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Updated: Mar 12 2023

Human Papilloma Virus

Images
https://upload.medbullets.com/topic/104176/images/koil1.jpg
https://upload.medbullets.com/topic/104176/images/anal-condyloma-acuminata-in-the-region-of-the-corrugator-cutis.jpg
  • Snapshot
    • A 38-year-old male presents to the clinic with a history of soft, raised flesh-colored growths on his glans penis, prepuce, and penile shaft. He is sexually active with multiple partners and uses condoms infrequently. Excisional biopsy was carried out.
  • Introduction
    • Classification
      • Virus
        • non-enveloped, circular double-stranded DNA virus
    • Epidemiology
      • only infect humans
        • most common sexually transmitted infection (STI)
        • among adults ages 18-59 in the U.S.A., prevalence of 45% for men and 40% for women
      • risk factors
        • multiple sex partners
        • individuals with new sex partners
    • Pathogenesis
      • transmission
        • from one epithelial surface to another
        • sexual activity
        • close skin-to-skin contact
      • multiple serotypes (> 75) and serotype determines disease
      • viral oncogenes in high-risk HPV infections (HPV types 16, 18, 31, and 33)
        • E6 degrades tumor suppressor p53 protein
        • E7 binds to Rb protein and disrupts interaction between Rb and E2F
          • allows for replication and cellular division
          • allows for replication and cellular division
        • allows for replication and cellular division
      • allows for replication and cellular division
    • allows for replication and cellular division
    • Associated conditions:
      • cutaneous warts (HPV types 1 and 2)
      • condyloma acuminata/anogenital warts (HPV types 6 and 11)
      • laryngeal papillomatosis (HPV types 6 and 11)
      • precancerous and cancerous genitourinary/oropharyngeal lesions (HPV types 16, 18, 31, 33)
        • cervical cancer
        • head and neck cancer
        • anal cancer
        • penile cancer
      • HIV infections promotes persistence of HPV infection and may promote HPV-associated oncogenesis
    • Prevention
      • vaccinations
        • Gardasil 9 in the USA
          • targets HPV types 6, 11, 16, 18, 31, 33, 45, 52, and 58
        • females age 9-26; males age 9-21
    • Prognosis
      • depends on clinical presentation and conditions
  • Presentation
    • Symptoms
      • most cases will present asymptomatically and will self-resolve
      • cutaneous warts/common hand warts
      • condyloma acuminata (anogenital warts)
      • laryngeal papillomatosis
        • hoarseness, shortness of breath, and chronic cough
        • dysphagia, pneumonia, and recurrent upper respiratory infections
      • oropharyngeal neoplasms/cancer
        • typically in young patients
      • genitourinary neoplasms/cancer
        • abnormal bleeding
        • discomfort during sexual intercourse
        • abnormal discharge
    • Physical exam
      • cutaneous warts/common hand warts
        • rough, raised bumps on hands, fingers, and soles of feet
      • condyloma acuminata
        • often cauliflower-shaped
      • oropharyngeal neoplasms/cancer
        • lesions occurs mainly at base of tongue and tonsils
        • ulcer, sores, swelling, and painful lesions
      • genitourinary neoplasms/cancer
        • cervical cancer
          • pelvic exam and colposcopy may demonstrate abnormal cells
        • anal cancer
          • digital rectal exam and anoscopy may demonstrate lesions
        • penile cancer
          • abnormal growths or lesions
  • Studies
    • Labs
      • gold standard is in situ hybridization or PCR to detect HPV DNA
        • HPV-16 viral load
    • Indirect laryngoscopy
      • allows for direct visualization of lesions at the larynx
    • Histopathology
      • koilocytic cells on biopsy or Pap smear
    • Screening
      • Pap smear for women beginning at age 21
  • Differential
    • Condyloma lata of secondary syphilis
      • differentiating factor
        • condyloma lata are more flat-topped
    • Molluscum contagiosum
      • differentiating factor
        • have central dimpling and often in immunocompromised individuals
    • Genital herpes
      • differentiating factor
        • painful ulcerating lesions
  • Treatment
    • Most HPV infections are cleared by the body’s immune system
    • Common warts
      • often resolve without treatment
      • use of OTC salicylic acid and other prescription medications
      • surgical procedures such as cryotherapy, electrocautery, and laser therapy
    • Laryngeal papillomatosis
      • surgical removal, though high recurrance rate
      • adjuvant non-surgical treatments
        • antiviral (e.g., cidofovir)
        • interferon
        • photodynamic therapy
    • Cancer
      • chemotherapy
      • immunotherapy
      • surgical resection +/- radiation therapy
  • Complications
    • Cervical cancer
    • Anal cancer
    • Head and neck cancer
    • Penile cancer
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