Sections View Full Chapter Figures Tables Videos Full Chapter Figures Tables Videos Supplementary Content +++ Key Features +++ Essentials of Diagnosis ++ Transmitted sexually Most frequent cause of an abnormal Papanicolaou (Pap) smear There are almost 100 serotypes of HPV Types 6 and 11 cause approximately 90% of genital warts Types 16 and 18 cause more than 70% of cervical dysplasia and cervical cancer Infection is more common in persons with multiple partners and in those who initiate sexual intercourse at an early age +++ General Considerations ++ An estimated 20 million people in the United States are infected each year with HPV, including approximately more than 9 million sexually active adolescents and young adults 15–24 years of age An estimated 32–50% of adolescent females having sexual intercourse in the United States have HPV infections, though only 1% may have visible lesions Thirty to 60% of males whose partners have HPV have evidence of condylomata on examination Pap smears should be obtained starting at age 21 and then every 3 years More frequent and earlier evaluations are recommended if there are additional risk factors, such as coinfection with HIV +++ Clinical Findings +++ Symptoms and Signs ++ In males, lesions Are found on the shaft or corona of the penis May develop in the urethra or rectum Do not produce discomfort May be single or found in clusters In females, lesions Develop on any genital mucosal surface, either internally or externally Perianal lesions often develop +++ Differential Diagnosis ++ Normal anatomic structures (pearly penile papules, vestibular papillae, and sebaceous glands) Molluscum contagiosum Seborrheic keratosis Syphilis +++ Diagnosis ++ Acetowhitening is used to indicate the extent of cervical infection Pap smears detect cervical abnormalities Changes range from atypical squamous cells of undetermined significance (ASCUS) to low-grade squamous intraepithelial lesions (LSIL) and high-grade squamous intraepithelial lesions (HSIL) LSIL encompasses cellular changes associated with HPV and mild dysplasia HSIL includes moderate dysplasia, severe dysplasia, and carcinoma in situ If results show signs of inflammation only, and concomitant infection such as vaginitis or cervicitis is present, the smear should be repeated after the inflammation has cleared Colposcopy Recommended if the grade of the atypical squamous cells remains uncertain or HSIL is detected on Pap smear Not needed if LSIL is detected, but a repeat Pap smear should be done in 1 year +++ Treatment ++ Warts may resolve or remain unchanged if left untreated or they may increase in size or number External lesions can be treated topically Patient applied Podofilox, 0.5% solution or gel; apply twice a day for 3 days Imiquimod 5% cream, applied 3 times a week overnight (maximum of 16 weeks) Imiquimod 3.75% cream, applied daily at bedtime (maximum of 16 weeks) Sinecatechins 15% ointment, applied 3 times daily (maximum of 16 weeks) Podophyllin, 25% in benzoin tincture applied directly ... GET ACCESS TO THIS RESOURCE Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth Get Free Access Through Your Institution Contact your institution's library to ask if they subscribe to McGraw-Hill Medical Products. Access My Subscription GET ACCESS TO THIS RESOURCE Subscription Options Pay Per View Timed Access to all of AccessPediatrics 24 Hour $34.95 (USD) Buy Now 48 Hour $54.95 (USD) Buy Now Best Value AccessPediatrics Full Site: One-Year Individual Subscription $595 USD Buy Now View All Subscription Options