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Enveloped virus
23%
22/96
Gram-negative coccobacillus
5%
5/96
Non-enveloped virus
64%
61/96
Obligate intracellular bacteria
6%
6/96
Spirochete bacteria
1%
1/96
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This patient with dyspareunia who is found to have a raised verruciform lesion most likely has condyloma acuminatum. This disease is caused by the non-enveloped human papillomavirus. Human papillomavirus is a non-enveloped, circular, double-stranded DNA virus that causes sexually transmitted infections. Presentations of this virus include cutaneous warts, condyloma acuminatum, cervical cancer, anal cancer, and penile cancer. Condyloma accuminata will present with a raised, cauliflower-shaped, verruciform lesion in the genital region. The lesion may be asymptomatic; however, it can also present with pruritus or dyspareunia. Lesions will often grow in size if left untreated, though the disease can be largely prevented through vaccination. Figure A shows a raised verruciform lesion that is characteristically seen in patients with condyloma accuminata. The irregular borders and raised nature of the lesion help to distinguish this from other genital ulcers. Incorrect Answers: Answer 1: Enveloped virus describes herpesvirus, which can cause genital ulcers; however, this disease will present with many painful vesicles and ulcers rather than a large raised lesion. This disease can be treated with acyclovir. Answer 2: Gram-negative coccobacillus describes Haemophilus ducreyi, which can cause chancroid; however, this disease presents with a painful ulcer that has a grey-yellow base with irregular borders. It would not have a raised verruciform lesion. This disease can be treated with azithromycin. Answer 4: Obligate intracellular bacteria describes Chlamydia trachomatis, which can cause lymphogranuloma venereum, which can lead to painless genital ulceration; however, this disease may also feature painful localized inguinal adenopathy. This disease can be treated with doxycycline. Answer 5: Spirochete bacteria describes Treponema pallidum, which causes syphilis and can lead to condyloma lata; however, these lesions tend to be painless, broad-based lesions that are flat and velvety. The pain and cauliflower-like projections of the lesions seen in this patient are more consistent with condyloma accuminata. This disease can be treated with penicillin. Bullet Summary: Condyloma accuminata is caused by the non-enveloped, circular DNA virus called human papillomavirus.
3.9
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