Human Papillomavirus Differential Diagnoses

  • Author: Peter A Gearhart, MD; Chief Editor: Burke A Cunha, MD   more...
 
Updated: May 3, 2012
 
 

Diagnostic Considerations

Failure to diagnosis genital warts correctly can result in considerable morbidity. Confusing condylomata lata for genital warts will miss the diagnosis of syphilis and will lead to inappropriate therapy. Confusing pearly penile papules or Fordyce spots with genital warts will result in unnecessary treatment and likely unwarranted psychosocial concern. Missing a diagnosis of verrucous carcinoma or squamous cell carcinoma is likely to delay appropriate therapy and may lead to needless morbidity or even mortality.

Most papillomas are sufficiently distinct to be clinically recognizable. Bowenoid papulosis may be mistaken for lichen planus, psoriasis, seborrheic keratoses, or condylomata acuminata.

In additions to the conditions listed in the differential diagnosis, other problems to be considered include the following:

  • Acanthosis nigricans
  • Acrochordon
  • Actinic keratoses
  • Anogenital malignancy
  • Anogenital warts in children
  • Bowenoid papulosis
  • Carbon dioxide laser surgery for intraepithelial cervical neoplasms
  • Cervical polyp
  • Condyloma latum
  • Corns and calluses
  • Dermatitis papillaris
  • Endoscopic gynecologic surgery
  • Epidermodysplasia verruciformis
  • Fordyce spots
  • Hymenal remnants
  • Hypopigmentation
  • Keloid and hypertrophic scar
  • Keratoacanthoma
  • Laryngeal papillomatosis of neonates and infants
  • Malignant tumors of the mobile tongue
  • Micropapillomatosis labialis
  • Nevi
  • Pap test
  • Pityriasis versicolor
  • Psoriasis (plaque)
  • Recurrent respiratory papillomatosis
  • Seborrheic keratosis
  • Sinonasal papillomas, treatment
  • Skin tags
  • Verrucous carcinoma
  • Vestibular papillomatosis

Differential Diagnoses

Proceed to Workup
 
 
Contributor Information and Disclosures
Author

Peter A Gearhart, MD  Assistant Professor of Obstetrics and Gynecology, University of Pennsylvania School of Medicine

Peter A Gearhart, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists

Disclosure: Merck Honoraria Speaking and teaching

Coauthor(s)

Thomas C Randall  MD, Associate Professor of Clinical Obstetrics and Gynecology, University of Pennsylvania School of Medicine; Director, Gynecologic Oncology, Pennsylvania Hospital

Thomas C Randall is a member of the following medical societies: American Association for Cancer Research, American Association for the Advancement of Science, and American College of Obstetricians and Gynecologists

Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD  Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital

Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Additional Contributors

Jeffrey D Band, MD Professor of Medicine, Oakland University William Beaumont School of Medicine; Director, Division of Infectious Diseases and International Medicine, Corporate Epidemiologist, William Beaumont Hospital; Clinical Professor of Medicine, Wayne State University School of Medicine

Disclosure: Nothing to disclose.

Ryan Brashear, MD Staff Physician, Department of Dermatology, Indiana University School of Medicine

Ryan Brashear, MD is a member of the following medical societies: American Academy of Dermatology and American Medical Association

Disclosure: Nothing to disclose.

David F Butler, MD Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Edward F Chan, MD Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania School of Medicine

Edward F Chan, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Tsu-Yi Chuang, MD, MPH Clinical Professor, Department of Dermatology, Keck School of Medicine of the University of Southern California; Staff Dermatologist, Desert Oasis Healthcare

Tsu-Yi Chuang, MD, MPH is a member of the following medical societies: American Academy of Dermatology, American Society for Dermatologic Surgery, and International Society of Dermatology

Disclosure: Nothing to disclose.

Mark W Cobb, MD Consulting Staff, WNC Dermatological Associates

Mark W Cobb, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, and American Society of Dermatopathology

Disclosure: Nothing to disclose.

Burke A Cunha, MD Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital

Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Dirk M Elston, MD Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose

Ronald A Greenfield, MD Professor, Department of Internal Medicine, University of Oklahoma College of Medicine

Ronald A Greenfield, MD is a member of the following medical societies: American College of Physicians, American Federation for Medical Research, American Society for Microbiology, Central Society for Clinical Research, Infectious Diseases Society of America, Medical Mycology Society of the Americas, Phi Beta Kappa, Southern Society for Clinical Investigation, and Southwestern

Disclosure: Pfizer Honoraria Speaking and teaching; Gilead Honoraria Speaking and teaching; Ortho McNeil Honoraria Speaking and teaching; Abbott Honoraria Speaking and teaching; Astellas Honoraria Speaking and teaching; Cubist Honoraria Speaking and teaching; Forest Pharmaceuticals Speaking and teaching

Mary D Nettleman, MD, MS, MACP Professor and Chair, Department of Medicine, Michigan State University College of Human Medicine

Mary D Nettleman, MD, MS, MACP is a member of the following medical societies: American College of Physicians, Association of Professors of Medicine, Central Society for Clinical Research, Infectious Diseases Society of America, and Society of General Internal Medicine

Disclosure: Nothing to disclose.

Charles V Sanders, MD Edgar Hull Professor and Chairman, Department of Internal Medicine, Professor of Microbiology, Immunology and Parasitology, Louisiana State University School of Medicine at New Orleans; Medical Director, Medicine Hospital Center, Charity Hospital and Medical Center of Louisiana at New Orleans; Consulting Staff, Ochsner Medical Center

Charles V Sanders, MD is a member of the following medical societies: Alliance for the Prudent Use of Antibiotics, Alpha Omega Alpha, American Association for the Advancement of Science, American Association of University Professors, American Clinical and Climatological Association, American College of Physician Executives, American College of Physicians, American Federation for Medical Research, American Foundation for AIDS Research, American GeriatricsSociety, American Lung Association, American Medical Association, American Society for Microbiology, American Thoracic Society, American Venereal Disease Association, Association for Professionals in Infection Control and Epidemiology, Association of American Medical Colleges, Association of American Physicians, Association of Professors of Medicine, Infectious Disease Society for Obstetrics and Gynecology, Infectious Diseases Societyof America, Louisiana State Medical Society, Orleans Parish Medical Society, Royal Society of Medicine, Sigma Xi, Society of General Internal Medicine, Southeastern Clinical Club, Southern Medical Association, Southern Society for Clinical Investigation, and Southwestern Association of Clinical Microbiology

Disclosure: Nothing to disclose.

John D Shanley, MD, MPH Professor Emeritus, University of Connecticut; Professor of Preventive Medicine, Stony Brook Medical Center

John D Shanley, MD, MPH is a member of the following medical societies: American Association for the Advancement of Science, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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Human papillomavirus (HPV). Condyloma acuminatum in a patient with a history of an allograft renal transplant.
Human papillomavirus (HPV). Note the extensive labial involvement.
Human papillomavirus (HPV). Anal condyloma acuminatum.
Human papillomavirus (HPV). These condylomata extend to the anal verge.
Verrucous warts in patient with HIV infection.
Plantar warts.
Flat wart.
Condyloma acuminatum.
Small papilloma of vulva.
"Cauliflower" condyloma of penis.
Small papilloma on shaft of penis.
Small papilloma of anus.
Table. Diseases Associated With Specific HPV Types
Nongenital Cutaneous Disease HPV Type
Common warts (verrucae vulgaris)1, 2, 4, 26, 27, 29, 41, 57, 65, 75-78
Plantar warts (myrmecias)1, 2, 4, 60, 63
Flat warts (verrucae planae)3, 10, 27, 28, 38, 41, 49
Butcher’s warts (common warts of people who handle meat, poultry, and fish)1-4, 7, 10, 28
Mosaic warts2, 27, 57
Ungual squamous cell carcinoma16
Epidermodysplasia verruciformis (benign)2, 3, 10, 12, 15, 19, 36, 46, 47, 50
Epidermodysplasia verruciformis (malignant or benign)5, 8-10, 14, 17, 20-25, 37, 38
Nonwarty skin lesions37, 38
Nongenital Mucosal Disease HPV Type
Respiratory papillomatosis6, 11
Squamous cell carcinoma of the lung6, 11, 16, 18
Laryngeal papilloma (recurrent respiratory papillomatosis)[14] 2, 6, 11, 16, 30, 40, 57
Laryngeal carcinoma6, 11
Maxillary sinus papilloma57
Squamous cell carcinoma of the sinuses16, 18
Conjunctival papillomas6, 11
Conjunctival carcinoma16
Oral focal epithelial hyperplasia (Heck disease)13, 32
Oral carcinoma16, 18
Oral leukoplakia16, 18
Squamous cell carcinoma of the esophagus16, 18
Anogenital Disease HPV Type
Condylomata acuminata1-6, 10, 11, 16, 18, 30, 31, 33, 35, 39-45, 51-59, 70, 83
Bowenoid papulosis16, 18, 34, 39, 40, 42, 45
Bowen disease16, 18, 31, 34
Giant condylomata (Buschke-Löwenstein tumors)6, 11, 57, 72, 73
Unspecified intraepithelial neoplasia30, 34, 39, 40, 53, 57, 59, 61, 62, 64, 66-69
Low-grade squamous intraepithelial lesions (LGSIL)6, 11, 16, 18, 26, 27, 30, 31, 33-35, 40, 42-45, 51-58, 61, 62, 67-69, 71-74, 79, 81-84
High-grade squamous intraepithelial lesions (HGSIL)6, 11, 16, 18, 31, 33, 35, 39, 42, 44, 45, 51, 52, 56, 58, 59, 61, 64, 66, 68, 82
Carcinoma of vulva6, 11, 16, 18
Carcinoma of vagina16
Carcinoma of cervix[15, 16] 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, 68, 70, 73, 82
Carcinoma of anus16, 31, 32, 33
Carcinoma in situ of penis (erythroplasia of Queyrat)16
Carcinoma of penis16, 18
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