1 / 68

Warts and All

Warts and All. Dr Daniela Brawley ST4 Genitourinary medicine 23 rd November 2010. Cases of genital warts/year in UK. Human Papilloma Virus. > 100 sub-types of HPV HPV 6 and 11 cause 90% of genital warts Most clear the infection in 9 months HPV 16 and 18 risk for malignant change

jovita
Download Presentation

Warts and All

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Warts and All Dr Daniela Brawley ST4 Genitourinary medicine 23rd November 2010

  2. Cases of genital warts/year in UK

  3. Human Papilloma Virus • > 100 sub-types of HPV • HPV 6 and 11 cause 90% of genital warts • Most clear the infection in 9 months • HPV 16 and 18 risk for malignant change • Persistent infection with oncogenic sub-types increases risk of malignant change

  4. Prevalence • 1% of population have visible warts • 10% have active HPV infection • 60% have cleared HPV • However can have long latent or lifelong phase • ? Missed opportunity with quadrivalent HPV vaccine (6/11/16/18)

  5. Transmission • Sexual in majority of cases • Female to male 71% at 3 months • Male to female 54% at 3 months • Condoms can reduce risk but don’t eliminate • Increased risk if immunocompromised and/or smoker

  6. Diagnosis • Diagnosis is by examination under good light • Consider referral/biopsy if atypical or unsure • STI screening • Partner notification not necessary

  7. STI screening • 10-20% have co-existing STIs • Extensive warts – HIV indicator disease • BHIVA 2008 HIV testing guidelines • Chlamydia/ Gonorrhoea • Urine in males • Vulvovaginal/cervical swab in females • HIV/Syphilis

  8. But first… ….what’s a normal lump?

  9. Pearly penile papules • Normal anatomy • No treatment • Common presentation in young men • Reassure strongly that are normal

  10. Vulval papillomatosis • Smooth and symmetrical • Easily confused with HPV • Don’t progress • review at 1 month • No treatment

  11. Parafrenular glands • Symmetrical, small and smooth surface • No treatment required

  12. Fordyce spots or sebaceous follicles • Glands in clusters • Prepuce, shaft of penis and vestibular area of vulva • More obvious when skin is stretched • Reassurance

  13. Sebaceous cysts • No treatment necessary unless become too large or get infected • Reassurance • In men scrotal sebaceous cysts may occur

  14. Lymphocoele • Hard swelling behind coronal surface • No treatment required • Usually resolves over time • Reassurance

  15. And now… other differentials

  16. Molluscum contagiosum • Pox virus • Skin to skin contact, most likely sexual • Cryotherapy • STI screening including HIV especially if extensive

  17. Condyloma Lata of Secondary Syphilis • Refer GUM • Syphilis PCR and serology • Dark ground microscopy • STI screening • Penicillin and GUM follow-up

  18. Now for warts…. • Site, distribution and number • Morphology- keratinised or non keratinised • Patient features • Experience and equipment • Availability of cryotherapy

  19. Treatments • Podophyllotoxin (warticon) • Cryotherapy • Imiquimod (aldara) • Smoking cessation • Excision

  20. Warticon • Purified extract of podophyllin • Solution (0.5%) or cream (0.15%) • Non-keratinised warts, not perianal • 3 days BD then 4 days rest for 4 weeks • Soreness and ulceration • NOT used in pregnancy

  21. Cryotherapy • Necrosis of dermal-epidermal junction • Keratinised warts and intrameatal warts • Weekly application with “Halo” and “Freeze and thaw” techniques • Safe in pregnancy

  22. Aldara • Immune response modulator • Non formulary and expensive (£50/month) • Used for resistant/extensive warts • 3 times a week for maximum 16 weeks • NOT used in pregnancy

  23. Source: Sandyford Protocols- External Anogenital Warts.

  24. Clearance rates Source: United Kingdom National Guideline on the Management of Anogenital Warts, 2007. (BASHH)

  25. Keratinised Warts • Cryotherapy first line • Imiquimod if not improving • Warticon less likely to be effective but can try for 4 weeks

  26. Non-keratinised warts • Warticon • Cryotherapy or imiquimod if not improving

  27. Perianal warts • Cryotherapy first line • Imiquimod if not improving • Warticon can be used but not licensed • Proctoscopy not indicated unless immune suppressed, or symptoms in anal canal

  28. Extensive Sub-preputial warts • GUM referral • Imiquimod and cryotherapy • Surgical referral

  29. 20 week pregnant female

  30. Warts in pregnancy • Cryotherapy • Warticon and Imiquimod contraindicated • Improve/resolve 6-8 weeks after delivery • Not an indication for Caesarean Section • Small risk of transmission both genital and laryngeal papilloma • 1 in 400 • No reduction with c-section

  31. Warts and Bowen’s Disease • Referral for biopsy of suspicious areas • Cryotherapy/ electrocautery • Circumcision

  32. Warts and VIN • Referral for biopsy of suspicious areas • Localised surgical excision • Referral to Gynaecology

  33. Features indicating biopsy • Atypical • Pigmentation • Flat warts • Older age groups • Immunosuppression including HIV • Heavy smokers

More Related