Vulva Human Papilloma Virus HPV

Human Papilloma Virus (HPV)

These are genital warts or condylomata acuminata. This is a growing sexually transmitted disease epidemic. 50% of patients with vulvar HPV have cervical HPV. 30% of patients regress spontaneously. Note there is no definite cure. Decreased immunity will result in increased number and size of warts.

The epidemiology shows 2/3 of patients have HPV 6 and 11; these are non-oncogenic. One third of cases are due to HPV types 16, 18, 31, 33, 35, and 51, the oncogenic viral types associated with viral intra-epithelial neoplasia (VIN) and squamous cell carcinoma.

Incubation period is 2-3 months. There is often a history of exposure. Warts are usually sexually spread. There can be complaints of varying degrees of irritation, itching and soreness depending on fissuring and the degree of trauma. Pinhead papules develop into filiform papules. Small papules can grow into cauliflower-like clusters. These can be skin-colored or hyperpigmented and can be anywhere on the genital area.

Note that 30-40% of children with anogenital warts have been abused, but determining which 30-40% is problematic and carries legal risks, privacy considerations and reporting obligations that vary from jurisdiction to jurisdiction.

Diagnosis is made on the clinical pattern. Treatment is indicated to control itching and burning, prevent spread and preserve normal function. Imiquimod cream is applied three times a week for up to 16 weeks.

Treatments include:

Imiquimod, liquid nitrogen, electrodesiccation, trichloroacetic acid, laser destruction.