Genital Warts (HPV Infection) Causes, Symptoms, Treatment

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Human Papilloma Virusassociated Neoplasms

Genital cancers and cervical intraepithelial neoplasia (CIN) have been strongly implicated in association with HPV infection. The first report demonstrating the association of HPV and cervical cancer was published by Zur Hausen et al.,123 showing that cervical cancer in the female genital tract has HPV-associated lesions. HPV infection of genital can either lead to asymptomatic infection or a wide range of genital lesions, ranging from genital warts to mild dysplasion to invasive carcinomas. Genital lesions are often referred to as cervical intraepithelial abnormalities or CIN, which is graded from I to III depending on the degree of epithelium abnormality. CIN I encompasses mild dysplasia or low-grade squamous intraepithelial lesions (SIL). CIN II represents high-grade SIL with moderate dysplasia, while severe dysplasia is referred to as CIN III.79 In 1993, the CDC has included invasive cervical cancer as one of the AIDS-defining illnesses. HIV infection has become an important risk...

Nuclear inclusions formed during polyomavirus and papillomavirus infection

Polyoma- and papillomaviruses are small double-stranded tumorigenic DNA viruses with genomes of 5 and 8 kbp, respectively. Replication and assembly of these two viruses follow similar strategies, and both involve ND10 bodies. The VP1 capsid protein of human polyomavirus JC is targeted to ND10 domains by VP2, VP3, and agnoprotein where they are assembled into virions (Shishido-Hara et al., 2004). A similar process occurs during papillomavirus infection where the minor capsid protein, L2, is responsible for targeting capsomeres of the major capsid protein, L1, to ND10 domains (Florin et al., 2002a). This process involves L2-induced redistribution of ND10 bodies by targeting SP100 for proteasomal degradation. At this point the cellular Daxx protein is recruited (Florin et al., 2002b). Daax has multiple functions in the nucleus including transcriptional activation and modulating Fas-mediated apoptosis reviewed by Salomoni and Khelifi (2006) . Its role in virus replication is at present...

Condylomata Acuminata

The management of condylomata acuminata depends on the extent and location of the lesions. Treatment options include destructive therapy (podophyllin, trichloroacetic acid, bichloroacetic acid, electrocautery, and laser surgery), excisional therapy, and immunotherapy. We prefer bichloroacetic acid 89 to 90 , a caustic agent that, unlike podophyllin, can be used on the perineum and inside the anal canal, has no systemic toxicity, and does not cause the histological changes resembling carcinoma in situ, which can occur after podophyllin application. Application can be done at 7 to 10 day intervals. Surgical excision has the immediate advantage of reliably eliminating warts and allowing tissue collection for histopathologic analysis. However, it is associated with significant pain, potential stricture formation, and cost for the anesthesia. Thus, topical therapy is preferred unless there is extensive condyloma. Immunotherapy is reserved for patients with recurrent warts.

Human Papillomavirus

Among HIV-infected individuals, human HPV infection has a well-established relationship with the elevated risk of invasive cervical cancer, anal cancer, and precursor lesions of both types of cancer, cervical intraepithelial neoplasia (CIN) and anal intraepithelial neoplasia (AIN).275-278 In addition, other HPV-associated intraepithelial neoplastic lesions and malignancies appear to be more prevalent among HIV-infected individuals. Petry et al.279 reported an increased prevalence among HIV-infected women of high-risk HPV infection associated vulval intraep-ithelial neoplasia (VIN). Frisch et al.280 reported an increase in both invasive and in situ forms of not only cervical and anal cancer, but also of vulvar vaginal and penile cancers among HIV-infected individuals. In Africa, several studies have found evidence of increasing conjuctival carcinoma as well as an association between HPV infection and the risk of squamous cell carcinoma of the conjunctiva.281,282 Moubayed et al.283...

Patients complaining of rectal bleeding consider

Blood spotting after anal sex and or blood spotting on the toilet paper is a common compliant in the GU clinic, and is usually the symptom of minor conditions such as haemorrhoids, anal fissures, genital trauma, or genital warts -which can be associated with pruritus (Rhodes & Hsin, 1995).

Recent Sexual History

'Was this person male or female ' This will guide your questioning and assist you in the risk assessment. Please remember that if the client is female and having sex with another woman this doesn't necessarily mean that they are not at risk that other woman may have had male relationships in the past and may have acquired chlamydia, genital warts or HIV. The use of shared sex toys may also be a risk factor.

Anogenital squamous cell carcinoma

Anal cancer like cervical cancer is related to human papillomavirus. HIV positive patients are two to six times more likely than HIV negative persons to have anal human papillomavirus infection. Persistence of infection is inversely related to CD4 count. Low-grade anal intraepithelial neoplasia is more likely to progress to high grade anal intraepithelial neoplasia in HIV positive patients. However it remains unclear whether HIV directly affects the development of anal carcinoma.

RING finger motif See RING finger proteins

RING finger proteins Proteins having a sequence related to the zinc finger but containing additional cysteine and histi-dine residues that help the molecule to form a ring. Play a critical role in mediating the transfer of ubiquitin both to heterologous substrates and to the RING finger proteins themselves. Ubiquitina-tion is a first step in protein degradation, and some viruses, notably Human papillomavirus, express ring finger proteins that cause ubiquitination leading to degradation of cellular proteins, such as p53.

Friend murine leukemia virus FrMLV A

Fringilla papillomavirus A probable species in the genus Papillomavirus. Isolated from papillomas excised from the leg of a chaffinch, Fringilla coelebs. Virion diameter 52nm sedimentation coefficient 300S and density in CsCl 1.34g ml. Composed of 72 morphological units arranged in a skew T 7d icosahedral lattice. The circular double-stranded genome measured 2.6 im. Protein composition similar to Human papillomavirus. Papillomas have only been found in two species of Fringilla the chaffinch and the brambling, F. montif-ringilla. Synonyms avian papillomavirus bird papillomavirus chaffinch papillo-mavirus.

Hivassociated Squamous Cell Cancer Of The Cervix Epidemiology of HIVAssociated Cervical Cancer

The relationship between HIV-infection and increased prevalence of CIN has been shown in many studies. Mandelblatt et al.298 performed a meta-analysis of 15 cross-sectional studies published between 1986 and 1998 that evaluated prevalence of cervical neoplasia, HPV infection and HIV infection among women. They found that among women infected with HPV, HIV-infected women were significantly more likely to develop cervical neoplasia, and that this effect was related to degree of immunodeficiency. Several other recent studies have also shown that HIV-infected women are at higher risk for CIN. A cross-sectional study conducted by the Women's Interagency Health Study (WIHS) group299 found that 38 of HIV-positive women had abnormal cytologic findings compared with 16 of HIV-negative women. In another cross-sectional multicenter study, Duerr et al.300 also found that HIV-positive women were more likely than HIV-negative women to present with atypical cervical cytology. Finally, Ahdieh et...

Current research and the future

The rapidly increasing evidence on viral involvement in AIDS-associated malignancies suggests novel molecular targets for drug discovery using drug screening and molecular modelling. Vaccines for cancers occurring in patients with human papilloma viruses associated with cervical and ano-genital carcinoma and EBV in haematological malignancies are currently being researched. Other therapeutic approaches include biological therapy (for example IL-2, IL-12, IFN-a), immune-based therapy (for example antigen-presenting cells and monoclonal antibodies against B-cell targets) and angiogenesis inhibitors.

Export of FGF1 and FGF2

Several reports provide evidence that export of FGF-1 and FGF-2 may involve a novel secretory pathway. Stably transfected NIH 3T3 cells, which expressed high levels of FGF-1, released inactive homodimers of FGF-1 on heat shock, in a process that required de novo synthesis of protein. This export was not prevented by Brefeldin A and methyl amine, inhibitors of ER-Golgi transport and exocytosis, respectively (130). Active export of FGF-2 in unusual high mol wt forms has been reported in cell lines derived from different stages of fibrosarcoma development in transgenic mice carrying the bovine papilloma virus genome (131). Cell lines established from the P-cell tumors of Rip1Tag2 transgenic mice (PTC) constitutively secreted FGF-1 into the culture medium (131a). Treatment of this medium with high salt recovered FGF-1 as high mol wt (HMW) forms with reduced heparin-affinity and a molecular mass of approx 40 kDa. Brefeldin A, an inhibitor of conventional secretion, did not interfere with...

Halogenated Compounds

Oral papillomas (Fig. 3.8) occurred on 73 of black bullheads (Ameiurus Ictalurus melas) living in a pond filled with chlorinated wastewater of domestic origin (Grizzle et al., 1981). After neoplasms were discovered, less chlorine was used for effluent disinfection, and the total residual chlorine concentration entering the pond decreased from 1.0-3.1 mg l-1 to 0.25-1.2 mg l-1 (monthly averages). Three years after the chlorination rate was reduced, prevalence of neoplasms had decreased to 23 (Grizzle et al., 1984). This population of fish has since been extirpated, presumably because reproduction was not successful in the contaminated water. There was no evidence that viruses were present in the oral papillomas on black bullheads living in chlorinated wastewater (Grizzle et al., 1984). Except for low concentrations of chloroform (9.0-13.5 mg l-1) and bromodichloro- Fig. 3.8. Papilloma from the head of a black bullhead. The fish was from a pond receiving chlorinated wastewater effluent....

Painted turtle herpesvirus Synonym for chelonid herpesvirus

Papilloma of chamois A parapox virus infection. See chamois contagious ecthyma virus. Papillomaviridae A family of viruses containing only one genus, Papillomavirus. The family description follows the genus description. Papillomavirus A genus of the family Papillomaviridae. Virions are 55nm in diameter, nonenveloped. The capsid is icosahedral composed of 72 capsomeres in a skewed (T 7) arrangement. The DNA genome is a single molecule of double-stranded DNA between 6.8 and 8.4 kb in length, G+C content 40-60 . Proteins are encoded on one DNA strand only, with 9-10 open reading frames called E1 to E8 and L1 to L2. Cause papil-lomas of the skin and mucous membranes in various species (cattle, deer, elk, reindeer, dog, humans, rabbit, horse, monkey, sheep, goat, elephant and birds) and are species-specific. Rarely cause transformation in cell cultures or CPE. Type species Cottontail rabbit papillomavirus. Chan S-Y et al (1992) J Virol 66, 5714 Myers G et al (1997) In Human...

Immune Surveillance

The evolutionary necessity of cancer protection is certainly true, but the unique role attributed to the immune system ignores two salient facts (1) tumor evolution involves the loss rather than the gain of many functions and (2) the cancer cell phenotype is easily malleable. This does not augur well for the immune recognition of tumors as nonself targets. Even if adventitious, immunologically recognizable mutations would occur, they may be readily circumvented by further mutations or phenotypic modulation. There is one important exception, however. Oncogenic proteins of DNA tumor viruses, such as SV40, polyoma, papilloma, and Epstein-Barr virus (EBV), are readily recognized by the immune system as nonself. They The strongest argument for immune surveillance is provided by the increased incidence of a given tumor in immunodefectives. Three types of human malignancies qualify by this criterion. All of them are virus related EBV carrying immunoblastoma, papillomavirus-associated...

Polycyclic Aromatic Hydrocarbons

The Elizabeth River runs through a heavily industrialized area of Virginia and is highly contaminated with PAH (Bieri et al., 1986). Mummichogs (Fundulus heteroclitus) from a portion of the river that had up to 3900 mg PAH kg-1 of sediment (adjacent to an abandoned creosote plant and an active oil transfer and storage site) had papilloma, schwannoma and haemangio-endothelioma (Hargis et al., 1989). The overall prevalence of neoplasms was 2 . Mummichogs in later collections in the Elizabeth River at a site with 2200 mg PAH kg-1 of sediment had a 73.3 prevalence of hepatic foci of alteration and a 35 prevalence of hepatocellular neoplasms (Vogelbein et al., 1990). Only 600 m away and across the river, PAH concentration was 61 mg kg-1 sediment, and mummichogs from this area had no hepatic lesions. Mummichogs from the contaminated site also had neoplasms of the exocrine pancreas (Fournie and Vogelbein, 1994). The Niagara River area near Buffalo, New York, has several sites that contain...

Parvoviruslike viruses

Clinical signs of HPV infection are poor growth, surface fouling, atrophy of the hepatopancreas and opacity of the abdominal musculature (Lightner and Redman, 1985). As with reovirus-like infections, these signs are non-specific and frequently complicated by multiple infections (Lightner et al, 1992b). Mortalities are higher in juveniles than in younger stages, with 100 cumulative mortality in P. merguiensis within 4-6 weeks of the appearance of clinical signs (Lightner and Redman, 1985). In contrast, a heavy infection was detected in an apparently healthy P. esculentis (Paynter et al., 1985, cited in Lightner, 1992b).

Simian enterovirus N203 SEVN203 A

Simian papillomavirus A possible species in the genus Papillomavirus. A natural infection of cebus monkeys causing papillomas. Papillomas can be transmitted experimentally to both New and Old World monkeys. After injection of tissue extract, hyperemic patches appear within 2 weeks and then the epidermis becomes thickened to form a papilloma. No evidence of invasion of normal tissue, and regression occurs in 4-6 months. Synonym monkey papillomavirus.

Squamous cell carcinoma of the nail apparatus has a good prognosis compared with other sites

Trauma, chronic infection and chronic radiation exposure are possible aetiological factors human papillomavirus (HPV) has been incriminated in some cases. Two reported cases had associated congenital ectodermal dysplasia. Most lesions occur on the fingers, particularly the thumbs and index fingers (Figure 5.31). The presenting symptoms include pain, swelling, inflammation, elevation of the nail, ulceration, a tumour 'mass', ingrowing of the nail, 'pyogenic granuloma' and bleeding. Bone involvement is a rare, very late sign. The duration of symptoms before diagnosis is greater than 12 months in over half the cases. Only in one published case (with ectodermal dysplasia) has the condition led to death, from rapid generalized metastases.

Retroviridae Neoplasms

Retroviruses probably cause most infectious neoplasms of fish. These neoplasms are diverse and include lymphosarcoma or leukaemia, dermal sarcoma, fibroma, leiomyosarcoma, papilloma and neural neoplasms. Viruses causing these diseases are difficult to isolate in cell culture, but transmission of the disease by cell-free inoculum and presence of reverse transcriptase activity provide evidence that retroviruses are the aetiological agents causing certain neoplasms of fish. Virus-like particles, typically C-type particles, have been seen in some lesions thought to be caused by retroviruses, but this evidence must be interpreted cautiously because of the similar appearing neurosecretory granules in some cells (Harada et al., 1990). White suckers (Catostomus commersoni) from Burlington Harbour and Oakville Creek in western Lake Ontario, had prevalences of oral papillomas of 35.1 and 50.8 , respectively (Sonstegard, 1977). Electron microscopy revealed C-type particles in the papillomas, and...

Screening in the Community

Public Health Nursing Pictures

In recent years, screening has been more commonly associated with the control of chronic conditions such as heart disease (e.g., blood pressure and cholesterol), cancer (e.g., mammography, Pap test, and testicular examination), and congenital abnormalities (screening among newborns). However, important applications of screening for the prevention and control of infectious diseases have a long history and current importance in traditional public health practice. For example, the US Preventive Services Task Force (USPSTF) has recommended selective screening in high risk populations for several infectious conditions (e.g., human immunodeficiency virus HIV , tuberculosis, chlamydia, rubella, syphilis, and gonorrhea) in the context of a clinical periodic health examination (USPSTF 1996). As with chronic conditions, early detection and treatment of cases of infectious disease improves the clinical outcome of persons affected by disease. In addition, early detection and successful treatment...

Oral and Esophageal Disease

Candidiasis decreases taste sensation and affects swallowing, in addition to causing oral or substernal discomfort. Most cases are due to Candida albicans. Candidiasis in the esophagus and may occur in the presence or absence of thrush. Hairy leukoplakia, a hyperkeratotic lesion found along the sides of the tongue and adjacent gingiva, may be mistaken for Candida, but is asymptomatic. Severe gingivitis or peri-odontitis, infectious or idiopathic ulcers, or mass lesions, such as Kaposi's sarcoma (KS) or lymphoma, occur in the oral cavity and can cause pain or interfere with chewing and swallowing. The esophagus is affected by many of the same lesions as the oral cavity. Overall, studies have demonstrated a decline in the incidence of both oral and esophageal disease in subjects on HAART, with the possible exception of human papilloma virus (HPV)-induced lesions.

Neoplastic Progression 1954

The ability to observe the growth of neoplasms in animals brought new concepts to experimental cancer research. From the very beginning of experimental cancer research, mice have been used to determine the origins of tumors and to watch how they evolve from benign (in situ) to invasive and from progress to metastatic. One key concept was that tumors do progress through stages. The term progression was first applied to virus-induced papillomas and carcinomas by Rous and Beard (Rous and Beard, 1935 Rubin, 1994). However, the seminal papers on the subject came in the 1950s from Leslie Foulds who used the mouse mammary tumor system for The reader should remember that the Papanicolaou and Trout monograph on cervical cytology to detect precancers of the cervix only appeared in 1943 (Papanicolaou and Traut, 1943) and the Pap Smear did not have widespread acceptance when Foulds' 1954 paper appeared (Shimkin, 1977a). However, the Pap Smear has saved countless lives from cervical cancer and...

E1B 55kDa Gene Deletion Mutant dl 1520

Hypothesized that an adenovirus with deletion of a gene encoding a p53-binding protein, E1B 55-kDa, would be selective for tumors that already had inhibited or lost p53 function. p53 function is lost in the majority of human cancers through mechanisms including gene mutation, overexpression of p53-binding inhibitors (e.g., mdm2, human papillomavirus E6), and loss of the p53-inhibitory pathway modulated by pl4ARF 33-35 . However, the precise role of p53 in the inhibition of adenoviral replication has not been defined to date. In addition, other adenoviral proteins also have direct or indirect effects on p53 function (e.g., E4orf6, E1B 19-kDa, E1A) 36 . Finally, E1B 55-kDa itself has important viral functions that are unrelated to p53 inhibition (e.g., viral mRNA transport, host cell protein synthesis shut-off) 37 (Fig. 3).

Cervical Cancer

Approximately 12000 women were newly diagnosed with cervical cancer in the USA in 2003.1 Although cervical cancer remains a leading killer of women worldwide, the incidence in the USA represents a significant decrease, mainly attributable to the widespread implementation of Pap test screening. The Pap smear is designed for detecting pre-invasive disease of the cervix. This allows treatment to be initiated prior to the development of cancer.2 Human papillomavirus (HPV) is a sexually transmitted virus associated with cervical dysplasia and invasive cancer. Low-risk HPV types, such as 6 and 11, are associated with cervical intraepithelial neoplasia (CIN) I and condyloma. High-risk types of HPV, such as types 16, 18, 31, 33 and 35, are observed in association with high-grade dysplasia or cervical cancer. HPV DNA can be detected in close to 100 of patients with invasive cervical cancer. Although the prevalence of HPV in some populations approaches 30-90 , only a small number of these women...

Treatment Of Warts

Condylomata acuminata (genital warts) are benign proliferative tumours, and are caused by human papilloma viruses (HPV). These are double-stranded DNA viruses that infect squamous epithelial cells. There are different types of HPV, which can be either low-risk (can cause genital warts) or high-risk (can cause cancers). Most patients that are infected with HPV will remain unsymp- tomatic however, a small minority of patients will develop genital warts. Immunocompromised patients are more likely to develop systemic infections due to HPV. Disease symptoms can be physically painful and can cause considerable psychological distress. Podophyllotoxin is the purified form of podophyllin, an antimitotic agent, and it is a chemical, topical treatment that is used to remove genital warts.

Figure 1065

Condyloma acuminata (anogenital venereal warts) are caused by infection with human papillomavirus 6 or 11. In transplant recipients they may become extremely extensive. Treatment has included fluorouracil, podophyllin, podophyllotoxin, intralesional interferon, topical interferon, systemic interferon, and, more recently, imiquimod, which causes the induction of cytokines, especially

Anorectal disease

Anal warts are common but rarely cause much in the way of symptoms and should be treated on merit given the absence of any effective antiviral therapy. Anal intraepithelial neoplasia has been described in association with human papillomavirus infection but reports of invasive malignancy are still infrequent.

Onychomatricoma

Onychomatricoma is a recently described entity, clinically characterized by a thickened, yellow longitudinal nail portion with splinter haemorrhages and a slight overcurvature, consisting of a markedly papillomatous lesion of the matrix covered by normal nail-producing epithelium. Its connective tissue stroma is densely cellular and contains fine collagen fibres. The tumour projections fit into channels in the thickened nail substance that run along the whole length of the nail. After avulsion, the nail substance shows these channels lined with the upper third to half of normal matrix epithelium, exactly as seen on the nail's undersurface after nail avulsion. The exact nature of this lesion is not yet clear however, human papillomavirus has not been demonstrated.

Frequency

The number of tetramers available for the study of CD8+ T-cell populations specific for various viruses is increasing e.g. influenza (26), HIV (19), EBV (27), CMV (28), hepatitis B virus (HBV) (29), hepatitis C virus HCV (30), human papillomavirus (HPV) (31), human T-cell lymphotrophic virus type 1 (HTLV-1) (32), RSV (33) and dengue virus (34) , covering a large range of HLA types. Together with these technological advances, a better identification of individuals in early stages of viral infections have facilitated more detailed studies of virus specific CD8+ T-cells found in human peripheral blood from primary infection to the establishment of viral latency. During primary infection, most viruses induce a substantial antigen-driven activation and expansion of CD8+ T-cells, referred to as the effector phase (35). The use of tetramers has revealed that T-cell frequencies in diverse viral infection are much higher than estimated previously. The expansion during the primary infection is...

Cervical carcinoma

Viral DNA from high-risk types of the human papilloma virus (HPV16, 18, 31, 33, and 45) is found in 90 of all cervical cancers irrespective of HIV status. Not every woman with HPV infection develops cervical carcinoma and HPV infection alone is not sufficient for tumour development. Persistence of infection is probably important and other risk factors include smoking, oral contraceptive use and early pregnancy. HPV infection in HIV-infected women may represent reactivation of HPV types acquired in the past rather than recent acquisition of new types. HIV positive women have a high rate of vulvo-vaginal infection which may make screening unreliable, regular Pap smears are therefore critical. Cervical intraepithelial neoplasia (CIN) is more commonly of a higher grade in HIV positive women and if invasive carcinoma ensues it is also more aggressive. A low threshold for referral for colposcopy is essential. Standard treatment strategies of ablation and excision have yielded disappointing...

Figure 1066

Verruca vulgaris (common warts) are caused by human papillo-maviruses 1, 2, 3, 4, 5, 8, 11, 16, and 18, as well as others, with the highest percentage by type 4. Warts are found most often on the fingers, arms, elbows, and knees and are much more numerous in the immunosuppressed patient. Treatment modalities have been the same as for condyloma acuminata, with the addition of topical cidofovir and hyperthermia. Therapy should be planned based on the location, extent, and size of the lesions. Not all lesions need treatment. Early dermatologic referral is needed for those lesions that appear to be advancing rapidly as certain papilloma viruses (16, 18, 31, 51, 52, 56) have been associated with squamous cell carcinomas of the skin and cervix. A and B, Verruca vulgaris of the finger and knee. Note the large size and multiple warts. C, Verruca planae, flat warts at multiple locations of the hand, also often seen on the face.

Transillumination

Transillumination of the breast began in 1929 with the real-time viewing (diaphanoscopy) of the breast by a dark-adapted examiner (Cutler, 1929). The technique was found somewhat helpful in distinguishing cystic from solid lesions and, specifically, in suggesting the diagnosis of hematoma and retroareolar intraductal papilloma. After a period of initial interest, the technique lapsed into relative obscurity, only to be revived in France in the 1950s with the recording of hard-copy images (diaphanography) on photographic film. Subsequent modifications in technique resulted in improved diagnostic performance, but transillumination still was considered useful only as an adjunct to other breast diagnostic procedures, especially, for identifying hematomas and some benign breast cysts (Gros et al., 1972). Specifically, the technique was not able to distinguish reliably between benign and malignant breast masses. For this reason, and particularly because dramatic advances in mammography were...

Galactography

Galactographic image demonstrating the abrupt duct termination due to an intraductal filling defect (arrow), in this case, a benign intraductal papilloma. Figure 3-26. Galactographic image demonstrating the abrupt duct termination due to an intraductal filling defect (arrow), in this case, a benign intraductal papilloma. Evaluation of women with bloody or serous nipple discharge should begin with mammogra-phy. If the mammogram is unrevealing, ductog-raphy can be performed by painlessly cannulat-ing the discharging duct and gently injecting radiographic contrast material. Postinjection mammographic images reveal intraductal filling defects or abrupt duct termination when pathology is present (Figure 3-26). The benign intraductal papilloma is the most common cause of spontaneous serosanguinous nipple discharge. Benign duct ectasia may also cause nipple discharge.

Groin And Pubic Area

In order to undertake a thorough examination of skin in the genital area it is essential to use a good light with magnification (Fuller & Schaller-Ayers, 2000). The pubic area needs to be checked for infestations, molluscum contagiosum, genital warts, ulceration, dermatosis etc. It is possible to see Phthirus pubis (pubic lice) on pubic hairs or attached to the skin. These can be easily removed and placed on a microscopy slide for microscopic observation. The eggs of the pubic lice can also be seen adhering to the pubic hairs. Infestation with Sarcoptes scabiei (scabies) mites can commonly be seen in the pubic region, where papular skin eruptions emerge over burrows made by the egg-laying female mites. Both pubic lice and scabies infestation can cause intense pruritus, and evidence of scratching may be visible on the skin. Molluscum contagiosum and genital warts are commonly diagnosed by visual examination of the genital and pubic skin. Small white or skin-coloured dome-shaped...

Cone biopsy

Paracervical Clock

Cone biopsy is indicated for the diagnosis or exclusion of microinvasive cervical cancer suspected from a presurgical Papanicolaou (Pap) smear or colposcopic punch biopsy. It should also be used to exclude and possibly treat endocervical adenocarcinoma. As mentioned above, a large scalpel cone biopsy may be a better option for these women. A LEEP cone biopsy is also indicated for patients with high-grade squamous epithelial lesions on Pap smear but no colposcopically identifiable lesion.

Rectal pain

Sexually transmitted infections need to be considered in anal lesions ulceration. Herpetic ulcers lesions can cause tenesmus and severe pain (BASHH, 2001b Morse et al., 2003), whereas the syphilitic ulcers lesions known as chancres are painless in nature (BASHH, 2002b Holmes et al., 1990). Herpetic lesions ulcers may look like clusters of blisters or healing sores, but often their appearance can be atypical. With syphilitic lesions in primary syphilis there is often one solitary circular sore but again this is not always the case. Swabs for Herpes simplex virus, microscopy and culture should be obtained, and dark-ground microscopy should be performed on wet mounts of serum and saline for Treponema pallidum as well as syphilis serology, which may have to be repeated in early suspected syphilis. Condylomata lata are mucosal lesions in secondary syphilis and tend to have a flatter appearance than anal warts, which are more papilliferous by nature (Holmes et al., 1990 Morse et al., 2003)....

Wart viruses

A growing recognition that there is an association between human papilloma viruses (HPV), which cause warts, and cancer has led to a renewed interest in these infections. The wart is one of the few tumours in which a virus can be seen to proliferate in the cell nucleus. The different clinical forms of wart are caused by range of HPV, currently divided into over 80 major types. These viruses are also responsible for cervical cancer and have been associated with squamous carcinomas in the immunosuppressed. Warts are classed as cutaneous or mucocutaneous. Epidermodysplasia verruciformis is a rare condition associated with a defect of specific immunity to wart virus. The following aspects should be remembered Genital warts (due to HPV) very rarely undergo malignant change but HPV infection of the cervix, caused by type 16, frequently leads to dysplasia or in some cases malignant changes. Cervical smears must be taken. There is an association between HPV infections of the skin in...

Anitroso Compounds

Branchial blastomas occur in medaka and channel catfish exposed to MNNG as a bath (Brittelli et al., 1985 Chen et al., 1996). These tumours are characterized by poorly differentiated anaplastic cells in nodules or cords that are highly proliferative and invade adjacent tissues. Papillomas also occur on gills of MNNG-exposed channel catfish (Chen et al., 1986). Lipomas were one of several types of neoplasms that occurred in channel catfish exposed to MNNG (Chen et al., 1996). Other neoplasms in this study were lymphosarcomas, papillomas, squamous cell carcinoma, fibroma, osteosarcoma, branchioblastomas, and epithelial thymomas incidence of all types of tumours was low. Three fish (of 172 examined) developed lipomas, which have seldom been investigated experimentally. Melanomas occurred in two strains of inbred medaka exposed to MNNG (Hyodo-Taguchi and Matsudiara, 1984). The strain that was less sensitive to the acute toxicity of MNNG had a higher incidence of amelanotic melanomas....

Mouth problems

Tinea Pedis Mouth

Other common dermatoses that respond to antifungal creams (for example Clotrimazole) include tinea cruris and pedis and candidiasis. Folliculitis often responds to 1 hydrocortisone and antifungal cream, impetigo to antibiotics and shingles to aciclovir, valaciclovir or famciclovir. Recurrent perianal or genital herpes may become more troublesome, with recurrences lasting longer and occurring more frequently if this persists for more than 3 months it is considered an AIDS-defining opportunistic infection (Group IVC1). Treatment with long-term acyclovir, valaciclovir or famciclovir suppression is often required. Genital and perianal warts are common, difficult to treat and frequently recurrent, and high-grade cervical dysplasia is seen more often in HIV-infected women.

Tinea cruris

GENITAL WARTS Genital warts are caused by human papillomavirus (HPV). Those with genital warts usually report the appearance of lumps or growths on their genitalia. Occasionally other symptoms such as itchiness are reported. A diagnosis of genital warts is made by visualisation of the lesions. Genital warts usually appear in women at the introitus, vulva, perineum and perianal area, and in men on the penis, scrotum, urethral meatus and perianal area. It is less common to find them on the vaginal walls or cervix in women. Areas of friction during sex are more commonly associated with warts. Different morphologies exist condylomata acuminata are cauliflower-like peduculated warts that are skin-coloured warts may also be flat or dome-shaped. However, despite differing appearances most genital warts are caused by HPV type 6 or 11. Differential diagnoses include the condylomata lata of secondary syphilis and tumours either malignant or benign.