eMedicine Specialties > Infectious Diseases > Sexually Transmitted Diseases

Papillomavirus: Differential Diagnoses & Workup

Author: John D Shanley, MD, MPH, Professor Emeritus, University of Connecticut; Professor of Preventive Medicine, Stony Brook Medical Center
Contributor Information and Disclosures

Updated: Aug 15, 2007

Differential Diagnoses

Basal Cell Carcinoma
Molluscum Contagiosum
Benign Vulvar Lesions
Papillomavirus
Dermatologic Diseases of the Male Genitalia: Malignant
Penile Cancer
Dermatologic Diseases of the Male Genitalia: Nonmalignant
Rectal Cancer
Gynecologic Cryosurgery
Recurrent Respiratory Papillomatosis
Gynecologic Laparoscopy
Surgical Treatment of Vaginal Cancer
Human Papillomavirus
Surgical Treatment of Vulvar Cancer
Malignant Vulvar Lesions
Urethral Warts

Other Problems to Be Considered

Endoscopic gynecologic surgery
Hypopigmentation

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

Workup

Laboratory Studies

Most cutaneous and external genital warts can be recognized clinically. In the case of genital intraepithelial neoplasia, determining the extent of disease is essential. This involves careful inspection, as well as colposcopy. In females, frequent PAP tests are useful. Polymerase chain reaction (PCR) used to detect HPV DNA is largely a research tool.

Imaging Studies

In general, imaging studies have a limited role in diagnosing papillomavirus infections. In rare instances, CT scan or MRI can be used to determine the extent of spread of cervical carcinoma and, in rare instances, extensive anogenital papillomatosis that has spread into the pelvis.

Histologic Findings

Histology of condyloma acuminata generally demonstrates disruption of the epidermis with hyperkeratosis, coarse keratohyaline granules, and koilocytes in a prominent granular layer. The epidermis or mucosa of flat condylomata demonstrates acanthosis. Koilocytes, the characteristic cytological feature of HPV infection, are present. Koilocytes are keratinocytes with pyknotic, deeply blue nuclei surrounded by a halo and clear cytoplasm with a paucity of keratohyaline granules.

Histology of Bowenoid papulosis reveals psoriasiform hyperplasia and hyperkeratosis of the epidermis. Mitotic figures are increased at all epidermal levels. Keratinocytes display enlarged pleomorphic and hyperchromic nuclei.

Histology of common cutaneous warts demonstrates marked hyperkeratosis, acanthosis, parakeratosis, and papillomatosis. Three features used to distinguish warts from other papillomas include the presence of koilocytes, vertical columns of parakeratosis, and foci of clumped keratohyaline granules.

More on Papillomavirus

Overview: Papillomavirus
Differential Diagnoses & Workup: Papillomavirus
Treatment & Medication: Papillomavirus
Follow-up: Papillomavirus
Multimedia: Papillomavirus
References
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References

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  2. Beutner KR, Ferenczy A. Therapeutic approaches to genital warts. Am J Med. May 5 1997;102(5A):28-37. [Medline].

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  4. Fazel N, Wilczynski S, Lowe L, Su LD. Clinical, histopathologic, and molecular aspects of cutaneous human papillomavirus infections. Dermatol Clin. Jul 1999;17(3):521-36, viii. [Medline].

  5. Koutsky L. Epidemiology of genital human papillomavirus infection. Am J Med. May 5 1997;102(5A):3-8. [Medline].

  6. Sedlacek TV. Advances in the diagnosis and treatment of human papillomavirus infections. Clin Obstet Gynecol. Jun 1999;42(2):206-20. [Medline].

  7. Tjalma WA, Arbyn M, Paavonen J, van Waes TR, Bogers JJ. Prophylactic human papillomavirus vaccines: the beginning of the end of cervical cancer. Int J Gynecol Cancer. Sep-Oct 2004;14(5):751-61. [Medline].

  8. Wiley DJ, Douglas J, Beutner K, Cox T, Fife K, Moscicki AB, et al. External genital warts: diagnosis, treatment, and prevention. Clin Infect Dis. Oct 15 2002;35(Suppl 2):S210-24. [Medline].

  9. Siddiqui MA, Perry CM. Human papillomavirus quadrivalent (types 6, 11, 16, 18) recombinant vaccine (Gardasil). Drugs. 2006;66(9):1263-71; discussion 1272-3. [Medline].

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Further Reading

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Keywords

human papillomavirus, HPV, common warts, verruca vulgaris, palmo-plantar warts, flat warts, verruca plana, oral warts, focal epithelia hyperplasia, epidermodysplasia verruciformis, EDV, genital warts, condyloma acuminata, Bowen papulosis, Bowen disease, papillomas of the mucosal surfaces, intraepithelial neoplasias, papovavirus, sexually transmitted disease, STD, laryngeal papillomas, mosaic wart, butcher wart, extragenital Bowen disease, macular plaque, flat condylomata, cervical intraepithelial neoplasia, Buschke-Löwenstein tumor, vulvar intraepithelial neoplasia, cervical cancer, penile intraepithelial neoplasia, anal intraepithelial neoplasia, verrucae vulgaris, verrucae plana, Heck disease, flat condylomata, squamous intraepithelial neoplasia, giant condyloma, verrucous carcinoma, Bowenoid papulosis

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Contributor Information and Disclosures

Author

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.

Medical Editor

Jeffrey D Band, MD, Clinical Professor of Medicine, Wayne State University School of Medicine; Director, Division of Infectious Diseases and International Medicine, William Beaumont Hospital Corporation
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

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 Geriatrics Society, 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 Society of 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.

CME Editor

Eleftherios Mylonakis, MD, Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital
Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America
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.

 
 
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