CLINICAL FINDINGS

HPVs are often categorized as cutaneous (nongenital) and include genotypes such
as HPV-1, -2, -3, and -4, whereas HPV-6, -11, -16, and -18 predominate in genital
and mucosal infections
 CUTANEOUS WARTS
1. Veruka Vulgaris/Common Warts

• Common warts (excluding plantar warts) are due mainly to HPV-2, but also
to the closely related types 27, 57 and types 1 and 4.

• Firm papules with a rough, horny surface, scaly, spiny papules or nodules
they range in size from less than 1 mm to over 1 cm in diameter, and by
confluence can form large masses

• Most commonly situated on the backs of the hands and fingers, and, in
children under 12 years of age, on the knees, but may occur anywhere on
the skin

Sterling J. Viral Infections. In: Burns T, Brethnach S, Cox N, Griffiths C, editors. Rooks Textbook of Dermatology. 8th ed. West Sussex: Willey
Blackwell; 2010
 CUTANEOUS WARTS
1. Veruka Vulgaris/Common Warts

• Usually symptomless, but may be tender on the palmar aspects of the

fingers

• About 65% of warts disappear spontaneously within 2 years and 95%

within 4 years

Sterling J. Viral Infections. In: Burns T, Brethnach S, Cox N, Griffiths C, editors. Rooks Textbook of Dermatology. 8th ed. West Sussex: Willey
Blackwell; 2010
1. Androphy E, Kirnbauer R. Human Papilloma Virus Infections. In: Goldsmith L, Katz S, Gilchrest B, Paller A, Leffell D, Wolff K, editors. Fitzpatrick’s Dermatology in General Medicine. 8th ed. New York: Mc.Graw Hill
Medical; 2012. p. 2421-33
2. Sterling J. Viral Infections. In: Burns T, Brethnach S, Cox N, Griffiths C, editors. Rooks Textbook of Dermatology. 8th ed. West Sussex: Willey Blackwell; 2010
 CUTANEOUS WARTS
2. Verruca Plana/Plane Warts

• Plane warts, due mainly to HPV-3 and 10

• Smooth, flat or slightly elevated and are usually skin-coloured or greyish-yellow, but may be
pigmented. They are round or polygonal in shape and vary in size from 1 to 5 mm or more in
diameter.

• The face and the backs of the hands and the shins are the sites of predilection and the
number present ranges from two or three to many hundreds

• Regression of plane warts is usually heralded by inflammation in the lesions, causing itch,
erythema and swelling, such that previously unnoticed warts may become evident

Sterling J. Viral Infections. In: Burns T, Brethnach S, Cox N, Griffiths C, editors. Rooks Textbook of Dermatology. 8th ed. West Sussex: Willey
Blackwell; 2010
2. Sterling J. Viral Infections. In: Burns T, Brethnach S, Cox N, Griffiths C, editors. Rooks Textbook of Dermatology. 8th ed. West Sussex: Willey Blackwell; 2010
 CUTANEOUS WARTS
3. Verruca Plantaris/Plantar warts

• Caused by HPV-1, 2, 4, 27 or 57. The deep ‘myrmecia’ form is due to HPV-1.

Smaller lesions may contain HPV-2, 4, 27 or 57, while mosaic warts are commonly
caused by HPV-2.

• Most plantar warts are beneath pressure points, the heel or the metatarsal heads.

• At first appears as a small shining ‘sago-grain’ papule, but soon assumes the typical
appearance of a sharply defined, rounded lesion, with a rough, keratotic surface
surrounded by a smooth collar of thickened horn. Mosaic warts are so described
from the appearance presented by a plaque of closely grouped small warts

Sterling J. Viral Infections. In: Burns T, Brethnach S, Cox N, Griffiths C, editors. Rooks Textbook of Dermatology. 8th ed. West Sussex: Willey
Blackwell; 2010
3. Verruca Plantaris/Plantar warts

• In addition they often have multiple small black “dots” at the surface
which are actually tiny blood vessels

• Pain is a common but variable symptom. Mosaic warts are often painless.

• Spontaneous regression occurs sooner in children than in adults and is

delayed if hyperhidrosis or orthopaedic defects are present

• Plantar warts can be persistent.

Sterling J. Viral Infections. In: Burns T, Brethnach S, Cox N, Griffiths C, editors. Rooks Textbook of Dermatology. 8th ed. West Sussex: Willey
Blackwell; 2010
Sterling J. Viral Infections. In: Burns T, Brethnach S, Cox N, Griffiths C, editors. Rooks Textbook of Dermatology. 8th ed. West Sussex: Willey
Blackwell; 2010
 CUTANEOUS WARTS
4. Periungual warts

• Common warts around the nails, especially at the nail folds or

beneath the nail, can disturb nail growth

• Nail biting may increase the risk of infection at this site

Sterling J. Viral Infections. In: Burns T, Brethnach S, Cox N, Griffiths C, editors. Rooks Textbook of Dermatology. 8th ed. West Sussex: Willey
Blackwell; 2010
Sterling J. Viral Infections. In: Burns T, Brethnach S, Cox N, Griffiths C, editors. Rooks Textbook of Dermatology. 8th ed. West Sussex: Willey
Blackwell; 2010
 GENITAL WARTS
5. Condyloma accuminata/anogenital warts

• Anogenital warts are common and are caused in 75% by HPV-6. The
remainder are caused by HPV-11 or more unusual, low-risk HPVs

• The typical anogenital wart is soft, pink, elongated and sometimes filiform
or pedunculated. The lesions are usually multiple especially on moist
surfaces, and their growth can be enhanced during pregnancy, or in the
presence of other local infections. Large malodorous masses may form on
vulvar and perianal skin

Sterling J. Viral Infections. In: Burns T, Brethnach S, Cox N, Griffiths C, editors. Rooks Textbook of Dermatology. 8th ed. West Sussex: Willey
Blackwell; 2010
5. Condyloma accuminata/anogenital warts
• This classical ‘acuminate’ (sometimes called papillomatous, or
hyperplastic) form constitutes about twothirds of anogenital
warts

• Most other lesions are flat, though more conspicuous than

plane warts elsewhere, and some of these, generally on
nonmucosal surfaces such as the penile shaft, pubic skin,
perianal skin and groins, may be sufficiently pigmented to
resemble seborrhoeic

Sterling J. Viral Infections. In: Burns T, Brethnach S, Cox N, Griffiths C, editors. Rooks Textbook of Dermatology. 8th ed. West Sussex: Willey
Blackwell; 2010
5. Condyloma accuminata/anogenital warts
• Occasionally, only lesions resembling common warts are seen, in men
usually on the penile shaft, and these may be the result of contact with
common warts elsewhere on the patient or on the sexual partner

• Both acuminate and flat types may coexist

• Patients with genital warts frequently have other genital infections. These
are mainly minor conditions such as candidiasis, trichomoniasis and non-
specific genital infection with occasional major venereal infections
(syphilis or gonorrhoea)

Sterling J. Viral Infections. In: Burns T, Brethnach S, Cox N, Griffiths C, editors. Rooks Textbook of Dermatology. 8th ed. West Sussex: Willey
Blackwell; 2010
1. Androphy E, Kirnbauer R. Human Papilloma Virus Infections. In: Goldsmith L, Katz S, Gilchrest B, Paller A, Leffell D, Wolff K, editors. Fitzpatrick’s Dermatology in General Medicine. 8th ed. New York: Mc.Graw Hill
Medical; 2012. p. 2421-33
2. Sterling J. Viral Infections. In: Burns T, Brethnach S, Cox N, Griffiths C, editors. Rooks Textbook of Dermatology. 8th ed. West Sussex: Willey Blackwell; 2010
6. Perianal warts
• In children, warts in the anogenital area are often more
hyperkeratotic than in adults and may be caused by HPV types
associated with cutaneous disease as well as HPV types 6 and
11.

• The duration of anogenital warts varies from a few weeks to

many years. Recurrences can be expected in about 25% of
cases, the interval varying from 2 months to 23 years

Sterling J. Viral Infections. In: Burns T, Brethnach S, Cox N, Griffiths C, editors. Rooks Textbook of Dermatology. 8th ed. West Sussex: Willey
Blackwell; 2010
Sterling J. Viral Infections. In: Burns T, Brethnach S, Cox N, Griffiths C, editors. Rooks Textbook of Dermatology. 8th ed. West Sussex: Willey
Blackwell; 2010
 MALIGNANCY in HPV
Cervical cancer
• 70% of cervical cancers are due to HPV-16 and HPV-18 types.
Although HPV is important, other cofactors are also needed.

• Although HPV is important, other cofactors are also needed.

for this cancer, such as long use of hormonal contraception,
high parity, smoking, immunosuppression, lack of certain
foods, genetics and viral factors.

E, Hidayat. , D.H.S, Hasibuan, Y, Fitrayati. 2014. Hubungan Kejadian Kanker Serviks Dengan Jumlah Paritas Di RSUD Moewardi Tahun 2013..JKKI, Vol.6, No.3, September-Desember 2014

5. ING, Budiana. 2013. Viral Loadpada Kanker Serviks Terinfeksi Human Papilloma VirusTipe 16. Vol. 21 No. 2 Mei - Agustus 2013 : 77-83
Cervical cancer
• Mechanism of HPV infection which consists of two phases,
namely the phase of latent virus infection and productive viral
infection

• The consequences of HPV infection are abnormalities of

cervical epithelial cells in the form of precancerous lesions, in-
situ cervical cancer, and finally squamous cell carcinoma

E, Hidayat. , D.H.S, Hasibuan, Y, Fitrayati. 2014. Hubungan Kejadian Kanker Serviks Dengan Jumlah Paritas Di RSUD Moewardi Tahun 2013..JKKI, Vol.6, No.3, September-Desember 2014

5. ING, Budiana. 2013. Viral Loadpada Kanker Serviks Terinfeksi Human Papilloma VirusTipe 16. Vol. 21 No. 2 Mei - Agustus 2013 : 77-83