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A - MSRA Gynaecology > Genital Warts > Flashcards

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
What cancer is HPV most commonly associated with?
Cervical cancer
26
What types of HPV are most commonly associated with cervical cancer?
- HPV 16 | - HPV 18
27
What % of cases of cervical cancer are associated with HPV 16/18 infection?
70%
28
How are most cases of HPV 16/18 infection detected?
Abnormal cervical screening result
29
Are HPV 6 and 11 associated with cancer?
No
30
What are the risk factors for genital warts?
- Early age at first sexual experience - Multiple partners - Immunosuppression - Smoking - Diabetes associated with persistence of warts
31
What happens in most cases of HPV infection?
Asymptomatic with spontaneous resolution
32
Where can genital warts affect?
- Penis - Scrotum - Vulva - Vagina - Cervix - Perianal skin - Inside the anus
33
How long can HPV infections take to present?
Weeks - years after initial infection
34
What is the typical nature of HPV warts?
Painless fleshy growths that can be soft or hard and singular or multiple
35
When can HPV warts be a problem for the patients?
They can cause irritation or inflammation
36
Can HPV types associated with genital warts cause infections elsewhere?
Some can cause lesions in the oral cavity, larynx, conjunctivae and nasal cavity
37
What are some differentials for genital warts?
- Vestibular papillomatosis | - Molluscum contagiosum
38
What is vestibular papillomatosis?
Projections of the vestibular epithelium or labia minor
39
How is vestibular papillomatosis spread?
Non-viral sexual transmission
40
How can HPV genital warts be differentiated from vestibular papillomatosis?
Application of acetic acid does not change the colour of vestibular papillomatosis lesions
41
What colour do HPV genital warts turn with acetic acid?
Whitish
42
What is molluscum contagiosum?
Viral infection causing small, firm, raised papules on the skin
43
What should patients with anogenital warts be offered at diagnosis?
Full STI screen
44
How is diagnosis of genital warts made?
Examination alone and sometimes magnifaction
45
When may proctoscopy be required in diagnosis of genital warts?
When warts are around the anal margin or present with irritation or bleeding
46
What further examination may females with genital warts require?
Speculum to look for internal warts
47
What may be required for atypical genital warts and suspected intraepithelial neoplastic lesions?
Biopsy
48
What happens to most genital warts?
Spontaneous resolution
49
How long may treatment of genital warts take?
Several months
50
What does treatment option for genital warts depend on?
Morphology, number and location
51
What are some topical treatments for genital warts?
- Podophyllotoxin - Imiquimod - Catephan - Trichloroacetic acid
52
How often is podophyllotoxin used?
BD for 3 days followed by 4 days rest for 4-5 weeks
53
When is podophyllotoxin the topical treatment of choice for genital warts?
Clusters of small warts - better for non-keratinised
54
How often is imiquimod used for genital warts?
3 times weekly and wash off after 6-10 hours (up to 16 weeks)
55
When is imiquimod the topical treatment of choice for genital warts?
Larger warts, particularly keratinised warts
56
Are catephan and trichloroacetic acid used in the UK?
No so don't remember :)
57
What are the disadvantages of topical genital warts treatments?
- Can weaken latex condoms - Contra-indicated in pregnancy and breastfeeding - Can cause inflammation
58
What are the physical ablation options for treatment of genital warts?
- Excision - Cryotherapy - Electrosurgery - Laser surgery
59
What is excision of genital warts?
Surgical removal under local anaeasthetics
60
What type of genital warts are better for excision?
Pedunculated/large warts or small inaccessible warts
61
What is cryotherapy for genital warts?
Using liquid nitrogen to freeze warts
62
How often is cryotherapy required for genital warts?
Repeated weekly for up to 4 weeks
63
What type of genital warts is cryotherapy better for?
Multiple small warts
64
What is electrosurgery for genital warts?
Excision removes most of the wart and then electric current is passed through metal loop to remove any remaining wart
65
What type of warts is electrosurgery better for?
Large warts that fail to respond to topical treatment
66
What is laser surgery for genital warts?
Laser burns the warts under local or general anaesthetic
67
What type of genital warts is laser surgery best for?
Difficult to access warts e.g. inside the anus
68
When is a change in therapy for genital warts recommended?
If there is a <50% response after 4-5 weeks (8-12 for imiquimod)
69
What group of people in the UK receive the HPV vaccine?
Girls aged 12-13
70
When was the HPV vaccine introduced?
2008
71
What types of HPV did the vaccine initially protect against?
16 and 18
72
What HPV vaccine was introduced in 2012?
Gardasil
73
What types of HPV are protected for by Gardasil?
6, 11, 16 and 18
74
When is the HPV vaccine of most benefit?
If administered before first sexual contact
75
What is the argued problem with only giving HPV vaccination to girls?
Will not protect males and herd immunity will not apply to MSM
76
Is HPV in pregnancy associated with miscarriage, premature birth or other pregnancy complications?
No
77
What effect can pregnancy have on HPV infection?
Hormonal changes can cause genital warts to enlarge or multiply
78
What is the aim of treatment of genital warts in pregnancy?
Reduce the burden if lesions so that during childbirth the neonate's exposure is reduced
79
What type of genital wart therapy is preferred in pregnancy?
Physical ablation
80
What is the risk of transmission of genital warts to neonate during delivery?
Very low
81
What can happen if the neonate contracts HPV during delivery?
- Usually clears | - May develop respiratory papillomatosis
82
What is respiratory papillomatosis?
Development of warts in the throat

A - MSRA Gynaecology (52 decks)

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