Warts are caused by a small DNA virus (papillomavirus)belonging to the papovavirus group. Anogenital warts are sexually transmitted and are regarded as importantin view of increasing evidence associating them withcervical cancer. In men warts can appear on any part of the genitalia, butespecially the frenulum, the coronal sulcus and the innersurface of the foreskin. They are called condylomataacuminata. They may be found in the male urethra andappear as bright red lumps at the meatus. In women the vulva and cervix can be involved , as can theperineal area in both sexes. Cervical condylomata may beflat and identifiable only by colposcopy. They may be associatedwith cervical dyskeratosis and koilocytosis.
Management Local application of cytotoxic agents such as podophyllin,or of destructive agents or methods such as trichloraceticacid, cautery, diathermy or cryosurgery, is still the maintherapeutic approach. Ablation of cervical warts by lasertherapy is effective. Sexual partners should be contacttraced and treated. Women diagnosed with genital warts,and the female partners of men with genital warts, shouldalso have cervical cytology.
CHLAMYDIA TRACHOMATIS Genital infectionChlamydia trachomatis is an obligatory intracellular parasitewhose replication results in the death of the infectedcell. During its lifecycle the infectious particle changes toan actively dividing form, which later reorganizes into theinfectious form that is released on cell lysis.Non-specific genital infection (NSGI), of which chlamydiainfection may account for up to 50% in the UK, maypresent as urethritis, cervicitis or proctitis. Other relevantorganisms include mycoplasmas and uroplasmas.Genital chlamydia infection is thought to be the commonestSTI in England, with prevalances of 2-12ected in studies of GP attendees. The rates of diagnosis have increased significantly over the last few years, thehighest among 16-19-year-old females.
Clinical features Men usually have urethral discharge and dysuria about 10days after exposure to infection. In women the infectionis usually silent, but may present with an abnormal vaginaldischarge or with symptoms of pelvic inflammatory disease. If uncomplicated rectal infection occurs there maybe anal discharge, perianal dampness, irritation and tenesmus.Complications are more common in women thanin men. In women they include bartholinitis, salpingitisand perihepatitis. In men the complications include epididymo-orchitis, prostatitis and sexually acquired reactive arthropathy
Diagnosis In men a Gram-stained urethral smear shows an excess ofpolymorphonuclear leukocytes but no gonococci, and issupportive of a diagnosis of non-gonoccoal urethritis. Inmen and women chlamydial infection is confirmed by identifyingantigen at the site of infection, or by culture.
Management Chlamydial infection and most other NSGI responds totetracycline therapy. The usual is doxycycline (100 mgdaily) for at least 7 days, or azithromycin 1 g orally as asingle dose. Erythromycin (500 mg twice daily) may beused as an alternative and is the first choice in pregnancyand in tetracycline allergy. Relapse or recurrent infectionis common in both sexes. There may be symptoms of apostinfective urethritis, with no signs of infection. Sexualpartners of both sexes should always be examined andtreated to identify asymptomatic infection, to preventserious complications of untreated infection in the contact,such as pelvic inflammatory disease, and to avoid reinfectionof the index case.
Congenital Chlamydia trachomatis infectionChlamydia trachomatis infection is now frequently seen asa cause of ophthalmia neonatorum. The infected babydevelops a conjunctivitis about 10 days after birth. Investigationshould include culture of pus, or a monoclonalantibody test for Chlamydia trachomatis. The organismmay also be a cause of pneumonia in the neonate. Treatmentis with erythromycin syrup. The baby’s parentsshould always be examined for Chlamydia and othergenital infections.
See the article here: GENITAL WARTS AND ITS CLINICAL FEATURES
