HPV

Question 1

What is HPV

Answer 1

Human papillomavirus is highly contagious, common virus.
Wart/verucca.
180 different subtypes
School-aged children, those w/ eczema, immunosuppressed.
Can be sexually transmitted and cause cancer, but not all.

Question 2

Pathophysiology of HPV

Answer 2

Virus infects superficial layer of epidermis, proliferation of keratinocytes. Process causes wart.
Virus wont widespread, new lesion will develop with trauma.
Can clear spontaneously (long time)

Question 3

Classification of HPV

Answer 3

Cutaneous warts
Most common cause = 2,3,4,10,27,29,57.

Anogenital warts
HPV 16 and 18 = cervical cancer and male HPV cancer
HPV 6 and 11 = genital warts

Question 4

Verruca vulgaris (common warts) features

Answer 4

Hyperkeratotic, dome shaped papule w/ central black dots that are clotted capillaries.

Found on fingers, hands, knees, toes.

Question 5

Verruca plantaris (plantar warts) features

Answer 5

Tender, inward growing lesion, painful.

Found on sole of foot.

Question 6

Verruca planus (plane warts) features

Answer 6

Small and slightly raised, can have flat surface, develop in clusters.

Found on face, back of hands, and shins.

Question 7

Filiform warts features

Answer 7

Long, slender, look like a finger

Found on face.

Question 8

Condyloma acuminata (genital warts) features

Answer 8

Flesh coloured, small papules. Cluster to form large cauliflower lesion.

Found on vulva, vagina, cervic, urethra, penis, scrotum, and anus.

Question 9

Treatment of cutaneous warts

Answer 9

No specific treatment available
Tissue destruction/immune modification.
Protect healthy skin.

Salicylic acid (wart off)
Podophyllum resin paint

Question 10

Treatment of anogenital warts

Answer 10

No specific treatment available
Eliminate physical/psychological symptoms
Self-applied or GP in surgery

Podophyllotoxin - good for anogenital, don’t need to wash off, first line for self-treatment
Apply bd for 3 days then no treat for 4 days. repeat 7 day cycle for 4-5 cycles.

Imiquimod cream - first line for self-treatment, apply 3 times a week until cleared.
Apply after sex, can weaken condom.

Question 11

Cryotherapy vs ablative therapy

Answer 11

Cryo=freeze using liquid nitrogen
Used for cutaneous and anogenital warts
Multiple treatments
Can be painful and cause scars

Ablative= burn wart, dissect, or laser. Use if cryo has failed.

Question 12

Referral for HPV

Answer 12

Refer if no response within a month
Widespread/multiple warts
Bleed, change colour, itch
50 years old
Anogenital all patients
Facial warts on eyes
Diabetes patients

Question 13

Lifestyle changes for HPV

Answer 13

Vaccination against HPV