Genital warts Flashcards
What causes genital warts?
Human Papilloma Virus (HPV) → epithelial or mucosal outgrowths
What types of HPV (2) are responsible for genital warts?
- More than 40 types of HPV have been associated with anogenital warts (condyloma acuminatum)
- HPV6 and HPV11 are responsible for roughly 90% of cases
How do genital warts spread?
- spread through skin-skin contact
- rarely, from the hand to genitals, during oral sex and to the neonate during delivery
*often during vaginal or anal sex, however a full penetration is not necessary for HPV to spread
Do condoms protect from HPV spread?
No, as they do not cover all of the skin e.g. inner thighs
Pathophysiology of genital warts development (from HPV infection)
Infection → virus penetrates epithelial barrier → basal keratinocytes are infected → viral replication within keratinocytes that multiply → manifest as lesions
Types of HPV that predispose to cancer
HPV 16 and HPV 18 → cervical cancer
Risk factors associated with HPV
- early age at first sexual intercourse
- multiple partners
- immunosuppression
- smoking
- diabetes (associated with persistence of warts)
What are the most common symptoms of HPV infection?
Most are asymptomatic -> do not result in lesion, resolve spontaneously
What may be seen in a symptomatic presentation of HPV infection?
- warts affecting penis, scrotum, vulva, vagina, cervix, perianal skin, anus
- extra-genital lesions possible: oral cavity, larynx, conjuctivae, nasal cavity
Characteristic features of genital warts
lesions are usually:
- painless
- soft or hard
- singular or multiple
- warts may cause irritation or become inflamed
How to diagnose genital warts?
- diagnosis usually made upon examination of genitalia/perianal skin → may require colposcope to show small lesions
- proctoscopy → if they are warts around anal margin or symptoms of irritation or bleeding
- vaginal speculum examination → to check for internal warts
- biopsy →for atypical lesions or if intraepithelial neoplasia is suspected
Is it necessary to treat genital warts?
- Treatment is not always necessary
- lesions will most likely resolve spontaneously over time
- Treatment for visible lesions may take several months and the choice of treatment depends on the morphology, number and location of the warts
Modes of treatment for genital warts
- topical treatments
- physical ablation: excision, cryotherapy, electrosurgery, laser surgery
1st line treatments (2) of genital warts
topical podophyllum or cryotherapy
2nd line treatment (1) of genital warts
imiquimod is a topical cream
class: immune-response modifier (increases body’s activity of an immune system)
Class and mechanism of action of Podophyllum/Podophyllin cream
Class: cytotoxic agent
MoA: it arrests cell cycle
Contraindications for topical treatments of genital warts
- contraindicated in pregnancy and breastfeeding
- may weaken latex condoms
- may cause local inflammation
What does HPV vaccine protects from? Name that vaccine
Currently used Gardasil vaccine (from 2012) protects from HPV 16, 18, 6 and 11 (so oncogenic ones but also warts)
Who does receive Gardasil vaccine?
- offered to all girls 12-13-year-old
* the most effective if administrated before first sexual contact
Is HPV infection in pregnancy dangerous?
- HPV does not cause stillbirth or miscarriage
- however, as immune system is weakened → warts would enlarge
Treatment would aim to reduce child exposure to HPV during childbirth
Treatment of HPV during pregnancy
- Podophyllotoxin and imiquimod are contraindicated in the pregnancy
- Therefore physical ablation options are recommended
What is the risk of transmission of HPV to neonate?
- extremely low risk of transmission to a neonate during birth
- if a baby gets infected → immune system would usually fight it off
- in rare cases, a baby may develop respiratory papillomatosis → warts develop in the throat
