00:02
Genital warts develop in about two-thirds of sexual contacts of persons who have genital warts,
so it's really highly contagious.
00:11
And what happens is the virus enters through the skin,
after some break in the skin,
and gets into the basal layers of the epidermis.
00:24
And there, the viral capsid modifies its conformation and enters the cell.
00:31
And so, I think you can see that problems develop in an upward direction
from the basal layer.
00:39
So basal layer infected initially,
and then the virus is moved to the surface
with the normal proliferation of squamous epithelium.
00:50
So the virus will replicate,
and then finally release the live and infectious virions
from the outermost portion of the skin, which is why it is so contagious.
01:04
So all epidermal layers proliferate leading to something called acanthosis,
which is simply hyperplasia of the squamous cell epithelium.
01:17
Also, parakeratosis,
which is keratinization of the surface cells
with retention of nuclei in the stratum corneum.
01:28
Those nuclei are not supposed to be there.
01:31
Hyperkeratosis, which produces this thickened appearance.
01:37
And then some cells transform into koilocytes,
and what’s showing here is these vacuolated cells,
which are called koilocytes.
01:49
That’s the hallmark pathologically of a HPV infection.
01:54
So clinically, these warts are flesh-colored to gray.
02:00
They’re hyperkeratotic and exophytic.
02:04
Exophytic means that they are proliferating out to the surface.
02:10
They’re normally sessile on the skin,
which means they’re flat and attached,
or they can be attached by a short, broad peduncle or stalk.
02:20
In uncircumcised men, they involve, as this picture shows,
the preputial cavity 85 to 95 percent of the time.
02:31
In the circumcised men, the penile shaft is involved.
02:35
And among men who have sex with men, we get these warts in the anal mucosa.
02:42
Women get this in the posterior introitus, the labia, or clitoris.
02:48
Now, most of these warts are asymptomatic.
02:51
But occasionally, the patient will complain of itching, burning, pain, or even tenderness,
but that’s not frequent.