Lecture 4: Infections Part 2 Flashcards
What is condyloma acuminatum?
Genital warts
What is the cause of condyloma acuminatum and the transmission?
- Cause: HPV, mainly 6 & 11
- 16, 18, 31, 33 are most dangerous
- Transmission via microabrasion, does not require active lesions
MC in sexually active young adults
What are the RFs for condyloma acuminatum?
- Number of partners
- Frequency of sex
- Partner with HPV
- Other STIs
Lots of sex with lots of people
Is conyloma acuminatum transmissible to a baby?
Yes, an infected mother can transmit it.
How does low risk and high risk condyloma acuminatum appear?
- Both appear with warts.
- However, if immunosuppressed, there is a higher risk for warts if infected.
Clinical manifestations of condyloma acuminatum?
Warts
- Asymptomatic is the MC presentation
- Anxiety
- Obstruction if large mucocutaneous lesions
What are the 4 types of mucocutaneous lesions seen in condyloma acuminatum?
- Small papular
- Cauliflower-floret
- Keratotic warts
- Flat topped papules/plaques (MC on cervix)
What is a red flag on condyloma acuminatum presentation that may suggest an immunocompromised state?
Large and multiple lesions
Where are the MC sites for lesions on a male with condyloma acuminatum? Female?
- Male: Frenulum, corona, glans penis, prepuce, shaft, and scrotum
- Female: labia, clitoris, periurethral, perineum, vagina, and cervix
- Both: perineal, perianal, anal canal, rectal, urethral meatus, urethra, and bladder
Features of laryngeal papillomas
- Uncommon with HPV 6 & 11
- MC on the vocal cords
- age: < 5 or > 20 = risk of SCCis and invasive SCC
What tests help diagnose condyloma acuminatum?
- Pap smear
- Dermatopathology
- Typically clinical diagnosis
- Dermoscopy showing papillomatosis = hallmark
- Shave biopsy if wart was refractive to tx
Finger like knob projections.
Tx for condyloma acuminatum
- Patient: imiquimod, podofilox, trichloroacetic acid
- Provider: Cryotherapy, electrosurgery, surgical removal, laser
Also can be self-resolving
Follow-up for condyloma
- Monthly until lesions are gone, then Q3months
- Routine PAP in females
- Prevention via Gardasil (6, 11, 16, 18)
Highest chance of recurrence is within 3 months
When is condyloma MC to recur within?
3 months
Hence why you still check within 3 months if lesions gone
Gardasil vaccine schedule
Starting at age 9 or 15
Summary of condyloma tx specifics
Non pharmaceuticals
Surgical is best for > 1 cm
MOA of imiquimod
Condyloma
Induction of immune system to recognize and destroy lesions
Anti-tumor topical; ImIquImod Induces Immune
How to use imiquimod?
- Small amount at bedtime 3x/wk.
- Wash off upon awakening
- Don’t have sex
- continue tx until complete clearance
- may need holidays due to strong SEs.
MOA of podofilox
Prevention of cell division and causes tissue necrosis
must know antimitotic
What is molluscum contagiosum?
Water warts, caused by poxvirus
How does molluscum contagiosum present?
- small, smooth, dome shaped papule with umbilicated center
- If adults: groin/lower abdomen area
- 3-6mm
- White, curd-like material can be expressed
- Usually no palm or sole involvement
- High risk for immunocomped or atopic patients
How does verruca vulgaris present?
- 1-10mm papules
- Isolated or multiple
- MCC: trauma, hands/fingers/knees
- Red and brown spots: thrombosed papilla capillary loops (seen on dermatoscope)
How does verruca plantaris present?
- Shiny plaques with a rough, hyperkeratotic surface
- Thrombosed capillaries
- Skin lines decrease
- Usually uncomfortable
- Tender
reminds me of a cigarette butt
How does verruca plana present?
- Sharply defined
- 1-5mm
- Flat surface
- Skin colored or light brown
- Round, oval, polygonal, or linear
- MC on face, beard, dorsa of hands and shins
How does HZV present?
Dermatomal infection with immense pain
Prior hx of chickenpox as child
How does the active phase in HZV present?
- Papules at 24h
- Vesicles/bullae at 48h
- Pustules at 96h
- Crusts at 7-10d
