Exam 2 - Genital warts Flashcards
Common clinical manifestations of warts (aka condyloma acuminata)
- Single/multiple, soft, flesy, papillary or flat, keratinized growths on genital mucosa
- Usually asymptomatic and painless
- May be painful and pruritic
- Can occur at multiple sites
- Commonly vaginal introitus, shaft of penis, vaginal wall, cervix
How would a provider diagnose genital warts?
- Visual inspection
- Biopsy NOT necessary, but can indicate if warts are atypical or used when warts don’t respond to treatment
- HPV testing not recommened
What differential diagnosis should the provider consider and rule out?
Condyloma lata
What is the mode of transmission for genital warts?
Sexual contact
Is it okay for the provider to choose not to treat?
Yes, can choose to monitor
- May spontaneously resolve within 1 year or get worse
Does treatment eradicate HPV infection?
No, genital warts can reoccur after treatment (especially in first 3 months)
What three patient applied treatment therapies could the provider use to treat genital warts?
- Imiquimod (Aldara) or Zyclara cream
- Podofilox (Condylox)
- Sinecatechins (Veregen)
What is the MOA of imiquimod (Aldara) or zyclara cream?
Active immune enhancer
- Stimulates production of interferon and other cytokines
How are imiquimod (Aldara) or zyclara cream applied?
Imiquimod (Aldara) - apply 3x weekly at bedtime, leave on for 6-10 hours, wash off with soap and water, continue for max of 16 weeks
Zyclara - apply daily at bedtime, leave on for 8 hours, wash off with soap and water, continue for max of 8 weeks
What is the MOA of podofilox (Condylox)?
Antimitotic that results in wart necrosis
- Should not prescribe more than 10 mg/day because can be cytotoxic
How would you advise patients to apply podofilox (Condylox)?
Apply daily for 3 days, stop for 4 days
- Repeat cycle four times then d/c
What is the MOA of sinecatechins (Veregen)?
Green tea extra with active catechins
How would you advise patients to apply sinecatechins (Veregen)?
Apply 3 times/day until warts are cleared (max of 16 weeks)
- Requires the most patient compliance
Can you prescribe topicals for genital warts for patients that are pregnant?
No
What are the main two provider applied treatment therapies could the provider prescribe for genital warts?
- Trichloroacetic acid (TCA)
- Bichloroacetic acid (BCA)
What is the MOA of TCA and BCA?
Destroys warts by chemical coagulation of proteins
- Patients need to come back weekly for treatment until warts resolve
Other than TCA and BCA, what other provider applied treatment therapies are available for patients with genital warts?
- Surgical removal for large warts
- Cryotherapy
Genital wart treatment side effects
- Local irritation
- Redness
- Itching
- Mild to moderate pain
- Ulcerations
- Persistent hyper or hypopigmentation
How often should patients come in for follow up for genital warts?
Return for regular treatment until lesions are resolved
- Most respond within 3 months of treatment
What are complications that are associated with anogenital warts?
- Large lesions may stimulate carcinoma and require biopsy
- In pregnancy, warts can enlarge (d/t immunocompromised state) and obstruct birth canal leading to c section
- People with HIV can have large warts
Genital warts prevention
- Abstain from sex
- HPV vaccination
- Condom use (but not fully protected)
Genital warts patient education
- Treatment DOES NOT kill the virus (only treats warts)
- Common for warts to reoccur in first 3 months
- Women with genital warts DO NOT need pap tests more often
- Sex parters can share HPV
- Can still be transmitted after warts are gone/removed
- Smoking cessation
