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Condyloma acuminatum (Anogenital Warts)
- Warts found typically in the genital/anal area
- Human papillomavirus (HPV) types 6 and 11
- Sexually transmitted
- Very contagious especially while warts are visible
Risk Factors
- Sexual activity with multiple or high risk partners
- Immunosuppression
- Smoking
Clinical Presentation
- External warts may have varied appearances
- Single or multiple lesions
- Shape: flat, dome shaped, cauliflower shaped etc
- Color: white, flesh colored, red, etc
- May be pruritic
Treatment
- Prevention
- Safe sexual practice
- Gardasil protects against HPV 6,11,16 and 18 (16 and 18 are linked to cervical cancer
- The goal of treatment is wart free periods of time without scarring
- There is no true cure
- Many different creams
- Laser removal
- Cryosurgery
Herpes Simplex
- Herpes simplex virus type 1 and type 2 are the main culprits
- It is often said that type 1 is oral herpes and type 2 is genital, but there is significant overlap
Clinical presentation
- Small groups of vesicles
- Typically found at the vermilion border (cold sore) or genital area
- Usually painful neuralgic symptoms including burning and itching
- Recurrence may be preceded by neuralgic symptoms
- Variations and Complications
- Herpetic Whitlow – infection of the fingers
- Herpes keratitis – eye infection
- Herpes encephalitis – CNS infection
- Neonatal infection – Active herpes infection in the mother is an indication for a c-section
Labs and Studies
- Generally a clinical diagnosis
- Stains of vesicles will show multinucleated giant cells
- Antibody test is available
Treatment
- No true cure
- Typically self limiting
- Topical antiviral 5% acyclovir
- Oral antiviral (expensive)
- acyclovir
- valacyclovir
- Tylenol and ibuprofen
Molluscum Contagiosum
- Common skin disease
- Caused by a virus
- Easily transmitted
- Sharing towels
- Sharing clothes
- Wrestling or gymnastics mats
Clinical Presentation
- Flesh colored bumps
- Dome shaped
- Pearly or waxy
- Umbilicated
- Not painful or pruritic
Labs and Studies
- Usually clinical diagnosis
- Biopsy will confirm
Treatment
- Self limiting but may take up to 18 months and is contagious while lesions are visible
- Removal of the lesions
- There are many different topical treatments with varying efficacy
- Laser
- Cryotherapy
- Topicles
Chickenpox (Varicella)
- Human herpesvirus 3 varicella zoster virus)
- Primary infection leads to chickenpox
- It is contagious if you touch the vesicles or by respiratory droplets. It is contagious for several days before lesions appear and up until all lesions have crusted over.
- There is a 14 to 21 day incubation period
Clinical Presentation
- Usually a child younger than ten presents with severely pruritic lesions
- Initially red macules and papules followed by vesicles which after a few days will crust over
- Dew drops on a rose petal
- Lesions appear in crops – this means that you get a certain number of lesions on day one. Then more appear on day two and so on. In this way the lesions are all in different phases. The lesions from day one may be crusting while new lesions are appearing on day three.
- Rash appears centrally and moves out to the extremities
- Fever and general malaise are common
Labs and Studies
- Clinical diagnosis
- Fluid taken from the vesicles and prepared with a Tzanck smear will show multinucleated giant cells.
Treatment
- Supportive care
- Do not give aspirin to kids under 19 (Reye’s syndrome)
- Prevent or treat secondary infections
- Antiviral may be appropriate in the immunocompromised
- A live attenuated virus is used for vaccination. It is always given twice.
Shingles (Zoster)
- A secondary outbreak of human herpesvirus 3 (varicella zoster virus).
- The virus remains dormant within nerve cells.
- Normally the immune system keeps the virus suppressed, but certain factors like aging and stress may lead to an outbreak.
Clinical Presentations
- Severe burning pain that begins before lesions are visible
- Hypersensitivity even before lesions are visible
- Vesicular lesions much like the chicken pox
- Typically affect one dermatome
- Hutchinson’s sign – A lesion at the tip of the nose indicates possible involvement with the eye.
Labs and Studies
- Typically a clinical diagnosis
- IgM antibody test available though it is unnecessary
Treatment
- Oral acyclovir or valacyclovir for 7 day
Study tip
Use a worry Journal
