Human papillomavirus (HPV).
|Warty growths in and around genital skin. Little discomfort (sometimes itchy) but often psychological distress is significant.||Warty growths in and around genital skin. Little discomfort. Sometimes itchy. Often psychological distress is significant.|
|Distorted urinary stream or bleeding with urethral lesions||Cervical lesions noted on vaginal examination should have cervical screening conducted as per national guidelines|
|Perianal itch||Perianal itch|
|PR bleeding after passage of stools with anal lesions||PR bleeding after passage of stools with anal lesions|
|Rarely malignancy (penile, anal, oropharynx) unless associated with oncogenic genotypes||
Rarely malignancy (vulvar, vaginal, cervical, anal, oropharynx) however generally associated with oncogenic genotypes
|Often detected on cervical cytology producing LSIL|
|LSIL – Low grade squamous intraepithelial neoplasia|
See STI Atlas for images.
Diagnosis is usually based on visual appearance. If there are atypical lesions (e.g. variable pigmentation, raised plaque-like lesions or cervical warts), consider histology biopsy to exclude cancer.
|Principal Treatment Options|
|Treatment for genital warts||Patient applied podophyllotoxin 0.15% cream or 0.5% paint topically applied, BD for 3 days, then 4 days off, repeated weekly for 4-6 cycles until resolution. Paint is more suited for use on external keratinised skin. Cream is best used in perianal area, introital area and under the foreskin.
Patient applied imiquimod 5% cream topically, 3 times per week at bedtime (wash after 6-10 hours) until resolution (up to 16 weeks).
|Clinician initiated Cryotherapy weekly.
Excision under local anaesthetic e.g. localised pedunculated warts.
Ablative therapy under general anaesthetic.
|Complicated or disseminated infection
||Consider referral for laser or diathermy. Persistent intra-anal lesions in HIV positive patients should be considered for surgical excision and HPV DNA typing to inform follow-up|
|Pregnant women||Cryotherapy can have a poor response. Lesions often resolve spontaneously postnatally when immune function returns to normal following delivery|
|Allergy to principal treatment choice||Cryotherapy or imiquimod. Use imiquimod with care in patients with history of significant eczema or dermatitis|
|Regional/Remote||Podophyllotoxin or imiquimod|
Not recommended. The majority of partners are probably infected subclinically.
Not required if symptoms resolve. Review if patient anxious or warts are difficult for patient to visualise.
Not required. Consider testing for other STIs, if not undertaken at first presentation, or retesting post the window period.
100% of patients diagnosed are offered treatment.