HPV

Papovavirus group Non-enveloped

dsDNA circular viruses

No virion polymerase

Ether insensitive
Dermotropic viruses Many subtypes No drug No vaccine

Most common viral STD but sex is not the only mean of spread

Condylomata acuminata (Warts)

Lesion: Tapering papillary Grey-white Multiple

HPV 6, 11

HPV subtypes (DNA sequence not serology)

Low-risk HPV 6 and 11
Genital warts (Condylomata acuminata) Skin warts (Verrucae vulgaris)

High-risk HPV16 and 18 CIN Invasive cancer cervix

Incidence of HPV

Difficulties
Subclinical cases No serologic testing No culture No animal model

Condylomata acuminata
Caused by low risk HPV 6 and 11 Sexual contact is not the only way of transmission Genital warts
Small discrete papules (Soft, fleshy, painless) Large cauliflower mass

Vertical transmission
Juvenile laryngeal papillomatosis (JLP)

Treatment of condylomata acuminata

Podophylin (C.I in pregnancy) Trichloroacetic acid 5-FU cream Retin-A cream Cryosurgery Laser ablation Electrocautary Surgical excision Cesarean section is not indicated to prevent vertical transmission (JLP is rare).

Viral oncogenesis
High-risk HPV 16 and 18 produce three very early proteins E5, E6, E7.
1. VEP E5 mitogen that stimulate EGFR 2. VEP E6 degrades p53 (TSG) 3. VEP E7 degrades pRb (TSG)

Diagnosis of HPV
Clinical-Biopsy Pap smear (koilocytes or halo cells) Colposcopy (flat acetowhite lesion) DNA hybridization PCR

Koilocytosis of HPV cervicitis