Cause:Human papilloma virus (Vaginal Carcinoma)
Pathophys:Virus present in normal as well as wart skin (Nejm 1985;313:784)
Venereal spread and highly infective; incidence ~40% in college women w resolution and reinfection common (Nejm 1998;338:423); prevalence higher in HIV-pos women (Nejm 1997;337:1343). Cause of laryngeal papillomas from aspiration at delivery (Nejm 1983;308:1261)
Sx: 1-6 mo incubation. Pain at site
Si: Warts on genitalia; in male partners, often flat and hard to see (Nejm 1987;317:916)
Cervical carcinoma (Cervical Carcinoma) (Lancet 2000;355:2189, 2194), especially types 16 and 18, intraepithelial neoplasia often within 2 yr of contagion (Nejm 1992;327:1272) and eventual cervical cancer in an unknown but significant number (Nejm 1999;341:1633); also associated with vaginal, endometrial, vulvar (Nejm 1986;315:1052), anal SIL and cancer rates higher in gay males esp if HIV pos than cx rates in women (Ann IM 2003;138:453; Nejm 1997;337:1350), laryngeal, and conjunctival (Nejm 1989;320:1442) cancers
r/o molluscum contagiosum (Molluscum Contagiosum)
r/o vestibular papillomatosis in women; causes pearly penile papules in men, which are benign (Nejm 2008;358:1495)
Rx: Preventive: Male circumcision halves rates (Nejm 2002;342:1105); barrier method birth control.
Vaccination w quadrivalent PPV at 0, 2, and 6 mo in sexually active women under age 24 yr, appears to be 100% effective (Nejm 2007;356:1915, 1928) in preventing cancer from those 4 types that cause 20-30% of the cancer if given before but no help if already infected (Jama 2007;298:743); adv effects: Guillain-Barré and thrombo-embolic (Jama 2009;302:750)
of disease: (Med Let 1999;41:90) to patient and partner; stain area w acetic acid 1st to bring out latent warts for rx, especially in men; all work for common warts rx too.