Fast Five Quiz: Test Your Knowledge of Human Papillomavirus

William James, MD


September 29, 2017

The histology of common cutaneous warts demonstrates marked hyperkeratosis, acanthosis, parakeratosis, and papillomatosis. Three features used to distinguish warts from other papillomas include the presence of koilocytes, vertical columns of parakeratosis, and foci of clumped keratohyaline granules.

The acetic acid test can be helpful in the diagnosis of genital warts. In particular, soaking acetic acid into suspicious lesions can enhance the degree of suspicion in lesions without classic features. The method involves applying a 3%-5% acetic acid-moistened gauze pad for 5-10 minutes on suspected lesions of the penis, cervix, labia, or perianal area. Inconspicuous, flat, genital lesions that might be difficult to assess become visible. Dysplastic and neoplastic tissues turn white (acetowhite). False-positive results are common and can result from anything that causes parakeratosis (eg, candidiasis, psoriasis, lichen planus, healing epithelium, sebaceous glands). The acetic acid test can be used in conjunction with colposcopy to examine cervical lesions. However, this test is reserved only for suspicious lesions and should not be used for routine screening.

Patients who present with typical-appearing condylomata acuminata usually do not need a vulvar biopsy. A biopsy is recommended for the following scenarios:

  • Women with a history of vulvar dysplasia

  • Postmenopausal women

  • Women in whom medical therapy fails

  • Clinical doubt about the diagnosis

The two common methods of HPV DNA testing are the Hybrid Capture II and PCR enzyme-linked immunosorbent assay. Both methods have similarly high sensitivities and are suitable tools for detection of HPV and posttreatment follow-up of CIN. HPV DNA testing is the preferred approach in the treatment of women whose Pap test results show atypical squamous cells of undetermined significance whenever liquid-based cytology is used or co-collection is available. HPV DNA testing is also useful in the management of CIN in certain situations. Detailed consensus guidelines for management of abnormal Pap test results and management of CIN are available from the American Society for Colposcopic and Cervical Pathology.

For more on the workup of HPV, read here.


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