Flashcards in Genital Warts Deck (82)
What are genital warts?
Benign epithelial growths or mucosal outgrowths
What causes genital warts?
Human Papilloma Virus (HPV)
What sort of virus is HPV?
How common are genital warts?
The most commonly diagnosed STI in the UK
What has affected the prevalence of genital warts?
Widespread vaccination for HPV
When was vaccination for HPV started?
What was the prevalence of genital warts in 14-24 year olds undergoing chlamydia screening prior to 2008?
What is expected to happen to the prevalence of genital warts?
How many types of HPV are there?
What varies with the type of HPV?
Type of warts
What number of HPV types have been associated with anogenital warts?
What is another name for anogenital warts?
What are the most important types of HPV?
- HPV 6
- HPV 11
What % of anogenital warts are caused by HPV 6 and 11?
How are infections of HPV causing genital warts spread?
Skin-to-skin contact in sex
What types of sex can cause genital wart transmission?
Do condoms stop the spread of genital warts?
Why don't condoms fully prevent genital warts spreading?
They do not cover all areas of skin e.g. inner thighs
How can genital warts be spread more rarely?
- Hand to genitals
- Oral sex
- To neonate during delivery
How does the HPV virus infect the host?
Penetrates the epithelial barrier and infects basal keratinocytes
What happens once HPV infects basal keratinocytes?
Replicates causing keratinocyte multiplication and rapid growth manifesting as lesions
Why is the main concern with HPV infection?
Some types are high-risk oncogenic
What can high-risk oncogenic types of HPV lead to?
What can persistent infection with high-risk oncogenic HPV types lead to?
Cancer of the cervix, vulva, vagina and anus (and penis)
What cancer is HPV most commonly associated with?
What types of HPV are most commonly associated with cervical cancer?
- HPV 16
- HPV 18
What % of cases of cervical cancer are associated with HPV 16/18 infection?
How are most cases of HPV 16/18 infection detected?
Abnormal cervical screening result
Are HPV 6 and 11 associated with cancer?
What are the risk factors for genital warts?
- Early age at first sexual experience
- Multiple partners
- Diabetes associated with persistence of warts
What happens in most cases of HPV infection?
Asymptomatic with spontaneous resolution
Where can genital warts affect?
- Perianal skin
- Inside the anus
How long can HPV infections take to present?
Weeks - years after initial infection
What is the typical nature of HPV warts?
Painless fleshy growths that can be soft or hard and singular or multiple
When can HPV warts be a problem for the patients?
They can cause irritation or inflammation
Can HPV types associated with genital warts cause infections elsewhere?
Some can cause lesions in the oral cavity, larynx, conjunctivae and nasal cavity
What are some differentials for genital warts?
- Vestibular papillomatosis
- Molluscum contagiosum
What is vestibular papillomatosis?
Projections of the vestibular epithelium or labia minor
How is vestibular papillomatosis spread?
Non-viral sexual transmission
How can HPV genital warts be differentiated from vestibular papillomatosis?
Application of acetic acid does not change the colour of vestibular papillomatosis lesions
What colour do HPV genital warts turn with acetic acid?
What is molluscum contagiosum?
Viral infection causing small, firm, raised papules on the skin
What should patients with anogenital warts be offered at diagnosis?
Full STI screen
How is diagnosis of genital warts made?
Examination alone and sometimes magnifaction
When may proctoscopy be required in diagnosis of genital warts?
When warts are around the anal margin or present with irritation or bleeding
What further examination may females with genital warts require?
Speculum to look for internal warts
What may be required for atypical genital warts and suspected intraepithelial neoplastic lesions?
What happens to most genital warts?
How long may treatment of genital warts take?
What does treatment option for genital warts depend on?
Morphology, number and location
What are some topical treatments for genital warts?
- Trichloroacetic acid
How often is podophyllotoxin used?
BD for 3 days followed by 4 days rest for 4-5 weeks
When is podophyllotoxin the topical treatment of choice for genital warts?
Clusters of small warts - better for non-keratinised
How often is imiquimod used for genital warts?
3 times weekly and wash off after 6-10 hours (up to 16 weeks)
When is imiquimod the topical treatment of choice for genital warts?
Larger warts, particularly keratinised warts
Are catephan and trichloroacetic acid used in the UK?
No so don't remember :)
What are the disadvantages of topical genital warts treatments?
- Can weaken latex condoms
- Contra-indicated in pregnancy and breastfeeding
- Can cause inflammation
What are the physical ablation options for treatment of genital warts?
- Laser surgery
What is excision of genital warts?
Surgical removal under local anaeasthetics
What type of genital warts are better for excision?
Pedunculated/large warts or small inaccessible warts
What is cryotherapy for genital warts?
Using liquid nitrogen to freeze warts
How often is cryotherapy required for genital warts?
Repeated weekly for up to 4 weeks
What type of genital warts is cryotherapy better for?
Multiple small warts
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
What type of warts is electrosurgery better for?
Large warts that fail to respond to topical treatment
What is laser surgery for genital warts?
Laser burns the warts under local or general anaesthetic
What type of genital warts is laser surgery best for?
Difficult to access warts e.g. inside the anus
When is a change in therapy for genital warts recommended?
If there is a <50% response after 4-5 weeks (8-12 for imiquimod)
What group of people in the UK receive the HPV vaccine?
Girls aged 12-13
When was the HPV vaccine introduced?
What types of HPV did the vaccine initially protect against?
16 and 18
What HPV vaccine was introduced in 2012?
What types of HPV are protected for by Gardasil?
6, 11, 16 and 18
When is the HPV vaccine of most benefit?
If administered before first sexual contact
What is the argued problem with only giving HPV vaccination to girls?
Will not protect males and herd immunity will not apply to MSM
Is HPV in pregnancy associated with miscarriage, premature birth or other pregnancy complications?
What effect can pregnancy have on HPV infection?
Hormonal changes can cause genital warts to enlarge or multiply
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
What type of genital wart therapy is preferred in pregnancy?
What is the risk of transmission of genital warts to neonate during delivery?
What can happen if the neonate contracts HPV during delivery?
- Usually clears
- May develop respiratory papillomatosis