Anogenital warts (rectal)
HPV enters the epidermis through sexual contact (ie, microabrasions), causing soft, fleshy, verrucous bumps that progress over several months.
| Etiology | • HPV 6 & 11 (low risk strains) |
|---|---|
| Risk factors | • chronic Tobacco use |
| • immunosuppression (eg, HIV) | |
| Clinical features | • Multiple pink or skin-colored lesions |
| • Lesions ranging from smooth, flattened papules to exophytic/cauliflower-like growths | |
| • Typically asymptomatic and nontender but may be pruritic and friable (bleed with manipulation) | |
| Diagnosis | • primarily clinical, based on the characteristic appearance of the lesions. |
| Treatment | • Chemical: podophyllin resin, trichloroacetic acid, salicyclic acid |
| • Immunologic: imiquimod | |
| • Surgical: cryotherapy, laser therapy, excision | |
| Prognosis | • Recurrence rates are high, regardless of treatment modality. |
| Prevention | • Vaccination |
| • Barrier contraception |
Once present, anogenital warts may worsen or regress spontaneously (ie, immune clearance). Most patients are asymptomatic, but some may develop pruritus or friability (spotting with wiping).
Small anogenital warts are treated with topical agents that either chemically injure the lesion (eg, trichloroacetic acid, podophyllin resin) or stimulate an immune response to it (eg, imiquimod). Surgical excision may be required for larger lesions.
The Q said →Cervical cancer screening last year revealed atypical squamous cells of undetermined significance, with negative testing for high-risk human papillomavirus.
Anogenital warts (condyloma acuminata) in children
Anogenital warts typically appear as clusters of soft, pink or skin-colored (fleshy) lesions in the internal or external vaginal, vulvar, and anal regions in women. Most lesions are exophytic, dry-appearing, and verrucous(ie, cauliflower-like), although some may appear sessile and flat
**Topical salicylic acid** is one of the first-line treatment options for the management of common warts in patients who present with associated pain, functional impairment, or discomfort. The benefits of this treatment option include high efficacy and availability, low cost, painless application, and minimal side effects, all of which make topical salicylic acid a safe option for wart removal in pediatric patients. Topical salicylic acid can also be combined with other first-line treatment options, such as cryotherapy with liquid nitrogen, for a faster and more effective therapeutic response.
Pulsed dye laser therapy is a second-line treatment option for patients with common warts. Given the high cost, low availability, and side effects of the procedure (e.g., skin discoloration, scarring, pain), pulsed dye laser therapy is reserved for patients who have not responded to first-line therapy.
Surgical excision (e.g., curettage) is a second-line treatment option for the management of common warts. This option is reserved for patients who have not responded to first-line therapy or who request the immediate removal of warts. However, surgery is associated with an increased risk of scarring, infection, and wart recurrence, which limits its use in clinical practice.
<aside> 💡 Choice B) Condylomata lata, caused by secondary syphilis, are raised, gray-white lesions that develop on mucosal surfaces (eg, mouth, perineum). In contrast to condylomata acuminata, condylomata lata typically have a broader base and a smooth, rather than a verrucous, surface.
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(Choices A and D) Avoiding tight-fitting clothing and maintaining proper vulvar hygiene (eg, wiping front to back) help prevent nonspecific vulvovaginitis, a common cause of itching and vulvar irritation in adolescents. However, these do not prevent HPV exposure or development of anogenital warts.
There is no association between BMI and anogenital warts.