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Patient Case: Human Papillomavirus (HPV) Infection

Patient Case: Human Papillomavirus (HPV) Infection

Discussion

Chief Complaint: “I’ve noticed some small bumps around my genital area that weren’t there before.”

History of Present Illness:
A 27-year-old woman presents with concerns about painless, flesh-colored growths on her external genitalia that she first noticed two months ago. The lesions have gradually increased in number and size. She denies itching, burning, or pain but feels embarrassed and anxious about their presence. She has been in a stable sexual relationship for the past year and has never had a similar issue before.

She has no history of sexually transmitted infections (STIs) and has never received the HPV vaccine. She reports inconsistent condom use and has never had an abnormal Pap smear. There is no history of recent illness, fever, or weight loss.

Physical Examination:

  • Multiple small, flesh-colored, verrucous papules on the labia majora and perineum
  • Some lesions have a cauliflower-like appearance
  • No signs of ulceration, discharge, or tenderness
  • No inguinal lymphadenopathy

Diagnosis:
Based on the characteristic appearance of the lesions, genital warts (condyloma acuminata) caused by HPV are suspected. The patient likely has low-risk HPV types 6 or 11, which are responsible for most cases of genital warts.

Management Plan:

  • Treatment Options:
    • Topical therapy: Patient-applied imiquimod or provider-administered cryotherapy
    • Surgical options: Electrocautery or excision if lesions are extensive
  • HPV Testing and Cervical Cancer Screening:
    • A Pap smear is recommended to check for cervical dysplasia (high-risk HPV types 16 and 18)
    • HPV DNA testing may be considered
  • Prevention and Education:
    • Discussing HPV vaccination (Gardasil-9) to prevent future HPV infections
    • Encouraging consistent condom use to reduce transmission risk
    • Providing reassurance that genital warts are benign but may recur

The patient is advised to return for follow-up treatment and routine cervical cancer screening.

Questions
  1. What is the most likely cause of this patient’s genital lesions?
    a) Herpes simplex virus (HSV)
    b) Treponema pallidum (syphilis)
    c) Human papillomavirus (HPV)
    d) Candida albicans (yeast infection)
  2. Which HPV types are most commonly associated with genital warts?
    a) 16 and 18
    b) 31 and 45
    c) 6 and 11
    d) 1 and 2
  3. What is the best initial treatment option for this patient?
    a) Topical imiquimod or cryotherapy
    b) Oral antibiotics
    c) High-dose corticosteroids
    d) Antifungal therapy
  4. Why is a Pap smear recommended in this patient?
    a) To confirm the presence of genital warts
    b) To screen for high-risk HPV types that may cause cervical cancer
    c) To check for bacterial infections
    d) To diagnose HIV infection
Reveal answers

Answers

  1. (c) Human papillomavirus (HPV) – The presence of painless, flesh-colored, verrucous lesions suggests genital warts, which are caused by low-risk HPV types (most commonly HPV 6 and 11). Unlike herpes, HPV lesions are non-painful and persistent.
  2. (c) HPV 6 and 11 – These low-risk HPV types are responsible for 90% of genital warts. In contrast, high-risk types (16 and 18) are associated with cervical and other anogenital cancers.
  3. (a) Topical imiquimod or cryotherapy – Genital warts are treated with topical medications (imiquimod, podophyllin, or sinecatechins) or provider-administered treatments like cryotherapy, electrocautery, or surgical excision.
  4. (b) To screen for high-risk HPV types that may cause cervical cancer – A Pap smear is essential for detecting cervical dysplasia caused by high-risk HPV types (16, 18, etc.), even in asymptomatic women.

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