2025 – PAGE 158 – DERMATOLOGY

(DOUBLE TAKE) HUMAN PAPILLOMA VIRUS (HPV)

Human papilloma virus (HPV) causes VERRUCA VULGARIS (warts). They can be on the hands, knees, and feet, and in the anogenital region. If genital, the condition is referred to as CONDYLOMA ACUMINATA. Genital human papilloma virus is considered to be an STD. In fact, HPV is considered the most prevalent STD of all. Only a small percentage of patients carrying HPV develop warts. More than 90% of infections are from HPV 6 or HPV 11, which are NOT likely to induce cervical cancer. The risk of cervical cancer is increased depending on the subtype (16 and 18 are most commonly associated with cervical cancer). Anogenital warts can be due to maternal-fetal transmission and may not present until 3 years after birth! BUT if you note anogenital warts AFTER 3 years of age, think SEXUAL ABUSE. Lesions are NOT tender but easily bleed with minimal trauma. Treat with self-applied topical podophyllotoxin or imiquimod. Treatment with cryotherapy or podophyllin is done by a physician.

PEARL: Cervical cytology (Pap test) is not recommended until 21 years of age for an average-risk asymptomatic woman.

IMAGE: www.pbrlinks.com/HPV1  (Acuminata)
IMAGE: www.pbrlinks.com/HPV2

MNEMONIC: Don’t get confused with molluscum. hpV = VVarts/Warts = Verruca Vulgaris = Venereal VVarts/Warts. “VVarts on your hands or knees? It’s probably from those darn V’s!”

MNEMONIC: The HPV 16 & HPV 18 strains are the two you should remember (associated with the highest risk of cervical cancer): Imagine an adolescent couple. Their birthdays are on the same day, 7/1 (Zodiac of CANCER). The boy is turning 18, and he’s excited to finally VOTE. His girlfriend is turning 16, and she’s excited because she’ll finally get her DRIVER’S LICENSE now that she’s celebrating her SWEET SIXTEENTH. As they go to blow out the BIRTHDAY CAKE candles, you notice that she has VVarts on her lips! It turns out he also has VVarts, but his are Venereal (anogenital).

NAME ALERT:  An “A” in Acuminata looks like a flipped “V,” which may help you remember that a diagnosis of Condyloma Acuminata represents an hpV infection. The “L” in Condyloma Lata should remind you that you are dealing with syphiLis.

CONDYLOMA LATA

Condyloma lata is found in secondary syphiLis = White-gray, coalescing papules. These appear much more FLAT than Condyloma Acuminata.

IMAGE: www.pbrlinks.com/CONDYLOMA1

NAME ALERT: An “A” in Acuminata looks like a flipped “V,” which may help you remember that a diagnosis of Condyloma Acuminata represents an hpV infection. The “L” in Condyloma Lata should remind you that you are dealing with syphiLis.

HERPES SIMPLEX VIRUSES 1 & 2 (HSV 1 & 2)

Herpes simplex viruses 1 and 2 are similar. HSV-2 is usually an STD usually affecting the genitals, while HSV-1 most commonly affects the mouth (gingivostomatitis) but can appear in other sites as well.

Initial infections are often asymptomatic but can be relatively severe with very painful lesions, fever, and lymphadenopathy. Look for multiple painful ulcers or vesicles on the labia or penis (HSV-2) or in and around the mouth (HSV-1). The vesicles are CLUSTERED on an ERYTHEMATOUS BASE. Lesions can also be ULCERATIVE. Diagnose by obtaining HSV PCR or a viral culture. The Tzanck smear is not specific for HSV. Treat with ORAL Acyclovir x 7 days (not topical). Treat babies with IV Acyclovir.

HSV becomes latent after the primary infection and can reactivate later. Recurrent infections tend to be less severe and of shorter duration than primary ones. Pain often precedes the appearance of lesions. Patients DO shed virus during secondary infections.

IMAGE: www.pbrlinks.com/HSVII1

PEARL: HSV-1 can be associated with a very painful infection called a HERPETIC WHITLOW (typically of a thumb or finger).

IMAGE: www.pbrlinks.com/HSVII2