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GPEP Sexual Health > Genital Warts > Flashcards

Genital Warts Flashcards

1
Q

Genital warts are caused by ____________

A

Human papillomavirus (HPV)

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2
Q

90% of genital warts are caused by (HPV subtypes)

A

HPV 6 or 11

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3
Q

How many types of HPV are there?

A

> 100

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4
Q

How many types of HPV can infect the anogenital and oropharyngeal mucosa

A

> 40

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5
Q

HPV can be divided into ______ and ______ types, based on their association with the development of malignancy

A

Low-risk and high-risk

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6
Q

Are HPV 6 and 11 low risk or high risk

A

These are low-risk types of HPV, which are generally not associated with malignancy

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7
Q

How common is HPV in sexually active populations

A

Almost universal
Can be regarded as an inevitable consequence of being a sexually active adult

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8
Q

How is HPV transmitted?

A

Skin-to-skin contact

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9
Q

What types of sex can transmit HPV?

A

Can occur through penetrative and non-penetrative sex, as well as sexual activity through fingers or sex toys from genital areas infected with HPV

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10
Q

Are most anogenital HPV infections symptomatic or asymptomatic?

A

Asymptomatic

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11
Q

Is HPV infection permanent or transient?

A

Most HPV infection is transient and often becomes undetectable within 12 months

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12
Q

What should you advise patients if genital warts develop during a long term relationship?

A

HPV infection may become latent, and reactivate after several years –> doesn’t necessarily imply the presence of other sexual contacts

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13
Q

Can immunity develop from natural infection?

A

Immunity from natural infection is poor. Previous infection does not necessarily create long-term immune memory, so may not prevent future infection with the same HPV type

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14
Q

How effective is vaccination at preventing HPV infection

A

Vaccination provides effective long-term protection against HPV acquisition

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15
Q

What is the vaccination available for HPV in NZ

A

Gardasil 9

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16
Q

What age group is Gardasil 9 funded for?

A

9-26 year olds

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17
Q

What does Gardasil 9 protect against?

A

Protects against the types of HPV that cause most genital warts, as well as 7 types of oncogenic HPV

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18
Q

Is vaccination recommended if you are already sexually active?

A

Yes

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19
Q

Clinical presentation anogenital warts

A

Warty growths in and around anogenital skin. Little discomfort (sometimes itchy)

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20
Q

Clinical presentation for warts on penile urethra

A

Distorted urinary stream or bleeding with urethral lesions

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21
Q

Clinical presentation for warts on cervix

A

Cervical lesions noted on vaginal examination

May cause mild transient cervical smear abnormalities

22
Q

Clinical presentation for anal warts

A

Rectal bleeding may occur after passage of stools with anal lesions

23
Q

Diagnosis of genital warts is made by…

A

Genital warts are clinically diagnosed, based on characteristic appearance. Consider biopsy if lesions are atypical

24
Q

The goal of treatment of genital warts is to…

A

Eliminate warts that cause physical or psychological symptoms

25
Q

Does the elimination of visible external warts decrease infectivity?

A

May not decrease infectivity since the warts may not represent the entire viral burden. For this reason recurrence is common, esp in first 3 months

26
Q

Treatment options for genital warts

A

No treatment
Cryotherapy
Podophyllotoxin 0.5% solution
Imiquimod 5% cream

27
Q

No treatment as an option

A

An option for asymptomatic warts. 30% of patients will experience spontaneous clearance of warts over a 6-month period.

28
Q

What is the only treatment suitable in pregnancy?

A

Cryotherapy

29
Q

How often does cryotherapy need to be repeated?

A

Weekly until clearance

30
Q

Instructions for treatment with podophyllotoxin 0.5% solution

A

Apply carefully to warts twice daily for 3 consecutive days, followed by 4 days rest each week, until warts have resolved, or for a maximum of 5 consecutive weeks

31
Q

Can you use podophyllotoxin 0.5% solution in pregnancy (or if partner is pregnant) or breastfeeding

A

No
Teratogenic

32
Q

Why does podophyllotoxin have very limited utility for vulvovaginal warts

A

Patients must be able to visualise, identify and reach their warts, as the solution must not come in contact with normal skin

33
Q

Instructions for treatment with Imiquimod 5% cream

A

Apply to affected area at bedtime 3 times per week (alternate days), wash off in the morning

34
Q

Duration of treatment with imiquimod

A

Can be used for up to 16 weeks, although the majority who clear their warts will do so by 8 weeks

35
Q

How often should you review someone on treatment with imiquimod?

A

Monthly review recommended

36
Q

S/E imiquimod

A

Local skin reactions are common, but rarely result in discontinuation of treatment

37
Q

What patients should you use imiquimod cautiously in

A

Patients with autoimmune conditions or those on systemic immunosuppressant drugs (discussion with specialist recommended)

38
Q

Can you use imiquimod in pregnancy?

A

No

39
Q

Do you need to treat genital warts in pregnancy?

A

Smaller genital warts may not require treatment as spontaneous resolution often occurs after delivery.
Genital warts are not a contraindication to vaginal delivery.

40
Q

When would c section be indicated due to genital warts

A

When genital warts are likely to cause obstruction of the pelvic outlet or excessive bleeding

41
Q

Special management considerations for immunocompromised patients with genital warts

A

May respond less well to therapy and may have more frequent recurrences after treatment. Manage in consultation with a sexual health specialist

42
Q

If a patient has urethral warts what should you do?

A

Refer for specialist management (risk of stenosis with over-zealous treatment)

43
Q

Management of cervical or vaginal warts

A

High rate of spontaneous resolution – consider no treatment

Follow up at 6 months, refer if still present

Cryotherapy possible

44
Q

Do you need to do a cervical smear for cervical or vaginal warts?

A

Not indicated unless due

45
Q

What should you for a patient with Intra-anal warts

A

Refer to specialist for management

46
Q

If no response to treatment in 4-6 weeks consider…

A

Change in treatment modality or onward referral

47
Q

What additional advice should you give to patients undergoing treatment? (Other supportive measures)

A

Saltwater baths can sooth and heal the genital skin during treatment
Avoid shaving or waxing as this may spread the warts

48
Q

Advice to a patient with genital warts re sexual activity

A

No need to alter sexual activity with a regular partner (sharing of HPV would have occurred long before the clinical appearance of the lesions)
Consistent condom use recommended if new sexual contact

49
Q

Consistent condom use has been shown to reduce the risk of HPV acquisition and genital warts by ____%

A

30-60%

50
Q

Is follow up with patients recommended?

A

Not required if symptoms resolve
Review if patient anxious, warts are difficult to visualise, or poor response to treatment

51
Q

Indications for specialist referral

A

Lack of response to therapy
Diagnosis unclear
Immunocompromised patients with genital warts
Urethral warts
Cervical warts which are still present after 6 months
Intra-anal warts

GPEP Sexual Health (8 decks)

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