Editing Sexually Transmitted Infections (section)

== Other genital lesions ==

=== Human papillomavirus (HPV) ===

==== Pathogen ====
* '''Double-stranded DNA virus''' (similar to herpes)
** '''Non-oncogenic subtypes: 6 and 11; account for ≈90% of anogenital warts, also known as condyloma acuminata'''
** '''Oncogenic subtypes: 16 and 18; account for cervical cancer and other types of anogenital cancer including penile, vulvar, vaginal, anal cancers; subtype 16 more important for penile cancer'''

==== Epidemiology ====
* > 50% of sexually active persons will become infected at least once in their lifetime

==== Natual history ====
* ≈70% of HPV infections resolve spontaneously in 1 year and 90% in 2 years, and HPV persistence develops in the remaining persons

==== Pathogenesis ====
* Transmission can occur from asymptomatic and subclinical patients.
** Among asymptomatic females in the general population, the prevalence of HPV infection ranges from 2-44%, and among men from 2-35%
* Risk factors: presence of foreskin, increasing numbers of sexual partners, lack of condom use, and smoking.

==== Diagnosis and Evaluation ====
* '''See Figure'''
* '''HPV warts can also occur in the urethra and can cause hematuria, dysuria, or difficulty voiding'''

==== Management ====
* '''The goal of treatment is removal of the warts; treatment will not eradicate the infection.'''
** '''Treatment is guided by wart size, number, and location, and patient preference.'''
* '''Options classified as patient-applied vs. provider-administered modalities'''
** '''Patient-applied (3):[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6620174/table/t1-cuaj-6-s2/?report=objectonly §]'''
**# '''Imiquimod cream, 3.75 or 5%, should be applied for 8 hrs daily for 2 weeks'''
**##'''Maximum of 8 weeks for 3.75% vs. 16 weeks every other day for 5% imiquimod'''
**# '''Podofilox cream, 0.5%, applied twice daily for 3 consecutive days each week, can repeat up to 4 weeks with at least 4 days in between'''
**# '''Sinecatechins ointment, 15%, applied 3 times daily for up to 16 weeks'''
** '''Provider-administered (4):'''
**# '''Podophyllin''' (less refined form of podofilox)
**# '''Trichloroacetic acid'''
**# '''Cryotherapy'''
**# '''Surgical therapy including direct excision with scissors, tangential shave excision, curettage, or laser therapy using a CO2 laser'''
* '''HPV vaccine'''
** '''Designed to prevent infection and are not effective in clearing an infection once established'''
** '''Recommended for females AND males age < 26''', preferably to start before onset of sexual activity.
** '''Gardasil'''
*** '''Quadrivalent HPV vaccine that provides protection against HPV types 6, 11, 16, and 18.'''
** '''Cervarix'''
*** '''Bivalent HPV vaccine that provides protection against HPV types 16 and 18'''

=== Scabies ===
* '''Skin infection caused by the mite Sarcoptes scabiei'''

==== Pathogenesis ====
* The female lays eggs in the skin, and transmission is by person-to-person skin-to-skin contact with passage of pregnant female mites.
* Incubation period: 2-6 weeks

==== Diagnosis and Evaluation ====
* History and Physical Exam
** Most common symptoms are skin rash and '''itching, especially at night''', from an allergic reaction to the mite proteins.
* Other
** Microscopic examination of a skin scraping to assess for mites, mite eggs, or fecal matter (scybala)

==== Management ====
* '''Permethrin cream''' or ivermectin 200 μg/kg orally

=== Pediculosis Pubis (Phthirus pubis): Pubic or Crab Louse ===
* Lice are obligate bloodsucking parasites of humans
* Transmission requires close contact
* The typical presentation is pruritus, which is caused by a delayed hypersensitivity reaction to the lice, and is usually worse at night and after baths
* Insert figure

* Management
** Permethrin 5% cream rinse applied to affected areas and washed off after 10 minutes or pyrethrins with piperonyl butoxide applied to affected areas and washed off after 10 minutes

=== Molluscum Contagiosum ===
* '''A superficial skin disease caused by the pox virus'''
* Can be sexually transmitted
* '''Characteristic lesions are small, discrete waxy papules 3-5 mm in diameter, with a central depression'''
* Diagnosis is generally on the basis of the characteristic appearance of skin lesions.
* The infection is usually self-limited and spontaneously disappears in 6-12 months, but may take up to 4 years to resolve. However, infection in immunocompromised individuals, such as those with HIV, is typically more severe and extensive.

=== Candidal infections ===
* The most common clinical syndromes caused by Candida albicans include genital mild burning and pruritus with erythema of the glans and/or the prepuce, and subpreputial discharge.
* '''Risk factors for fungal balanitis (especially Candida balanitis):'''
** '''Diabetes mellitus'''
** '''HIV infection'''
** '''Iatrogenic immunosuppression'''
** '''Presence of foreskin'''
** '''Widespread use of antibiotics'''
* Management
** The guidelines for the treatment of Candida balanitis have not yet been standardized.
** Treatment options usually involve topical antifungal therapy, either associated or not with systemic antifungal treatment.
*** Azole agents, such as clotrimazole, miconazole, econazole, fluconazole, and itraconazole, are the usually recommended antifungal agents