Viral Warts and Their Types
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Questions and Answers

What virus is responsible for causing Viral Warts?

  • Herpes simplex virus
  • HIV
  • Human papillomavirus (correct)
  • Cytomegalovirus

    • Which HPV types are most commonly associated with genital warts?

  • HPV 6, 11, 16 and 18 (correct)
  • HPV 1 and 4
  • HPV 2 and 16
  • HPV 3 and 10

    • What characteristic is specific to common warts?

  • They may present with black dots when scraped. (correct)
  • They are typically painful.
  • They have a smooth surface.
  • They are flat and elevated.

    • What is a typical feature of plantar warts?

    <p>They may appear as painful, deeply embedded papules.</p> Signup and view all the answers

    Which of the following generally occurs from direct skin-skin contact?

    <p>Common warts</p> Signup and view all the answers

    Which HPV genotypes are primarily associated with cervical and anal cancers?

    <p>HPV 16 and 18</p> Signup and view all the answers

    How long can the majority of warts take to regress spontaneously?

    <p>1-2 years</p> Signup and view all the answers

    What type of wart is characterized as slightly elevated, flat, and smooth?

    <p>Plane or flat wart</p> Signup and view all the answers

    What is the primary mode of transmission for HSV-1?

    <p>Direct contact with contaminated saliva or lesions</p> Signup and view all the answers

    Which symptom typically precedes the onset of mucocutaneous lesions in primary HSV-1 infection?

    <p>Tender lymphadenopathy</p> Signup and view all the answers

    Which of the following is NOT commonly associated with recurrent infections of HSV?

    <p>Pregnancy</p> Signup and view all the answers

    What characteristic feature distinguishes primary herpes infection from recurrent disease?

    <p>Presence of regional lymphadenopathy and fever</p> Signup and view all the answers

    What type of presentation can occur in patients with eczema who develop HSV infection?

    <p>Eczema herpeticum</p> Signup and view all the answers

    What type of lesions are characteristically formed during primary HSV-2 infection?

    <p>Painful grouped vesicles</p> Signup and view all the answers

    What treatment is recommended for eczema herpeticum in young infants?

    <p>Acyclovir 5-10 mg/kg IV</p> Signup and view all the answers

    How long does a typical primary HSV-1 infection take to show symptoms after exposure?

    <p>3 to 7 days</p> Signup and view all the answers

    Which areas are most commonly affected by warts?

    <p>Face and dorsum of the hands</p> Signup and view all the answers

    What is Koebner’s phenomena associated with?

    <p>Occurrence of new lesions at trauma sites</p> Signup and view all the answers

    Which HPV types are most commonly associated with genital warts?

    <p>Types 6 and 11</p> Signup and view all the answers

    What is the most standard method for wart treatment?

    <p>Cryotherapy by liquid nitrogen</p> Signup and view all the answers

    What is the primary cause of oral warts?

    <p>Low-risk genital HPV types</p> Signup and view all the answers

    What is a common characteristic of mucosal warts?

    <p>They often appear macerated and pale</p> Signup and view all the answers

    Which virus is associated with chickenpox and herpes zoster?

    <p>HHV-3</p> Signup and view all the answers

    Which method is NOT a routine treatment for warts?

    <p>Immediate surgical removal of all warts</p> Signup and view all the answers

    What is the primary mode of transmission for Orf (Ecthyma Contagiosum)?

    <p>Contact with infected livestock</p> Signup and view all the answers

    Which of the following is NOT a characteristic of the lesions caused by Orf infection?

    <p>Contains pus and drains fluid</p> Signup and view all the answers

    Which complication is most commonly associated with Orf infection?

    <p>Secondary bacterial infection</p> Signup and view all the answers

    What is the recommended management for a healthy individual infected with Orf?

    <p>Use of topical antibiotics to prevent infection</p> Signup and view all the answers

    Which group of individuals may require more intensive treatment for Orf infection?

    <p>Immunocompromised patients</p> Signup and view all the answers

    What is the appearance of the initial varicella lesion?

    <p>2-4 mm red papule with irregular outline and clear vesicle</p> Signup and view all the answers

    What is a known complication of varicella?

    <p>Reye's syndrome</p> Signup and view all the answers

    Which treatment is contraindicated during varicella due to the risk of Reye's syndrome?

    <p>Aspirin</p> Signup and view all the answers

    In herpes zoster, pain often localizes to which area before the skin eruption?

    <p>The affected dermatome</p> Signup and view all the answers

    What triggers the reactivation of varicella-zoster virus leading to shingles?

    <p>Emotional upset and immunosuppression</p> Signup and view all the answers

    How is herpes zoster characterized in terms of its eruption?

    <p>Grouped vesicles on erythematous bases along a sensory nerve</p> Signup and view all the answers

    What dosage of oral acyclovir is recommended for adults with chickenpox?

    <p>800 mg five times daily for 7 days</p> Signup and view all the answers

    Which of the following statements about herpes zoster is true?

    <p>It can occur multiple times in a lifetime</p> Signup and view all the answers

    What type of wart is primarily associated with painful, deeply embedded papules on the sole of the foot?

    <p>Plantar wart</p> Signup and view all the answers

    HPV types 16 and 18 are linked to cervical and anal cancers.

    <p>True</p> Signup and view all the answers

    Name one HPV type that is associated with common and plantar warts.

    <p>HPV 1, 2, or 4</p> Signup and view all the answers

    Mosaic warts consist of a plaque of closely grouped ______.

    <p>warts</p> Signup and view all the answers

    Match the type of wart with a characteristic feature:

    <p>Common wart = Firm, papules with hyperkeratotic surfaces Filiform wart = Thread-like projections on the face Plane wart = Slightly elevated, smooth papules Mosaic wart = Closely grouped plaques of warts</p> Signup and view all the answers

    How does genital wart transmission primarily occur?

    <p>Intimate contact</p> Signup and view all the answers

    Most warts will not regress on their own within 1–2 years.

    <p>False</p> Signup and view all the answers

    What are the names of the HPV types that are commonly found in genital warts?

    <p>HPV 6 and 11</p> Signup and view all the answers

    What is the primary characteristic of anogenital warts?

    <p>They appear as well-defined papules.</p> Signup and view all the answers

    Koebner's phenomena is not observed in warts.

    <p>False</p> Signup and view all the answers

    What is the primary mode of transmission for Orf (Ecthyma Contagiosum)?

    <p>Direct contact with infected animals</p> Signup and view all the answers

    Name one treatment option for flat warts.

    <p>Retinoids</p> Signup and view all the answers

    Warts caused by low-risk genital HPV types ______ and ______ are typically responsible for anogenital warts.

    <p>6, 11</p> Signup and view all the answers

    Orf lesions typically clear within 3 to 6 weeks without active treatment.

    <p>True</p> Signup and view all the answers

    Name one comorbidity that can lead to more severe manifestations of Orf infection.

    <p>Immunocompromised status</p> Signup and view all the answers

    Match the herpes viruses with their associated diseases:

    <p>HSV-1 = Herpes Labialis HSV-2 = Herpes Genitalis VZV = Chickenpox and Herpes Zoster EBV = Infectious Mononucleosis</p> Signup and view all the answers

    What percentage of warts typically resolves on their own within two years?

    <p>More than two-thirds</p> Signup and view all the answers

    The lesion progresses through six stages, including maculopapular, targetoid, _____, regenerative, papillomatosis, and regression.

    <p>weeping nodule</p> Signup and view all the answers

    Match the following stages of Orf lesion progression with their descriptions:

    <p>maculopapular = Initial rash stage weeping nodule = Fluid-filled lesion papillomatosis = Growth of wart-like lesions regression = Healing phase where lesions diminish</p> Signup and view all the answers

    Surgical excision is an unnecessary treatment for all types of warts.

    <p>False</p> Signup and view all the answers

    What is a standard method used for wart treatment?

    <p>Cryotherapy</p> Signup and view all the answers

    Which route is primarily responsible for the transmission of HSV-2?

    <p>Sexual contact</p> Signup and view all the answers

    Primary HSV-1 infection always presents with noticeable symptoms.

    <p>False</p> Signup and view all the answers

    What medical treatment is recommended for eczema herpeticum in young infants?

    <p>Acyclovir 5-10mg/kg IV</p> Signup and view all the answers

    Symptoms of primary HSV-1 infection typically occur within _____ days after exposure.

    <p>3 to 7</p> Signup and view all the answers

    Match the clinical features with the appropriate type of HSV infection:

    <p>Primary HSV-1 = Painful, grouped vesicles on an erythematous base Primary HSV-2 = Extremely painful erosive balanitis Recurrent HSV-1 = Lesions occur in the same location each time Eczema herpeticum = Rapid, widespread discrete erosions</p> Signup and view all the answers

    Which of the following are common triggers of recurrent HSV infections? (Select all that apply)

    <p>Menstruation</p> Signup and view all the answers

    In addition to painful lesions, primary HSV-2 infection can also present with constitutional symptoms.

    <p>True</p> Signup and view all the answers

    What is a distinguishing feature of lesions during recurrent infections of HSV?

    <p>Lesions usually occur on the same place each time.</p> Signup and view all the answers

    What complication is associated with recurrent herpes simplex infections?

    <p>Erythema multiforme</p> Signup and view all the answers

    An attack of chickenpox usually confers lifelong immunity.

    <p>True</p> Signup and view all the answers

    Which topical antiviral cream is commonly used to manage mild recurrent herpes simplex attacks?

    <p>Acyclovir</p> Signup and view all the answers

    The lesions of chickenpox are usually present at different stages, including papules, vesicles, pustules, and __________.

    <p>crusts</p> Signup and view all the answers

    Match the following terms related to herpes simplex and varicella infection with their descriptions:

    <p>Eczema herpeticum = Herpes infection occurring in individuals with atopic dermatitis Herpetic whitlow = Painful vesicular infection of the finger Varicella-zoster virus = Causes chickenpox and shingles Acyclovir = Antiviral medication used to treat herpes infections</p> Signup and view all the answers

    What is the incubation period range for varicella (chickenpox)?

    <p>9 to 21 days</p> Signup and view all the answers

    Herpetic whitlow primarily affects adults and is rarely seen in children.

    <p>False</p> Signup and view all the answers

    What is the first sign of recurrence for which acyclovir cream should be applied?

    <p>Pain or itching</p> Signup and view all the answers

    What type of HPV is primarily associated with cervical and other anogenital cancers?

    <p>HPV 16</p> Signup and view all the answers

    HSV-2 is primarily associated with oral herpes.

    <p>False</p> Signup and view all the answers

    Name one common treatment option for managing common warts.

    <p>Salicylic acid</p> Signup and view all the answers

    Herpes Simplex Genitalis is characterized by painful __________.

    <p>genital sores</p> Signup and view all the answers

    Match the clinical manifestations with their corresponding virus:

    <p>HPV = Plantar warts HSV-1 = Cold sores HSV-2 = Genital sores</p> Signup and view all the answers

    What is a characteristic feature of flat warts?

    <p>Usually found on the face or shins</p> Signup and view all the answers

    Direct skin-to-skin contact is the only method for transmitting HPV.

    <p>False</p> Signup and view all the answers

    What antiviral medication is commonly used to reduce the symptoms of herpes simplex virus infections?

    <p>Acyclovir</p> Signup and view all the answers

    Which virus is primarily responsible for causing shingles?

    <p>Varicella-Zoster Virus</p> Signup and view all the answers

    What is a potential complication of untreated herpes simplex virus infections?

    <p>Painful vesicular lesions</p> Signup and view all the answers

    Which of the following symptoms is most commonly associated with varicella?

    <p>Pruritic vesicular rash</p> Signup and view all the answers

    What is the main mode of transmission for Human Papillomavirus (HPV) associated with genital warts?

    <p>Skin-to-skin contact</p> Signup and view all the answers

    What is the characteristic appearance of lesions caused by Orf (Ecthyma contagiosum)?

    <p>Painful nodular lesions</p> Signup and view all the answers

    Which type of herpes simplex virus is primarily associated with oral lesions?

    <p>HSV-1</p> Signup and view all the answers

    Which high-risk HPV types are associated with an increased risk of certain cancers?

    <p>HPV 16 and 18</p> Signup and view all the answers

    Which treatment is often used for molluscum contagiosum lesions?

    <p>Cryotherapy</p> Signup and view all the answers

    Study Notes

    Viral Warts

    • Caused by the Human Papillomavirus (HPV)
    • More than 150 HPV genotypes
    • Genital Warts are spread via intimate contact
    • Non-Genital Warts are spread via skin-to-skin contact, contaminated surfaces, objects (e.g. swimming pool, gym), or autoinoculation
    • Most warts resolve within 1-2 years
    • Persistent infection with sexually transmitted high-risk mucosal types, mostly HPV 16 and 18, can cause cervical, anal, vaginal, vulvar, penile, oropharyngeal cancers

    Common Wart (Verruca Vulgaris)

    • Firm, papules with hyperkeratotic surfaces
    • Occur singly or in groups
    • Commonly on fingers and hands
    • Filiform warts, a variant of Common Warts, show thread-like keratinous projections and occur mostly on the face and scalp

    Plantar Wart (Verruca Plantaris)

    • Painful, deeply embedded papules on the sole of the foot, esp. on pressure points
    • May be single or multiple
    • Covered with a rough hyperkeratotic surface, when removed, black dots (thrombosed capillaries) become apparent
    • Mosaic wart is a plaque of closely grouped warts
    • DDx: Corn, Callus

    Plane or Flat Wart (Verruca Plana)

    • Slightly elevated, flat, smooth papules
    • Usually skin-colored or pigmented
    • Commonly on face and dorsum of hands
    • Occur in numbers ranging from few to hundreds
    • Koebner’s phenomena (i.e.occurrence of new lesions at trauma sites) is positive, like in the common wart
    • DDx: Lichen Planus, Acne

    Anogenital Wart (Condylomata Acuminata)

    • Affect vulva, vagina, cervix, penis, scrotum, perianal skin, and anal canal
    • Lesions are well-defined papules
    • On mucosal surfaces, they are macerated and appear pale, on dry skin, they can become hyperkeratotic
    • May be small or coalesce into cauliflower-like masses

    Oral Warts

    • Warts on the lips, in the oral cavity, and upper respiratory tract
    • Usually regarded as STD
    • Low-risk genital HPV (6,11) types cause oral warts, less commonly other HPV subtypes

    Treatment Considerations

    • Routine treatment of every wart is unnecessary
    • Self-resolution may occur (more than 2/3 resolve within 2 years)

    Topical Applications

    • Common and plantar warts: keratolytics (salicylic acid and lactic acid) and Trichloroacetic acid (TCA)
    • Flat warts: Retinoids
    • Anogenital warts: Podophyllin and Imiquimod cream

    Surgical Methods

    • Standard: Cryotherapy by liquid nitrogen
    • Filiform warts and exophytic lesions: Curettage
    • Electrosurgery and Cautery
    • Recalcitrant warts: Surgical excision and Laser Surgery

    Herpes Simplex Viruses (HSV-1 & HSV-2)

    • Herpes Labialis, Cold Sore, Fever Blister, Herpes Genitalis
    • Produce primary and recurrent vesicular eruptions, favoring the orolabial and genital regions
    • HSV-1: cause extra-genital infection, HSV-2: cause genital disease.
    • Transmission can occur during asymptomatic periods of viral shedding.

    HSV-1 Transmission

    • Spread primarily through direct contact with contaminated saliva or lesions secretions.

    HSV-2 Transmission

    • Spread primarily by sexual contact.

    Clinical Features

    • HSV replicates at the site of infection and then travels by retrograde axonal flow to the nerve ganglia, where it establishes latency until reactivation
    • Asymptomatic infection is common
    • Symptoms typically occur within 3 to 7 days after exposure.
    • Prodrome of tender lymphadenopathy, malaise, anorexia, and fever often occurs before the onset of mucocutaneous lesions
    • Mucocutaneous lesions may be preceded by localized pain, tenderness, burning, and tingling
    • Painful, grouped vesicles appear on an erythematous base, followed by erosions or ulcerations with a scalloped border
    • Primary HSV-2 infection is frequently asymptomatic but can present as extremely painful erosive balanitis, vulvitis or vaginitis.

    Primary HSV-2 Infection

    • Presents with constitutional symptoms and painful grouped vesicles in genitalia
    • Progresses to pustules, crusting, and tender ulcers
    • May have painful lymphadenopathy, cervicitis, urethritis, and proctitis
    • More extensive local involvement, regional lymphadenopathy, and fever distinguish primary herpes infection from recurrent disease

    Recurrent HSV-1 and HSV-2 Infection

    • Lesions usually occur in the same place each time
    • Precipitated by:
      • Fever
      • Respiratory tract infection
      • Exposure to sun
      • Menstruation
      • Stress
      • Trauma

    Cutaneous Herpes Simplex

    • Occurs in patients with atopic dermatitis and other skin diseases with impaired skin barrier

    Eczema Herpeticum

    • Rapid, widespread, monomorphic, discrete, 2–3 mm punched-out erosions with hemorrhagic crusts
    • Mostly occur in areas of active or recently healed atopic dermatitis, particularly the face
    • The disease in most cases is a primary HSV-1 infection
    • Severity of infection ranges from mild to fatal
    • Eczema herpeticum of the young infant is a medical emergency, treated with acyclovir 5-10mg/kg 8 hourly IV
    • In adults, acyclovir 800mg 3 times daily for 10 days.

    Oral Lesions (enanthem) and Scalp Lesions

    • Highly suspicious for HSV-1 infection

    Varicella (Chickenpox)

    • The lesion starts as a 2-4 mm red papule that develops an irregular outline (rose petal) and a thin-walled clear vesicle appears on the surface (dewdrop)
    • This lesion, "dewdrop on a rose petal," is highly characteristic of varicella

    Complications of Varicella

    • Secondary bacterial infection
    • Encephalitis
    • Reye’s syndrome
    • Pneumonia
    • Scarring (if lesions are secondarily infected or excoriated)

    Treatment of Varicella

    • In healthy children, varicella is generally benign and self-limited
    • Cool compresses, calamine lotion locally, and oral antihistamines may relieve itching
    • Antipyretic like Paracetamol (excluding aspirinà Reye’s syndrome)
    • Oral antibiotic against Strep.and Staph. like cephalexin is indicated for secondarily infected lesions
    • Adult chickenpox, in addition to the above, should be treated with oral acyclovir (800mg 5 times daily for 7 days)
    • Shingles: Same dose as adult chickenpox (800mg 5 times daily for 7 days)
    • Children: 20 mg/kg/dose

    Herpes Zoster (HZ) (Shingles)

    • Varicella and shingles are both produced by the same virus.
    • Varicella results from contact of a non-immune person with the virus, whereas shingles occurs in persons who have had previous varicella, either clinically or subclinically
    • Reactivation of a latent infection in either a spinal or a cranial sensory ganglion causes HZ.
    • Precipitating factors for reactivation:
      • Age
      • Immunosuppression (drug, disease)
      • Emotional upset
      • Radiation
    • Occurs largely in adults, particularly in old age, but it can occur in children with a mild course
    • Localized pain, tenderness, paresthesia precedes the eruption by 4-5 days, accompanied by fever, headache, and malaise
    • Regional lymphadenopathy may be present
    • Pain may simulate pleurisy, MI, renal pain, abdominal disease, or migraine headache
    • Transmission of the virus is possible and can cause chicken pox in non-affected individuals
    • Eruption consists of grouped vesicles on an erythematous and edematous inflammatory base, arranged along the course of a sensory nerve in an interrupted or continuous band
    • HZ is characteristically unilateral, dermatomal
    • Thoracic region affected in 2/3 of cases
    • Possible, though very unusual, to have two or three episodes in a lifetime

    Molluscum Contagiosum

    • Benign poxvirus infection
    • Lesions are small, waxy, pearly, flesh-colored papules with a central umbilication
    • Typically occur on the face, trunk, extremities, and genitals
    • Cause: human molluscum contagiosum virus (MCV)
    • Spread: direct contact, fomites (especially contaminated towels), autoinoculation
    • Usually self-limiting, resolving within 6 to 18 months without treatment
    • Treatment:
      • Cryotherapy (liquid nitrogen)
      • Curettage (squeezing out the lesions with forceps, piercing them with a needle, and curettage)
      • Wart paints and topical imiquimod
    • Young children generally don't require treatment as Mollusca are self-limiting and usually clear in 6–9 months.

    Orf (Ecthyma Contagiosum)

    • Zoonotic infection caused by orf virus
    • Contracted from sheep and goats
    • Most commonly seen on the hands and fingers of shepherds, their wives who bottle-feed lambs, butchers, vets, and meat porters
    • Lesion develops 3–7 days after contact with an infected animal or animal carcass
    • Progresses through six stages:
      • maculopapular
      • targetoid
      • weeping nodule
      • regenerative
      • papillomatosis
      • regression
    • May be accompanied by lymphangitis, lymphadenopathy, malaise, fever
    • DDx: Milker’s nodule, Pyogenic granuloma, and Herpetic whitlow

    Orf Complications:

    • Secondary bacterial infection
    • Erythema multiforme is a well‐recognized sequel of orf infection
    • Giant orf or widespread lesions can occur in persons with impaired immunity
    • Bullous-pemphigoid‐like eruptions may rarely develop

    Orf Management

    • No active treatment is required, the lesions heal after 3–6 weeks
    • Topical antibiotic can be used to prevent secondary bacterial infection
    • Immunocompromised patients may require debridement, antiviral cidofovir cream, or imiquimod topical immunomodulatory therapy

    Viral Warts

    • Caused by Human papillomavirus (HPV), a DNA virus that infects the skin and mucous membranes
    • HPV affects people of all ages and races, but it is most common in children and young adults.
    • More than 150 genotypes of HPV exist, each with varying specificity for different anatomical sites, causing different skin lesions.
    • HPV types 1, 2, and 4 are found in common and plantar warts.
    • HPV types 3 and 10 are found in plane warts.
    • HPV types 6, 11, 16, and 18 are most common in genital warts and oral warts.
    • Genital warts are mostly transmitted by intimate contact, while non-genital warts can be spread through direct skin-to-skin contact or contaminated surfaces (e.g., swimming pools, gyms).
    • Autoinoculation (spreading the virus from one part of your body to another) is also possible.
    • The majority of warts resolve spontaneously within 1-2 years.
    • Reinfection with the same HPV type after clearance is uncommon.
    • Persistent infection with high-risk mucosal HPV types, particularly HPV 16 and 18, can cause cervical and most anal cancers, along with other cancers, including vaginal, vulvar, penile, and oropharyngeal cancers.
    • Persistent infection with these high-risk HPV types is rarely linked to cancers of the digits.

    Common Wart (Verruca Vulgaris)

    • Characterized by circumscribed, firm papules with "verrucous" hyperkeratotic surfaces.
    • Occur singly or in groups.
    • Usually associated with minimal tenderness.
    • Most commonly found on the dorsal aspects of fingers and hands.
    • Filiform warts, a variant of common warts, show thread-like keratinous projections, mostly occurring on the face and scalp.

    Plantar Wart (Verruca Plantaris)

    • Typically present as deeply embedded, painful papules on the sole of the foot, specifically on pressure points.
    • Can be singular or multiple.
    • Covered with a rough hyperkeratotic surface. Black dots (thrombosed capillaries) may become visible when the surface is removed with a scalpel.
    • A plaque of closely grouped warts is known as a mosaic wart.

    Plane or Flat Wart (Verruca Plana)

    • Slightly elevated, flat, smooth papules.
    • Usually skin-colored, but may be pigmented.
    • Most commonly affect the face and the dorsum of the hands.
    • Numbers can range from a few to hundreds.
    • Positive Koebner phenomenon (new lesions develop at trauma sites) is present, similar to common warts.

    Anogenital Wart (Condylomata Acuminata)

    • Found on the vulva, vagina, cervix, penis, scrotum, perianal skin, and anal canal.
    • Appear as well-defined papules.
    • On mucosal surfaces, they are often macerated and appear pale.
    • On dry skin, they can become more visibly hyperkeratotic.
    • May be small or coalesce into cauliflower-like masses.

    Oral Warts

    • Warts can develop on the lips, in the oral cavity, and in the upper respiratory tract.
    • Usually considered sexually transmitted.
    • The low-risk genital HPV types (6, 11) are the most common cause, with other types causing the condition less frequently.

    Treatment of Warts

    • Routine treatment is not necessary for every wart as self-resolution may occur.
    • More than two-thirds of warts resolve within 2 years.
    • Topical applications:
      • Keratolytics (salicylic acid and lactic acid) for common and plantar warts.
      • Trichloroacetic acid (TCA) is also used for common and plantar warts.
      • Retinoids might be effective for flat warts.
      • Podophyllin is used for anogenital warts.
      • Imiquimod cream is effective for various types of warts.
    • Surgical methods:
      • Cryotherapy (liquid nitrogen) is a standard treatment for warts.
      • Curettage (especially for filiform warts and exophytic lesions).
      • Electrosurgery.
      • Cautery.
      • Surgical excision.
      • Laser surgery (especially for recalcitrant warts).

    Herpes Simplex Viruses (HSV-1 & HSV-2)

    • Also known as Herpes Labialis, Cold Sore, Fever Blister, Herpes Genitalis.
    • Cause primary and recurrent vesicular eruptions that favor the orolabial and genital regions.
    • HSV-1: causes extra-genital infections.
    • HSV-2: causes genital infections.
    • Both viruses can affect any area of skin or mucous membrane.
    • Transmission:
      • HSV-1 is spread through direct contact with contaminated saliva or lesion secretions.
      • HSV-2 is spread primarily through sexual contact.
    • Pathogenesis:
      • Virus replicates at the site of infection.
      • Travels by retrograde axonal flow to the nerve ganglia where it remains latent until reactivation.

    Clinical Features of HSV Infection

    • Primary HSV-1 Infection:
      • Asymptomatic infection is common.
      • Symptoms usually appear within 3-7 days of exposure, often preceded by localized pain, tenderness, burning, and tingling.
      • Prodrome (symptoms before the rash) may include tender lymphadenopathy (swollen lymph nodes), malaise, anorexia, and fever.
      • Painful, grouped vesicles (small, fluid-filled blisters) on an erythematous (reddened) base appear.
      • Lesions progress to erosions or ulcerations with a characteristic scalloped border.
    • Primary HSV-2 Infection:
      • Frequently asymptomatic but can be extremely painful.
      • Often presents as erosive balanitis (inflammation of the head of the penis), vulvitis (inflammation of the vulva), or vaginitis (inflammation of the vagina).
      • May involve constitutional symptoms (fever, chills, muscle aches, etc.).
      • Characterized by painful, grouped vesicles in the genitalia that progress to pustules, crusting, and tender ulcers.
      • Can also cause painful lymphadenopathy, cervicitis (inflammation of the cervix), urethritis (inflammation of the urethra), and proctitis (inflammation of the rectum).
      • More extensive local involvement, regional lymphadenopathy, and fever help distinguish primary herpes infection from recurrent disease.
    • Recurrent Infection of Both HSV-1 & HSV-2:
      • Lesions usually occur in the same location each time.
      • Recurrent outbreaks can be triggered by:
        • Fever.
        • Respiratory tract infections.
        • Sun exposure.
        • Menstruation.
        • Stress.
        • Trauma.

    Cutaneous Herpes Simplex

    • Other clinical presentations of HSV infection include:
      • Eczema Herpeticum:
        • Occurs in patients with conditions that impair the skin barrier, such as atopic dermatitis.
        • Rapid, widespread monomorphic (uniform), discrete (separate), 2-3 mm punched-out erosions with hemorrhagic crusts.
        • Usually appears in areas of active or recently healed atopic dermatitis, particularly the face.
        • Usually a primary HSV-1 infection.
        • Severity ranges from mild to fatal.
        • Treatment:
          • Eczema herpeticum in young infants is a medical emergency and requires intravenous acyclovir at a dosage of 5-10 mg/kg every 8 hours.
          • In adults, acyclovir is typically prescribed at a dose of 800 mg three times daily for 10 days.
      • Herpetic Whitlow:
        • Cutaneous herpetic infection presenting with pain, swelling, and clustered vesicles on a finger.
        • Often affects young children, usually due to HSV-1.
        • Can also affect dental and medical professionals who did not wear gloves.
        • Caused by direct virus inoculation through abraded skin.

    Investigations for HSV Infection

    • Typically not necessary, but may be considered in doubtful cases.
    • Possible investigations include:
      • Tzank smears (examination of a sample of skin for multinucleated giant cells, characteristic of HSV infection).
      • Viral culture.
      • Polymerase chain reaction (PCR) testing.
      • Skin biopsy.

    Complications of HSV Infection

    • Secondary Bacterial Infection: Common complication.
    • Erythema Multiforme: Can follow recurrent herpes simplex infections.
    • Recurrent Dendritic Ulcers: Can lead to corneal scarring.
    • Disseminated Herpes Simplex: Can cause severe illness, especially in newborns or immunosuppressed patients.
    • Herpes Encephalitis and Meningitis: Can occur without accompanying skin or mucous membrane manifestations.

    Management of HSV Infection

    • The disease is generally self-limited and no significant intervention is often required.
    • For mild recurrent attacks, a cool water compress or surgical spirit dabbing and topical antibacterial cream may suffice.
    • More severe and frequent outbreaks may require the application of acyclovir cream (5 times daily for 5 days) at the first sign of recurrence.
    • Oral acyclovir (200 mg five times daily for 5 days) is more effective and can be used for widespread or systemic involvement.
    • Famciclovir and valacyclovir are alternative antiviral treatments.

    Varicella (Chickenpox)

    • Highly contagious viral infection caused by varicella-zoster virus (VZV).
    • Transmission occurs through droplets or vesicular fluid.
    • Contagious period: 2 days before onset of the rash until all lesions have crusted.
    • Chickenpox usually confers lifelong immunity.
    • After causing chickenpox, VZV remains latent in the dorsal root ganglia.
    • Incubation period: 14 days on average, ranging from 9 to 21 days.
    • Prodromal symptoms in children are often absent or mild, consisting of low fever, headache, and malaise. Symptoms are more severe in adults.
    • Skin lesions of different stages (papules, vesicles, pustules, and crusts) are present simultaneously in any given body area.
    • New lesion formation ceases by day 4 and most crusting occurs by day 6.
    • The rash begins on the face and trunk and spreads to other parts of the body.

    Molluscum Contagiosum

    • Caused by Molluscum contagiosum virus (MCV) - a poxvirus.
    • Common, highly contagious, and self-limiting.
    • Transmission occurs through direct contact, fomites (inanimate objects), or autoinoculation.
    • The incubation period is 2-7 weeks.
    • Lesions are small, pearly, umbilicated papules (dome-shaped, with a central depression).
    • They are usually asymptomatic or mildly pruritic (itchy).
    • Commonly found on the face, trunk, arms, and legs.
    • Can occur in children, adults, and immunocompromised individuals.
    • Can be triggered by trauma to the skin.

    Treatment of Molluscum Contagiosum

    • Routine treatment is not usually necessary as most cases resolve spontaneously within six months to two years.
    • Treatment is more often pursued in cases of extensive or symptomatic lesions, or in immunocompromised individuals.
    • Treatment options include:
      • Cryotherapy (liquid nitrogen):
        • Effective in destroying lesions.
        • May be painful and leave a light scar.
    • Curettage (scraping off the lesions): - Effective but can be painful and may cause bleeding.
    • Electrocautery (burning off the lesions): - Effective but can be painful and leave a scar.
    • Topical treatments: - Cimetidine cream: - May be used for treating lesions on the face.
    • Other treatment options: - Laser ablation:
      - Can be effective but may result in scarring.
      - Imiquimod cream: - Stimulates the immune system to fight the virus. - May cause redness, irritation, and itching.

    Orf (Ecthyma Contagiosum)

    • Zoonotic infection caused by orf virus (a parapoxvirus).
    • Acquired through contact with infected sheep or goats.
    • Commonly seen on the hands and fingers of individuals who work with sheep, goats, or their carcasses (e.g., shepherds, butchers, veterinarians).
    • Lesion development occurs 3-7 days after contact with an infected animal, progressing through six stages:
      • Maculopapular (flat, red, raised).
      • Targetoid (resembling a bull's eye).
      • Weeping nodule.
      • Regenerative.
      • Papillomatosis (formation of wart-like growths).
      • Regression (healing).
    • Might be accompanied by lymphangitis (inflammation of lymph vessels), lymphadenopathy, malaise, and fever.

    Differential Diagnosis of Orf

    • Milker's nodule (another zoonotic infection).
    • Pyogenic granuloma (non-infectious, benign growth).
    • Herpetic whitlow (viral infection of the fingers).

    Complications of Orf

    • Secondary bacterial infection.
    • Erythema multiforme.
    • Giant orf or widespread lesions in immunocompromised individuals.
    • Bullous-pemphigoid-like eruptions.

    Management of Orf

    • No active treatment usually required, as lesions heal spontaneously after 3-6 weeks.
    • Topical antibiotics can be used to prevent secondary bacterial infection.
    • Immunocompromised patients might require debridement, antiviral cidofovir cream, or imiquimod topical immunomodulatory therapy.

    Human Papillomavirus (HPV)

    • Over 200 types of HPV exist, with over 40 types capable of infecting the genital area, mouth, and throat.
    • HPV is primarily spread through direct skin-to-skin contact, including sexual and non-sexual routes.
    • Common Warts are caused by HPV types 1, 2, and 4, appearing on hands and feet.
    • Plantar Warts, painful warts located on the soles of the feet, are also caused by HPV.
    • Flat Warts, usually found on the face or shins, are caused by HPV types 3 and 10.
    • Genital Warts, appearing as small, flesh-colored bumps in the genital area, are caused by HPV types 6 and 11.
    • High-risk HPV types such as 16 and 18 are linked to cervical and anogenital cancers.
    • Diagnosis involves clinical appearance, patient history, and in certain cases, biopsy or HPV typing for high-risk types.
    • Treatment options include topical treatments like salicylic acid and cryotherapy, as well as surgical options like excision and laser therapy for persistent cases.
    • The HPV vaccine (Gardasil and Cervarix) is effective against most high-risk HPV types.

    Herpes Simplex Virus (HSV)

    • HSV is classified into two main types: HSV-1 (primarily oral herpes) and HSV-2 (primarily genital herpes).
    • Transmission occurs through direct contact with infected areas or bodily fluids, even when lesions are not present.
    • Herpes Simplex Labialis (cold sores/fever blisters) appears around the lips.
    • Herpes Simplex Genitalis presents as painful genital sores.
    • Herpetic Whitlow, an infection on fingers, is common in healthcare workers.
    • Eczema Herpeticum is an acute infection in patients with atopic dermatitis.
    • Diagnosis is based on clinical history, examination, viral culture or PCR for active lesions, and serological testing for antibodies.
    • Management includes antiviral medications like acyclovir, valacyclovir, and famciclovir, which reduce symptoms and outbreak frequency.
    • Symptomatic relief can be achieved with analgesics and topical treatments.
    • Preventative strategies include condom use and suppressive therapy for recurrent cases.
    • Potential complications include neurological complications like herpes simplex encephalitis and the risk of neonatal herpes for pregnant women during delivery.

    Herpes Simplex Virus (HSV)

    • Causes skin infections, commonly known as cold sores and genital herpes.
    • Two types: HSV-1 primarily affects the mouth, while HSV-2 primarily affects genitals.
    • Symptoms include painful blisters, itching, and burning.
    • Spreads through direct contact with infected lesions or mucous membranes.
    • Diagnosed through clinical examination, viral culture, PCR, or serology.
    • Treated with antiviral medications like acyclovir and valacyclovir, and pain management.

    Human Papillomavirus (HPV)

    • Causes warts and is linked to certain skin cancers, including squamous cell carcinoma.
    • Over 200 types, with the most common ones: HPV 6 and 11 causing genital warts, and HPV 16 and 18 being high-risk types linked to cervical and anal cancers.
    • Symptoms include raised, flat, or cauliflower-like skin lesions.
    • Transmission occurs through skin-to-skin contact and sexual contact for genital warts.
    • Diagnosed via clinical assessment and biopsy when necessary.
    • Treatment involves topical therapies like salicylic acid and cryotherapy, and surgical options like excision and laser therapy.

    Varicella-Zoster Virus (VZV)

    • Causes chickenpox and shingles.
    • Chickenpox is highly contagious, characterized by an itchy, vesicular rash and systemic symptoms like fever and malaise.
    • Shingles is a reactivation of the latent virus, manifesting as a painful, dermatomal vesicular rash.
    • Spreads through respiratory droplets and direct contact with lesions.
    • Diagnosed through clinical presentation, and VZV PCR or serology for atypical cases.
    • Treatment includes antiviral medications like acyclovir for shingles and supportive care with antihistamines and analgesics.

    Molluscum Contagiosum

    • Caused by a poxvirus, commonly affecting children.
    • Characterized by dome-shaped, flesh-colored papules with a central depression.
    • Spreads through skin-to-skin contact, sharing personal items like towels and toys.
    • Often asymptomatic, but can cause itching or irritation.
    • Diagnosed through clinical examination and biopsy when unsure.
    • Often self-resolving, but lesions can be removed through cryotherapy, curettage, or topical agents.

    ORF (Ecthyma Contagiosum)

    • Caused by the Orf virus, a zoonotic parapoxvirus primarily affecting sheep and goats.
    • Characterized by a painful, nodular lesion that progresses to a vesicular stage and can ulcerate.
    • Transmission occurs through direct contact with infected animals or contaminated materials.
    • Symptoms include a localized red papule that becomes crusted.
    • Diagnosed through clinical presentation and confirmed with PCR when needed.
    • Usually self-limiting, but wound care and symptomatic treatment can be provided.

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    This quiz explores various types of viral warts, focusing on their causes, transmission, and characteristics. Learn about the different HPV genotypes, how warts can manifest on different body parts, and their potential links to cancer. Test your knowledge on common, plantar, and genital warts.

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