What
we as gynecologists, need to know
on Genital warts ??
Ans:
Genital warts is a disease which has
been known at least since the time of Hippocrates in 300 BC.
Prevalence of genital wart?? About 1% of people
have genital warts. Many people, however, are infected and do not have
symptoms. Without vaccination nearly all sexually active people will get
some type of HPV at one point in their lives.
Clinical
features??
Small Condylomata:
Where to look for?? How they lesion look like??
Ans:
They may be found anywhere in the anal or genital area, and are frequently
found on external surfaces of the body, including the penile shaft, scrotum, or
labia majora of the vagina. They can also occur on internal surfaces like
the opening to the urethra, inside the vagina,
on the cervix, or in the anus. They can be as small as
1-5mm in diameter, but can also grow or spread into large masses in the genital
or anal area. In some cases they look like small stalks. They may be hard
("keratinized") or soft. Their color can be variable,
and sometimes they may bleed.
In
most cases, there are no symptoms of HPV infection other than the warts
themselves. Sometimes warts may cause itching, redness, or discomfort,
especially when they occur around the anus. Although they are usually without
other physical symptoms, an outbreak of genital warts may cause psychological
distress, such as anxiety, in some people
The
diagnosis of genital warts is most often made visually, but may require
confirmation by biopsy in some cases, Smaller warts may
occasionally be confused with molluscum
contagiosum. Genital
warts, histopathologically, characteristically
rise above the skin surface due to enlargement of the dermal papillae, have parakeratosis and the
characteristic nuclear changes typical of HPV infections (nuclear enlargement with
perinuclear clearing). DNA tests are available for diagnosis of high-risk HPV
infections. Because genital warts are caused by low-risk HPV types, DNA tests
cannot be used for diagnosis of genital warts or other low-risk HPV infections.
This is a sexually transmitted
infection caused
by certain types of human papillomavirus (HPV). They
are generally pink in color and project out from the surface of the skin. Usually they cause few symptoms, but can
occasionally be painful. Typically they appear one to eight months following
exposure. Warts are the most
easily recognized symptom of genital HPV
infection. genital warts or
anogenital warts) refers to an epidermal manifestation attributed to the epidermotropic
human papillomavirus (HPV), More than 100 types of double-stranded HPV papovavirus
have been isolated to date.. Many of these have been related
directly to an increased neoplastic risk in men and women.
Bacteriology
of genital wart ?? Approximately 90% of Condylomata acumina are related to
HPV types 6 and 11. These 2 types are the least likely to have a neoplastic
potential. Risk for neoplastic conversion has been determined to be moderate
(types 33, 35, 39, 40, 43, 45, 51-56, 58) or high (types 16, 18), with
many other isolated types. The picture is complicated by proven coexistence of
many of these types in the same patient (10-15% of patients), the lack of
adequate information on the oncogenic potential of many other types, and
ongoing identification of additional HPV-related clinical pathology.
Some
practitioners use an acetic acid solution to identify smaller warts
("subclinical lesions"), but this practice is
controversial. Because a diagnosis made with acetic acid will not
meaningfully affect the course of the disease, and cannot be verified by a
more specific test, a 2007 UK
guideline advises against its use.
·
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How to treat wart ?? Podophylin if freshly prepared acts well Available
from Dermatologist .Podopwart is to be applied by the clinician and not given
to the patient to apply......it s applied with a "ear bud" in a very
touch and go fashion. Once applied it takes some days for the wart to go, as
the action lasts few days. If the patient keeps on applying it herself, the
skin may get some effects and cause burning
Beware
of Cautery, if it is near or above the clitoris, so it may cause some bleeding
that may at times be difficult to control given the rich vascular supply to the
erectile tissues there
correct
description by dr p p . I hv used for 2 pts like this with ear bud , repeated
after 1 week ,
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