Epidemiology

  • The most common STI in the UK
  • Estimated that 10-20% of the population have a genital HPV infection, but only 1% of the population are symptomatic at any one time

Pathology

The result of HPV infection. There are >100 types of HPV, and only several cause warts.
  • HPV types 6 and 11 account for >90% of cases

Spread

  • Usually by sexual contact
    • Can be spread via oral sex (in both directions!), although less common than intercourse spread
  • Incubation period is usually a matter of weeks, but may be months, or even years
  • The partner (Source of infection)  may not have any visible lesions
  • 70% risk of transmission if unprotected sex with infected partner

Presentation

  • Skin lesions on the penis, vulva, anus, vagina, perineal or perianal region. They can also be found inside the anus and urethra.
  • Look a little bit like skin tags
  • Tend to form in clusters
  • Usually painless, but may be itchy
  • May or may not be pedunculated
    • Slightly less common in men
    • Usually on the penis in men, not other areas
    • Rarely may occur around / in mouth due to oral contact

Management

HPV infection is very difficult to eradicate. the warts themselves can be removed, but are likely to recur.
  • Many cases may resolve spontaneously
  • Typically, the longer a symptomatic infection is present, the larger the growths

Treatment

Notoriously difficult to get rid of

Treat both the patient and their partner! – its no good treating one patient only to see them be re-infected straight away.

  • Consider smear in any woman who has not recently had one

Podophyllin Paint

  • Can be applied weekly in clinic to the affected area. If widespread, don’t treat all warts at once to avoid toxicity.
  • Leave for 30m then wash off
  • Avoid in pregnancy

Podophyllotoxin cream

  • Can be applied by the patient at home every 12h for 3 days
  • o   Repeat weekly if necessary

Cryocauterisation

  • Freezing off the warts – usually with nitrogen
  • o   Quite useful, may be used in conjunction with podophyllin paint at clinic sessions
  • o   Often used as solitary treatment during pregnancy
  • o   About 70% effective, but up to 60% of cases will reccurr within 6 months

Diathermy

  • Cauterise them off with a hot wire

Surgical removal

  • Just cut them off!
  • Best for large warts, but likely to scar

Laser therapy

  • Not widely used
  • No more effective than other removal techniques
  • Expensive

These last four methods may be uncomfortable, but are generally not painful. If persistent, these methods will generally remove any visible warts, but they can recur at any stage.
The patient is also infective during asymptomatic periods – however, they are more infectious when visible lesions are present.

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