45
HPV excision - describe monopolar surgery
different waveforms can be generated, allowing desiccation, cutting, or coagulation cleaner cut and less damage to surrounding tissue
46
When might laser treatment be considered for anogenital warts?
Large volume warts
47
What is the main limitation to laser treatment for HPV?
Expensive
48
What treatment can be offered for intravaginal warts?
``` Cryotherapy Electrosurgery TCA or Podophyllotoxin off license ```
49
What treatment can be offered for urethral meatus warts?
``` If base of wart can be seen: cryotherapy electrosurgery laser ablation podophyllotoxin Imiquimod ```
50
When should urethral meatal warts be referred to urology?
If unable to see base of wart
51
What treatment can be offered for intra-anal warts?
cryotherapy topical Imiquimod (unlicensed indication) electrosurgery laser ablation trichloroacetic acid
52
What treatment should be avoided in pregnancy?
Podphyllotoxin Imiquimod 5-FU

DipGUM (39 decks)

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