HUMAN PAPILLOMAVIRUS INFECTION
Most HPV infections are asymptomatic, subclinical, or unrecognized. Visible genital warts are usually caused by HPV types 6 and 11 (Figure 2). Other HPV types in the anogenital region (types 16, 18, 31, 33, and 35) have been strongly associated with cervical dysplasia.
Diagnosis. The use of type-specific HPV nucleic acid tests is not justified in the routine diagnosis and management of visible genital warts. Biopsy is rarely needed to confirm the diagnosis of genital warts, except in the following circumstances:
• Diagnosis is uncertain.
• Lesions do not respond to standard therapy.
• Disease worsens during therapy.
• Patient is immunocompromised.
• Warts are pigmented, indurated, fixed, and ulcerated.
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