1. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 1 Human Papilloma Virus HPV CAPT Mike Hughey, MC, USNR

2. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 2 Clinical Warts Cauliflower-like lesions White or flesh-colored May cause itching/burning May have no symptoms

3. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 3 Sub-clinical Warts Flat Virtually invisible May cause itching/burning May have no symptoms Identify with vinegar and 4-10X magnification

4. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 4 Transmission Skin to skin contact Condoms offer little protection Don't treat partners unless symptomatic

5. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 5 Relationship to Cancer Appears to be a pre- requisite to cervical cancer Vast majority of those with HPV do not develop cancer Smoking, immune response are co-factors

6. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 6 Treatment of Warts All treatment involves destroying the patients skin which has grown in a strange and annoying way. You are not eliminating the virus, nor eliminating any chance of re-occurrence. Don’t overtreat.

7. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 7 Treatment with Cryosurgery Liquid nitrogen Nitrous oxide/CO2 gun Use only on wart DON’T USE INSIDE THE VAGINA Multiple treatments

8. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 8 Treatment with Podophyllin Wash off in 4-6 hours Hepatotoxic, nephrotoxic Small amounts Don't use inside vagina MULTIPLE TREATMENTS

9. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 9 Other Treatments Bichloracetic Acid (BCA or TCA) Cut them out Burn them off Electrocute them Nothing (50% resolve in 1 year)

10. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 10