1680
Refer to as genital warts and anal warts.
Caused by human papillomaviruses (HPV) 6 and 11.
Estimated incidence is less than 0.1% in the general population.
Occur in about 1-2% of sexually active adults.
Risk factors include: number of sexual partners, frequency of vaginal intercourse, presence of warts in the sex partner.
Occurs preferentially in males in their 40s.
May occur on the vulva and perineal areas, vagina, rectum, urethra, and urinary bladder.
Anal warts are irregular, verrucous lesions caused by human papilloma virus.
Anal warts are usually transmitted by unprotected, anoreceptive intercourse.
Anal warts may be asymptomatic, or may cause rectal discharge, anal wetness, rectal bleeding, and pruritus ani.
Lesions can also occur within the anal canal, where they are more likely to create symptoms.
Most genital warts in infants and children are related to child abuse.
Diagnosis is a clinical one based on the gross appearance of the warts.
Findings of characterized by hyperkeratosis, parakeratosis, acanthosis, koilocutosis.
Neoplastic transformation is frequent and includes squamous cell carcinoma, carcinoma in situ, and verrucous carcinoma.
No curative treatment is presently available.
HPV vaccines prevent about 90% of cases.
Morbidities related to the tumor and its treatment which can result in severe tissue infections, necrosis, fistulas, stenosis, or incontinence.
Treatment modalities include topical imiquimod, podophyllin, 5-fluorouracil, trichloroacetic acid, isoretinoin, electrocautery, cryotherapy, carbon dioxide laser therapy surgical excision, intralesional interferon alpha and radiotherapy.
Eradication or reduction of symptoms is the primary goal of treatment.
Elimination of dysplastic lesions is the goal in treating squamous intraepithelial lesions (SILs).
Treatment is reserved for patients with visible warts.
Treatment is not recommended for subclinical anogenital or mucosal human papillomavirus (HPV) infection in the absence of coexistent dysplasia.
No evidence demonstrates that treatment eliminates HPV infection or that it decreases infectivity.
Warts may recur after treatment because of activation of latent virus present in healthy skin adjacent to the lesion.
Factors that influence treatment include the size, morphology, number, and anatomic site of lesions.
The treatment of most HPV infections involves agents that directly ablate the lesions: surgical excision, chemical ablation, and cryotherapy.
Regardless of the mode of therapy chosen, recurrence rates are high for any patient with condylomata acuminata.
Lesions tend to proliferate doing pregnancy and topical treatment of trichloroacetic acid is commonly used at that time.
If condyloma develops,during pregnancy rapid growth can be observed.
Factors responsible include suppression of immunity during pregnancy and hormonal changes.
Small asymptomatic lesions need not be treated; larger lesions can be treated with keratolytics or cryotherapy.
Occasionally, condylomata in pregnant women become large and macerated, requiring surgical excision after the first trimester.
Treatment options we use with demonstrated success rates, include topical therapies with imiquimod, podophyllin and podophyllotoxin, and sinecatechins.
The use of ALA-PDT is an alternative for treatment of condylomata.
Optimal treatments based on virus clearance and recurrence rate include 5-aminolevulinic acid-mediated photodynamic therapy (ALA-PDT).
Treatment with ALA-PDT for a single CA lesion < 0.5 cm in diameter, ALA-PDT plus cryotherapy for lesions 0.5-2.0 cm, and cryotherapy or CO2 laser treatment followed by ALA-PDT retreatment for lesions > 2.0 cm.
Quadrivalent HPV vaccine protects against HPV types 6 and 11 which cause about 90% of condylomas, referred to as genital warts.
Maximum reduction in condyloma risk is seen after three doses of Quadrivalent HPV vaccine, and two doses of the vaccine is also associated with a considerable reduction in condyloma risk.