A 37-year-old man comes to his primary care physician for the evaluation of slightly pruritic skin lesions on his penis and around his anus. He has no fever, malaise, or anorexia. He is sexually active with multiple male partners and uses condoms occasionally. The patient has never been tested for HIV or other sexually transmitted diseases. He has no drug allergies. Examination shows skin-colored, verrucous, papilliform lesions as shown in the image below. Which of the following is the most likely cause of this patient's skin condition?

Question

A 37-year-old man comes to his primary care physician for the evaluation of slightly pruritic skin lesions on his penis and around his anus.  He has no fever, malaise, or anorexia.  He is sexually active with multiple male partners and uses condoms occasionally.  The patient has never been tested for HIV or other sexually transmitted diseases.  He has no drug allergies.  Examination shows skin-colored, verrucous, papilliform lesions as shown in the image below.  Which of the following is the most likely cause of this patient's skin condition?

Quizplus · Accepted Answer

Condylomata acuminata (anogenital warts) are caused by the human papillomavirus (HPV), which is the most common sexually transmitted disease in the United States. The characteristic lesions are verrucous, papilliform, and either pink or skin-colored. The lesions are usually asymptomatic but may have mild itching or burning. Systemic symptoms are usually absent. The diagnosis of condyloma acuminata is primarily based on clinical presentation. Biopsy may be considered in atypical cases. HPV infection (especially serotypes 16 and 18) is associated with increased risk for squamous cell carcinoma of the anus, genital organs, and throat. HPV is also associated with increased risk for other sexually transmitted diseases, especially HIV. HIV screening should be offered to patients with a new diagnosis of HPV. The condition is self-limited in most cases. If specific treatment is desired, options include: Chemical or physical agents (eg, trichloroacetic acid, podophyllin)Immune therapy (eg, imiquimod)Surgery (eg, cryosurgery, excision, laser treatment) Chemical or physical agents (eg, trichloroacetic acid, podophyllin) Immune therapy (eg, imiquimod) Surgery (eg, cryosurgery, excision, laser treatment) (Choice A) Pearly pink penile papules are a common anatomical variant, typically presenting as small papules evenly distributed in a ring around the corona of the glans penis. They are a benign non-infectious condition, though patients often request removal to avoid the appearance of having a sexually transmitted disease. (Choice B) Herpes simplex is characterized by small grouped vesicles that erode to form small ulcers. Herpes simplex (Choice D) Molluscum contagiosum is a self-limited, localized skin infection caused by a poxvirus. It is characterized by small pink or skin-colored papules with indented centers that may occur anywhere except the palms and soles. These lesions may be widely scattered and may occur in a linear pattern due to spread of the virus to adjacent skin via scratching. Molluscum contagiosum (Choice E) Condyloma lata are a manifestation of secondary syphilis characterized by flattened pink or gray velvety papules. These are seen most commonly at the mucous membranes and moist skin of the genital organs, perineum, and mouth. Condyloma lata Educational objective: Condylomata acuminata (anogenital warts) are verrucous papilliform lesions located in the anogenital region. These lesions are caused by human papillomavirus, which is the most common sexually transmitted disease in the United States. Certain serotypes (especially 16 and 18) are associated with squamous cell carcinoma of the anus, genital organs, and throat. References: Genital HPV infection and related lesions in men. (http://www.ncbi.nlm.nih.gov/pubmed/21962470)

A 37-Year-Old Man Comes to His Primary Care Physician for the Evaluation