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Los botones se encuentran debajo. HPV can reside in epithelial basal cells and lead to subclinical or latent infection. More than 80 genotypes have been identified; HPV 6, 11, and 16 are most commonly associated with genital warts. HPV 6 and 11 are rarely associated with cervical cancer. HPV 16 and 18 are more likely to be present in subclinical infection and are the types most commonly associated with genital cancer. Bowenoid papulosis is most commonly caused by HPV It is associated with HPV types 6 and Incidence The incidence of genital warts is increasing rapidly and exceeds the incidence of genital herpes.
It is the most common viral sexually transmitted disease. Most cervical dysplasias and cancers are related to oncogenic HPV. Transmission Risk factors for acquisition of condyloma in women have been identified as the number of sexual partners, frequency of sexual intercourse, and presence of warts on the sexual partner.
Men have been found to be at increased risk if they fail to wear a condom. Condoms reduce the transmission of HPV but they do not eliminate it. Transmission of HPV during infant delivery may rarely occur. Clinical presentation Genital warts condyloma acuminata or venereal warts are pale pink with numerous, discrete, narrow-to-wide projections on a broad base. The surface is smooth or velvety, moist, and lacks the hyperkeratosis of warts found elsewhere Figures to     .
The warts may coalesce in the rectal or perineal area to form a large, cauliflower-like mass Figures and Perianal warts may be present in persons who do not practice anal sex. Another type is seen most often in young, sexually active patients. Multifocal, often bilateral, red- or brown-pigmented, slightly raised, smooth papules have the same virus types seen in exophytic condyloma, but in some instances these papules have histologic features of Bowen’s disease.
See discussion of bowenoid papulosis later in this chapter. Warts spread rapidly over moist areas and may therefore be symmetric on opposing surfaces of the labia or rectum Figure Common warts can possibly be the source of genital warts, although they are usually caused by different antigenic types of virus. Warts may extend into the vaginal tract, urethra, and anal canal or the bladder, in which case a speculum or sigmoidoscope is required for visualization and treatment.
Condylomas may spontaneously regress, enlarge, or remain unchanged. Genital warts frequently recur after treatment. There are two possible reasons. Latent virus exists beyond the treatment areas in clinically normal skin.
Pxrafimosis lesions were asymptomatic. Magnification was necessary to detect oral lesions. The diagnosis was confirmed by biopsy. The tongue was the site most frequently affected. Oral condylomas appeared as multiple, small, white or pink papules, sessile or pedunculate, and as papillary growths with filiform characteristics.
HPV types 16, 18, 6, and 11 were found. Removal of visible lesions decreases viral transmission. All treatment methods are associated with a high rate of parrafimosis that is likely related to surrounding subclinical infection. Management of sexual partners Examination of sexual partners is not necessary for the management of genital warts because the role of reinfection is probably minimal.
Many sexual partners have obvious warts and may desire treatment. The majority of partners are probably already subclinically infected with HPV, even if they do not have visible warts. Nanejo use of condoms may reduce transmission to partners likely to be uninfected, such as new partners. HPV infection may persist throughout a patient’s lifetime in a dormant state and become infectious intermittently.
Whether patients with subclinical HPV infection are as contagious as patients with exophytic warts is unknown. One study showed that the failure rate of treating women with condylomata acuminata did not decrease if their male sexual partners were also treated. Genital papillary lesions have a tendency to proliferate and to become friable during pregnancy. Many experts advocate the removal of visible warts during pregnancy. HPV types 6 and 11 can cause laryngeal papillomatosis in infants. The route of transmission is unknown, and laryngeal papillomatosis has occurred in infants delivered by caesarean section.
Caesarean delivery should not be performed solely to prevent transmission of HPV infection to the newborn. In rare instances, cesarean delivery may be indicated for women with genital warts if the pelvic outlet is obstructed or if vaginal delivery would result in excessive bleeding.
Children Spontaneous resolution of pediatric condyloma occurs in more than half of cases in 5 years. Nonintervention is a reasonable initial approach to managing venereal warts in children.
Improved efficacy and lower recurrence rates occur with imiquimod Aldara by inducing the body’s own immunologic defenses. Imiquimod has an immunomodulatory parafimosie and does not rely on physical destruction of the lesion.
It has antiviral properties by induction of cytokines, including interferon, tumor necrosis factor, interleukin IL -6, IL-8, and IL Imiquimod enhances cell-mediated cytolytic activity against HPV.
Patología Genital en el Varón – ppt descargar
The cream is applied at bedtime every other day, for a maximum of 16 weeks. On the morning after application, the treated area should be cleansed. Local mild-to-moderate irritation may occur. Systemic reactions have not been reported. Imiquimod has not been studied for use during pregnancy. Podofilox, also known as podophyllotoxin, is the main cytotoxic ingredient of podophyllin.
Podofilox gel Condylox is available for self-application and is useful for responsible, compliant patients. Patients are instructed to apply the 0. This cycle is repeated at weekly intervals for a maximum of 4 to 6 weeks.
Podofilox is not recommended for perianal, vaginal, or urethral warts and is contraindicated in pregnancy. Liquid nitrogen delivered with a probe, as a spray, or applied with a cotton applicator is very effective for treating smaller, flatter genital warts.
It is too painful for patients with extensive disease. Exophytic lesions are best paarafimosis with excision, imiquimod, or podofilox.
Warts on the shaft of the penis and vulva respond very well, with little or no scarring. Cryosurgery of the rectal area is painful. A conservative technique is best.
Over-aggressive therapy causes pain, massive swelling, parafimsois scarring. A blister appears, erodes to form an ulcer in 1 to 3 days, and the lesion heals in 1 to 2 weeks.
Repeat treatment every 2 to 4 weeks as necessary. Two to three sessions may be required. Cryotherapy is effective and safe for both mother and fetus when applied in the second and third trimesters of pregnancy.
An aprafimosis spray technique, praafimosis a small spray tip, is used to achieve a small region of cryonecrosis, limiting the run off and scattering of liquid nitrogen. Cervical involvement that requires cervical cryotherapy does not increase the risk to mother parafimosus fetus. Scissors excision, curettage, or electrosurgery produce immediate results.
They are useful for both extensive condylomas or a limited number of warts. Small isolated warts on the shaft of the penis are best treated with conservative electrosurgery or scissor excision rather than subjecting the patient to repeated sessions with podophyllum.
Large, unresponsive masses of parafimowis around the rectum or vulva may be treated by scissor excision of the bulk of the mass, followed by electrocautery of the remaining tissue down to the skin surface. It is most effective on small, moist warts. This is an ideal treatment for isolated lesions in pregnant women. The acid is then neutralized with water or bicarbonate of soda.
The tissue slough heals in 7 to 10 days. Repeat each week or every other week as needed.
Patología Genital en el Varón
Excessive application causes scars. Take great care not to treat normal surrounding skin. Podophyllin is a plant compound that causes cells to arrest in mitosis, leading to tissue necrosis. Patient applied medications are now commonly used. The medication can be very effective especially for moist warts with a large surface area and lesions with many surface projections.
Podophyllun is relatively ineffective in dry areas, such as the scrotum, penile shaft, and labia majora. It is not recommended for cervical, vaginal, or intraurethral warts.
The compound is applied with a cotton-tipped applicator.
The entire surface of the wart is covered with the solution, and the patient remains still until the solution dries in approximately 2 minutes. When lesions parqfimosis by the prepuce are treated, the applied solution must be allowed to dry for several minutes before the prepuce paravimosis returned to its usual position. Powdering the warts after treatment or applying petrolatum to the surrounding skin may help to avoid contamination of normal skin with the irritating resin.
The medicine is removed by washing 1 hour later.