Snapshot A 45-year-old female finally visits her gynecologist due to her embarrassment of her genital growths. She complains of large bumps on the vulva and groin area for the past year. She denies dyspareunia, vulvar pruritus, change in vaginal discharge, and dysuria. She was sexually active with numerous sexual partners, the last encounter being about one year ago. She has an IUD and her last partner used condoms infrequently. Physical exam reveals multiple large flesh colored pedunculated papules on the vulva and inguinal region and medial thigh. A Pap smear and excisional biopsy were carried out. Introduction Classification virus DNA non-enveloped papillomavirus human papilloma virus Presentation Cutaneous warts serotypes 1, 2, and 4 hands, fingers, and soles of feet Anogenital warts (condylomata acuminata) serotypes 6 and 11 90% are benign koilocytes epithelial cells with structural changes characteristic of HPV infection enlarged nuclei hyperchromasia in image on the right, HPV-infected cells seen on the right vs normal on left Cervical intraepithelial neoplasia serotypes 16, 18, 31, and 33 are preneoplastic can progress to squamous cell carcinoma or spontaneously resolve Squamous cell carcinoma seen in AIDS anus or cervix most important risk factor is multiple sexual partners serotype 16 also implicated in head and neck cancers (oropharyngeal) Evaluation Screening with Pap smear koilocytic cells indicate infection Clinical presentation Differential Condyloma lata of secondary syphillis Treatment Cryotherapy, electrocautery, or salicylic acid chemical therapy Drugs imiquimod induces proinflammatory cytokines IFN cidofovir Prognosis, Prevention and Complications Prevention vaccine protects aginsts serotypes 16,18, 6, and 11 the first vaccine to prevemnt cancer made of capsid proteins Complications untreated lesions may grow to the point of requiring surgical excision infections with serotypes (16 and 18) that have malignant potential