And now, let's talk about human papilloma virus
which of course can cause condyloma acuminata.
Our focus today is on skin manifestations but
remember that HPV has 200+ different subtypes
some of which can cause things like cervical
cancer, particularly subtypes 16, 18 and 31.
We're not gonna talk about more about those
today, we're gonna focus on the skin.
The HPV has multiple wart subtypes and we're gonna
go through a few of them in just a few moments.
The way that it works is that HPV is transmitted
through contact from infected skin or mucosa
and it can certainly be sexually transmitted.
It infects squamous epithelium of the skin and the mucous
membranes leading to benign epithelial hyperplasia.
Usually, the incubation period is maybe 3 weeks to as long
as 8 months before you start to see any manifestations.
What you'll see actually on the
skin are hyperkeratotic papules
and if you look on that finger
all the way over on the far right,
you can see those cauliflower-like papules
or nodules on the tip of the finger.
The immune status of the host dictates the size and
number of lesions and folks who are immunocompromised
can have lots and lots of these
verrucous lesions in multiple locations.
Note by the way the red and black
dots on the cauliflower-like lesions.
These are evidence of thrombosed capillary
loops and particularly with plantar warts
can help be distinguished between an HPV-mediated wart
compared with something like just
a simple hyperkeratotic corn.
The diagnosis is essentially clinical, you shouldn't
really need to do a biopsy or any other testing
and you're gonna treat them with watchful waiting,
1 out of 3 of them will regress spontaneously.
You can however, if patients are inpatients or if they're
uncomfortable, you can treat with topical salicylic acid.
You could use a more aggressive treatment
like topical fluorouracil or imiquimod,
or you can also use cryotherapy, though
cryotherapy can be somewhat painful.
Next up, we'll talk about the four different
subtypes of warts caused by human papilloma virus.
First stop, plantar warts.
These, as you might imagine, appear on the
plantar surface of the foot or on the toes.
As shown here, we've got several lesions
on the plantar side of the great toe.
These are painful at pressure points and
it's basically pain with ambulation
that leads patients to come to their primary
care provider to get them taken care of.
Next stop, the most common
type of wart is common warts.
These are also called verruca vulgaris.
You'll commonly see them on the hands and fingers
of kids and they disrupt the finger prints
and one way to tell you that you've
efffectively treated the lesion
is when a fingerprint start to immerge again
from behind these cauliflower-shaped lesions.
Next one is anogenital warts and again, I'll remind
you, these are also called condylomata acuminata.
They are pretty much only transmitted through sexual
contact and they're caused by these serotypes 6 and 11.
These are low risk serotypes, they don't cause cancer
and those serotypes alone make up about
90% of all anogenital wart lesions.
And lastly, flat warts.
These are flat, they don't have that cauliflower-shaped
appearance as you can see here on the face.
They're flat-topped, pink papules,
oftentimes on the face or on the hands
and they're much less keratotic
than some of the other ones.
So less rough and indurated and nodular.
Alright, so knowing all that information,
now, let's quickly revisit our case.
So, we've got a sexually active young
man with asymptomatic, skin-colored,
fleshy papules scattered on the shaft of his penis.
Okay, this is definitely condylomata acuminata.
Again, also known as genital warts caused by HPV.
In contrast to treating common warts, we tend to
recommed imiquimod as our first line approach,
followed by cryotherapy.
As you might imagine, cryotherapy on the
shaft of the penis is going to be painful.
And again, you can remind the patients that about a third of
these lesions will resolve without any treatment whatsoever.
So sometimes, just watchful waiting
is the most prudent approach.