Genital warts usmle step 2 mynotes5/30/2023 ![]() Biopsy : shows focal epidermal hyperplasia and epidermal dysplasia.Clinical features: multiple, flat, red-brown pigmented papules on the external genitalia.♂: glans penis, foreskin, shaft, perianal region.Description : : An HSIL that resembles squamous cell carcinoma in situ on histology but tends to occur in younger individuals and has a lower risk of malignant transformation.Perianal intraepithelial neoplasia (PAIN).Penile intraepithelial neoplasia ( PeIN).Vaginal intraepithelial neoplasia ( VaIN).Vulvar intraepithelial neoplasia ( VIN).Cervical intraepithelial neoplasia ( CIN ).Squamous intraepithelial lesion (SIL): low-grade ( LSIL) or high-grade ( HSIL).Incidence: ∼ 14 million annually in the US.50% of new infections affect individuals between 15–24 years of age. Most common sexually transmitted infection ( STI ).Inhibits p21 and p27 ( CDK inhibitors ) → increased activity of cyclin-dependent kinaseĦ comes before 7 and P comes before R: E6 inhibits P53 and E7 inhibits pRb Anogenital manifestations.Inhibition of retinoblastoma protein ( pRb ) → increased activity of E2F -family of transcription factors.E6 → inhibition of p53 protein → inhibition of the intrinsic apoptotic pathway and inhibition of p21 protein.HPV expresses the following oncoproteins.Additional risk factors for genital/ mucosal HPV infections include:.Immunodeficiency (e.g., HIV infection, chemotherapy ).Damaged skin/ mucous membranes (e.g., maceration, trauma, herpes simplex virus infection).Close personal contact: cutaneous warts.Transmission occurs between two epithelial surfaces.HPV types 1, 2, and 4: cause skin warts, such as common warts ( verruca vulgaris ) and plantar warts ( myrmecias ).High risk of anogenital, oral, and oropharyngeal squamous cell carcinoma.Cervical cancer (responsible for 70% of cases).High-risk HPV types 16, 18, 31, and 33.Tumors of nongenital mucosal membranes (e.g., respiratory tract, oral cavity, esophagus, eye).Anogenital warts ( condylomata acuminata ).Double-stranded, circular, nonenveloped DNA virus with an icosahedral capsid.Prevention includes education about safe sexual practices and the proper use of condoms, as well as vaccination of all persons 9–26 years of age. However, surveillance is important since recurrence rates are high and malignant transformation is possible. Treatment of condylomas includes the use of local ointments, cryotherapy, and electrocoagulation. Diagnosis is often based on the physical exam alone, but can be confirmed with diagnostic tests (e.g., PCR), particularly in asymptomatic HPV infections of the cervix. Most HPV infections are asymptomatic and self-limiting, although pruritus, tenderness, and bleeding may occur. Risk factors for infection include skin damage, immunocompromise, early first sexual intercourse, and frequent change of sexual partners. These high-risk strains account for more than 70% of cervical cancers and can also cause genital, oral, and oropharyngeal squamous cell cancers. ![]() Infection with oncogenic high-risk HPV types (especially HPV-16 and HPV-18) may lead to malignant disease. Low-risk types (especially HPV-6 and HPV-11) can cause benign anogenital warts ( condylomata acuminata) and papillomatous nodules in other genital (e.g., squamous intraepithelial lesions of the cervix) or non-genital (e.g., oral warts, respiratory papillomatosis) mucosal areas. Other strains are sexually transmitted (especially in young adults) and can be further divided into low-risk and high-risk HPV types. Many HPV strains are already spread during infancy and childhood through direct skin-to- skin contact and may remain dormant inside the cell, while others (especially HPV-1, HPV-2, and HPV-4) can cause common warts ( verruca vulgaris). The locations and specific manifestations of infection depend on the type of virus and its mode of transmission. The human papilloma virus ( HPV) causes infections of the skin and mucous membranes. ![]()
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