Genital warts are an epidermal manifestation attributed to the epidermotropic human papillomavirus (HPV). > than 100 types of double-stranded HPV papovaviruses have been isolated thus far, and, of these, about 35 types have affinity to genital sites

1. GENITAL WARTS
HAMISI MKINDI,MD5

2. INTRODUCTION
• Genital warts are an epidermal manifestation
attributed to the epidermotropic human
papillomavirus (HPV).
• > than 100 types of double-stranded HPV
papovaviruses have been isolated thus far,
and, of these, about 35 types have affinity to
genital sites

3. INTRODUCTION
• 2 general categories of genital human
papillomavirus (HPV) exist:
– low-risk benign HPV lesions and high-risk
neoplastic HPV lesions.
– The low-risk strains are responsible for genital
warts and recurrent respiratory papillomatosis
(RRP), as well as low-grade cervical lesions.
– Two types, 6 and 11, account for more than 90%
of genital warts and most cases of RRP.
– These are least likely to have malignant potential.

4. • Thirteen human papillomavirus (HPV) types
(ie, 33, 35, 39, 40, 43, 45, 51-56, 58):
-have a moderate risk for neoplastic
conversion;
-HPV-16 and HPV-18 are considered high
risk; more than 70% of cervical, vaginal, and
penile cancers are caused from 2 types

5. PATHOPHYSIOLOGY
• Human papillomavirus (HPV) invades cells of the basal layer
of the epidermis, penetrating skin and mucosal micro
abrasions in the genital area.
• A latency period of 3 weeks to 9 months may ensue.
Following that period, viral DNA, capsids, and particles are
produced. Host cells become infected and develop the
morphologic atypical koilocytosis of genital warts.
• When epithelia cells are infected by HPV, they undergo a
transformation in which they divide continuously causing a
buildup of abnormal tissue that eventually becomes a wart

6. PATHOPHYSIOLOGY
• Most frequently affected are the penis, vulva, vagina,
cervix, perineum, and perianal area. These mucosal
lesions occasionally can be found in the oropharynx,
larynx, and trachea. HPV-6 even has been reported in
other uncommon areas (e.g., extremities).
• Multiple simultaneous lesions are common and may
involve subclinical states as well as different anatomic
sites. Subclinical infections have an infectious and
oncogenic potential. However, most infections are
transient and clear up within 2 years without
intervention.

7. TRANSMISSION
• Genital warts are very contagious.
Infection is Acquired:
• oral,
• vaginal, or
• anal sex .

8. • soft, moist, or flesh colored
• appear in clusters that resemble
cauliflower-like bumps,
• either raised or flat, small or large
Features of CONDYLOMATA

9. cauliflower-like lesions

10. Symptoms of HPV
• discharge,
• pruritis,
• difficulty with defecation,
• anal pain,
• tenesmus,
• foul odor, and
• rectal bleeding

11. MANIFESTATIONS
• Warts are usually, small,
• discrete, elevated.

12. • For the cauliflower-like lesions, clinical
presentation is enough.
• These must be differentiated from condyloma
lata and molluscum contagiosum.
• cytology
• PCR
• immunofluorescence
• electron microscopy
Diagnosis

13. LOCATION of GENITAL WARTS
• Although genital warts are most often found
on or inside the genitals, they can also be
found on the mouth, eyelid, lip, nipple, and
around the anus.

14. Male locations: Genital Warts
• Anal verge/canal
• just inside the opening of the urethra,
• frenulum,
• head of the penis,
• coronal ridge,
• inner surface of the foreskin,
• along the penile shaft.

19. Female locations: Genital Warts
• Opening to the vagina,
• inner third of the vagina,
• and cervix.
• .

20. www.skinchoice.com

21. Condyloma Acuminata

22. Condyloma Acuminata

23. Perianal Condyloma Acuminata

24. HPV Warts on the Thigh
24

25. Possible HPV on the Tongue
25

26. Condyloma on Tongue

27. HPV Penile Warts
27
Source: Cincinnati STD/HIV Prevention Training Center
HPV

28. Genital Warts in a Woman
28
HPV
Source: CDC/NCHSTP/Division of STD, STD Clinical Slides

29. Perianal Wart
29Source: Cincinnati STD/HIV Prevention Training Center
HPV

30. Condylomata Acuminata

31. Condylomata Acuminata

32. Condylomata Acuminata

33. Condylomata Acuminata

34. Condylomata Acuminata

35. Condylomata Acuminata
• Successful therapy requires accurate diagnosis and
eradication of all warts
• All patients undergo anoscopy and genital
examination
• Once identified, there are many different treatments
depending on disease progression
• Each treatment has advantages and disadvantages

36. Treatment Modalities
KERATOLYTICS
- These agents cause the cornified epithelium to swell,
soften, macerate, and then desquamate.
PODOPHYLLIN- cytotoxic chemical agent very toxic to
normal skin. Can only be used on external warts.
• Local complications include necrosis, fistula, and anal
stenosis
• Multiple treatments are usually required
• Other caustic agents are available
• Eg. Bichloracetic Acid

37. VACCINES
• HPV vaccines are now available for prevention of HPV-
associated dysplasias and neoplasia including cervical
cancer, genital warts (condyloma acuminata), and
precancerous genital lesions.
 GARDASIL:
• Papillomavirus vaccine is a quadrivalent HPV recombinant
vaccine.
• It is indicated for prevention of condyloma acuminata
caused by HPV types 6 and 11 in boys, men, girls, and
women aged 9-26 years.
• It is recommended as part of routine vaccination in girls
and boys aged 11-12 years.

38. IMMUNE RESPONSE MODIFIERS
• These agents are indicated for treatment of genital
warts. Induces secretion of interferon alpha and other
cytokines; mechanisms of action are unknown. They
may be more effective in women than in men.
• Diamantis et al note that complete clearance of warts
occurred in 50% of patients treated with imiquimod 5%
cream (administered once-daily, 3 times/wk, up to 16
wk.
IMIQUIMOD(ALDARA)5% CREAM
Imiquimod induces secretion of interferon alpha and
other cytokines; the mechanisms of action are unknown.

39. Ablative therapy
 Cryotherapy- topical application of Liquid Nitrogen
commonly used by dermatologists for the treatment of
conventional warts
 Laser Therapy- work through thermonecrosis
• Success rate from 88-95%
• Higher rate of recurrence seen than electrocoagulation
• No difference in healing time, pain or scarring reported