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Flashcards in HPVFlashcards Deck (33):
1

**Appearance of Condyloma Acuminatum:

**Hyperkeratotic, Firm Exophilic Papules that can be **1mm-2 cm** caused by HPV

2

Symptoms of Condyloma Acuminatum:

75% asymptomatic otherwise itching, pain and burning

3

Differentiating between normal tissue and cervical wart in clinical setting:

Use of 3-5% acetic acid > turns wart tissue white while surrounding tissue remains flesh-colored.

4

Laryngeal Papillomas/Respiratory Papillomatosis:

Caused by HPV 6 or 11, nodules on the ciliated and squamous epithelial junction of the larynx

5

Laryngeal Papillomas/Respiratory Papillomatosis Symptoms:

Altered cry, Hoarseness, Stridor, Respiratory Distress, (common in children)

6

Laryngeal Papillomas and babies:

C-section NOT proven to reduce prevention of HPV infection. Surgical removal necessary.

7

HPV Virus Family:

Papovaviridae

8

**HPV Virus Genome (?) and Envelope (?)

Non-enveloped dsDNA

9

HPV Pathology in Warts:

Basal epithelium: site of PRIMARY infection > viral gene expression > viruses assembled > Virus shed from skin when most differentiated tissue is sloughed off surface. REQUIRES 3-Dimensional Differentiation

10

Two broad HPV groups:

Cutaneous infection, Mucosal infection

11

HPV-16 makes up what % of Cervical cancer cases:

49%

12

Second most common HPV serotype associated with cervical cancer:

HPV-18

13

General HPV Life Cycle and Cancer:

There is NOT virus PRODUCTION/genome amplification, instead there is genome INTEGRATION with increased E6 and E7 gene production.

14

HPV Life Cycle with Warts:

CIRCULAR with E2 serving as a NEGATIVE regulator of E6 and E7. E2 binds to promoter sequence only allowing minimal E6/E7 production.

15

HPV Life Cycle with Cancer:

LINEAR with INTEGRATION of virus. No E6/E7 regulation by E2 > up regulation of E6 + E7 production> proliferation and possible mutations contribute to cancer formation. VIRUS PRODUCTION MINIMIZED

16

Pathogenesis of E6 + E7 with Cervical Cancer:

HPV E7= inactivates Rb, HPV E6 inactivates p53. NO REGULATION FROM G1 > S phase for cell > increased replication and proliferation

17

Between what ages is there peak incidence of HPV in the genital tract?

15-25 years old

18

HPV-infected cervix and Precancerous lesions:

BOTH can REGRESS to previous state. Precancerous lesion> HPV-cervix > normal cervix.

19

Initial infection with HPV infection in cross section shows:

CIN1: Very mild/mild dysplasia and Low grade squamous intraepithelial Lesion (LSIL) with virus production

20

Diagnosis of HPV (3):

Clinical appearance usually sufficient. Pap Smear: Hyperkeratosis + KOILOCYTES are histological markers. PCR used for HPV serotypes.

21

**Abnormal Pap Smear:

Presence of KOILOCYTES: enlarged keratinocytes that contain irregular hyper chromatic nuclei surrounded by a characteristic HALO.

22

What age to start screening for cervical cancer:

21 years old

23

Treatment of Genital Warts caused by HPV:

Cryotherapy or CO2 laser.

24

Treatment of Low Grade Lesions caused by HPV (4):

Cryotherapy, CO2 laser, Loop excision, or Cauterization

25

Treatment of High Grade Lesions Caused by HPV (3):

Hysterectomy, Radiation, or Chemotherapy

26

HPV Prevention: Gardasil:

Quadrivalent- protects from 6, 11, 16, 18

27

HPV Vaccines prepared from:

Viral Capsid Protein= L1, made in yeast

28

**HPV Prevention: Cervarix:

Bivalent- protects against **16+ 18

29

Recommendation for girls and HPV vaccination:

Universal vaccination with EITHER quad or bivalent vaccine for all 11-12 year old girls.

30

Recommendation for boys and HPV vaccination:

Universal vaccination with ONLY QUADRIVALENT vaccine for all 11-12 year olds.

31

HPV Serotypes associated with Laryngeal Papillomas:

HPV 6 + 11

32

HIGH RISK HPV Serotypes Associated With Anogenital warts:

HPV 16, 18, 31, 33

33

LOW RISK HPV Serotypes Associated with Anogenital Warts:

HPV 6 + 11