Sunday, March 26, 2023

Genital Warts

Background

Genital warts are an epidermal manifestation attributed to the epidermotropic human papillomavirus (HPV). More than 100 types of double-stranded HPV papovaviruses have been isolated thus far, and, of these, about 35 types have affinity to genital sites. Many have been linked directly to an increased neoplastic risk in men and women.

Two general categories of genital human papillomavirus (HPV) exist: low-risk benign HPV lesions and high-risk neoplastic HPV lesions. The low-risk strains are responsible for genital warts and recurrent respiratory papillomatosis (RRP), as well as low-grade cervical lesions. Two types, 6 and 11, account for more than 90% of genital warts and most cases of RRP. These are least likely to have malignant potential.

Thirteen human papillomavirus (HPV) types (ie, 33, 35, 39, 40, 43, 45, 51-56, 58) have a moderate risk for neoplastic conversion; HPV-16 and HPV-18 are considered high risk; more than 70% of cervical, vaginal, and penile cancers are caused from 2 types. This picture is complicated by the proven coexistence of many types in the same patient (10-15%), lack of adequate information on the oncogenic potential of many other types, and ongoing identification of additional HPV-related clinical pathology. For example, bowenoid papulosis, seborrheic keratoses, and Buschke-Lowenstein tumors —previously parts of the differential diagnosis of genital warts—all have been linked to HPV infections.

Bowenoid papulosis consists of rough papular eruptions and is considered a carcinoma in situ. Eruptions can be red, brown, or flesh colored and may regress or become invasive.

Seborrheic keratoses previously were considered a benign skin manifestation. These consist of rough plaques and have an infectious and an oncogenic potential.

Buschke-Lowenstein tumor (giant condyloma) is a fungating, locally invasive, low-grade cancer attributed to HPV.

Also see Human Papillomavirus.

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