This article has been cited by other articles in PMC. Abstract External genital warts, also known as condylomata acuminata, are extremely common, with between , to one million new cases diagnosed each year in the United States alone.
Epidemiology The prevalence of HPV infection has risen steadily in the past 35 years, with as many as 20 million people in the United States believed to be infected. Open in a separate window. Dermatopathology Histopathologically, the hallmark of an HPV-infected cell is the development of morphologically atypical keratinocytes known as koilocytes.
Clinical Presentation Once infected with HPV, the virus typically requires an incubation period ranging anywhere from 3 weeks to 8 months prior to clinical manifestation. Complications of Untreated HPV Infection Both low-risk subtypes 6 and 11 and high-risk subtypes 16 and 18 HPV subtypes have also been associated with the very low-grade, well-differentiated squamous cell carcinoma known as verrucous carcinoma VC.
Therapy The current options available for the treatment of CA are largely centered upon removal of the warty growth rather than elimination of the underlying viral infection. Conclusion External genital warts and their associated HPV infections are considered among the most common sexually transmitted diseases affecting the general population.
References 1. Fleischer AB, Jr. Condylomata acuminata genital warts : patient demographics and treating physicians. Sex Transm Dis. Cates W. Estimates of the incidence and prevalence of sexually transmitted diseases in the United States. American Social Health Association Panel. Batista CS, et al. Cochrane Database Syst Rev. Markowitz LE, et al. Tyring SK. Human papillomavirus infections: epidemiology, pathogenesis, and host immune response.
J Am Acad Dermatol. Lombard I, et al. Human papillomavirus genotype as a major determinant of the course of cervical cancer. J Clin Oncol. Brown DR, et al. Detection of multiple human papillomavirus types in Condylomata acuminata lesions from otherwise healthy and immunosuppressed patients. J Clin Microbiol. Epidemiologic natural history and clinical management of human papillomavirus HPV disease: a critical and systematic review of the literature in the development of an HPV dynamic transmission model.
BMC Infect Dis. Moore RA, et al. Imiquimod for the treatment of genital warts: a quantitative systematic review. Epidemiology of genital human papillomavirus infection. Epidemiol Rev. Sexually transmitted diseases among American youth: incidence and prevalence estimates, Perspect Sex Reprod Health.
Scheinfeld N, Lehman DS. An evidence-based review of medical and surgical treatments of genital warts. Dermatol Online J. Mougin C, et al. Recent knowledge] Presse Med. Sanclemente G, Gill DK. Human papillomavirus molecular biology and pathogenesis. J Eur Acad Dermatol Venereol. Koutsky L. Am J Med. Koliopoulos G, et al. Diagnostic accuracy of human papillomavirus testing in primary cervical screening: a systematic review and meta-analysis of non-randomized studies.
Gynecol Oncol. Jenkins D, et al. J Clin Pathol. Methods for diagnosing papillomavirus infection. Ciba Found Symp. MIB-1 immunostaining is a beneficial adjunct test for accurate diagnosis of vulvar condyloma acuminatum. Am J Surg Pathol. Winer RL, et al. Genital human papillomavirus infection: incidence and risk factors in a cohort of female university students. Am J Epidemiol.
Baken LA, et al. Genital human papillomavirus infection among male and female sex partners: prevalence and type-specific concordance. J Infect Dis. Ho GY, et al.
Natural history of cervicovaginal papillomavirus infection in young women. N Engl J Med. Coleman N, et al. Immunological events in regressing genital warts. Am J Clin Pathol.
Oriel JD. Natural history of genital warts. Br J Vener Dis. Dubina M. Viral-associated non-melanoma skin cancers: a review. Am J Dermatopathol. Schwartz RA. Verrucous carcinoma of the skin and mucosa. Scheffner M, et al. The E6 oncoprotein encoded by human papillomavirus types 16 and 18 promotes the degradation of p Brownstein MH, Shapiro L.
Verrucous carcinoma of skin: epithelioma cuniculatum plantare. Batsakis JG, et al. The pathology of head and neck tumors: verrucous carcinoma, part Head Neck Surg. Drachenberg CB, et al. Cancer Detect Prev. Stanley M. Pathology and epidemiology of HPV infection in females. Maden C, et al. History of circumcision, medical conditions, and sexual activity and risk of penile cancer. J Natl Cancer Inst. Podophyllotoxin for condyloma acuminata eradication. Clinical and experimental comparative studies on Podophyllum lignans, colchicine, and 5-fluorouracil.
Acta Dermatolvenereol. Mohanty KC. The cost effectiveness of treatment of genital warts with podophyllotoxin. Lacey CJ, et al. Randomised controlled trial and economic evaluation of podophyllotoxin solution, podophyllotoxin cream, and podophyllin in the treatment of genital warts.
Sex Transm Infect. Greenberg MD, et al. A double-blind, randomized trial of 0. Obstet Gynecol. Genitourin Med. Transthoracic current paths include hand to hand, hand to foot, and front of the chest to the back of the chest. Animal experiments have suggested that the ventricular fibrillation threshold is inversely proportional to the square root of the duration of current flow. A factor that makes a large difference in the injury sustained in low-voltage shocks is the inability to let go.
The amount of current in the arm that will cause the hand to involuntarily grip strongly is referred to as the let-go current. The pain associated with the let-go current is so severe that young, motivated volunteers could tolerate it for only a few seconds. However, the muscles of flexion are stronger, making the person unable to voluntarily let go. Nearly all cases of inability to let go involve alternating current.
Alternating current repetitively stimulates nerves and muscles, resulting in a tetanic sustained contraction that lasts as long as the contact is continued. If this leads to the subject tightening his or her grip on a conductor, the result is continued electric current flow through the person and lowered contact resistance. With alternating current, there is a feeling of electric shock as long as contact is made.
In contrast, with direct current, there is only a feeling of shock when the circuit is made or broken. While the contact is maintained, there is no sensation of shock. Below mA DC rms, there is no let-go phenomenon because the hand is not involuntarily clamped. There is a feeling of warmth while the current travels through the arm. Making or breaking the circuit leads to painful unpleasant shocks. Above mA, letting go may be impossible. Heating power is also increased when a person cannot let go.
This is because a firm grip increases the area of skin effectively in contact with the conductors. Additionally, highly conductive sweat accumulates between the skin and conductors over time. Both of these factors lower the contact resistance, which increases the amount of current flow. In addition, the heating is greater because the duration of the contact is often several minutes in comparison with the fraction of a second that it takes to withdraw from a painful stimulus.
Being unable to let go results in more current for a longer period of time. This will increase damage due to heating of muscle and nerves. There will also be an increase in pain and the incidence of respiratory and cardiac arrest. There can also be shoulder dislocation with associated tendon and ligament injury, as well as bony fractures in the area of the shoulders.
Several different outcomes may occur when a person grasps a conductor giving 10 kV AC hand-to-hand voltage. It takes over 0. However, within 10 to milliseconds, muscles in the current path will strongly contract. The person may be stimulated to grasp the conductor more tightly, making a stronger mechanical contact. Or, the person may be propelled away from the contact.
Which of these events occurs depends on the position of the hand relative to the conductor. Most eyewitnesses report the victims being propelled from the conductor, possibly because of generalized muscle contractions. The time of contact is estimated to be about milliseconds or less in such cases. Drowning and near drowning can result from electricity in the water.
Conditions requiring treatment of near drowning caused by electricity are mostly the same as conditions related to nonelectrical near drowning. These conditions include myoglobin elevations that can result in renal failure detected by creatine kinase [CPK] elevations and urine examination , adult respiratory distress syndrome, hypothermia, hypoxia, electrolyte abnormalities, and arrhythmias that include ventricular tachycardia and ventricular fibrillation.
Creatine kinase and myoglobin levels in nonelectrical near-drowning events are thought to be due to a violent struggle, along with sometimes prolonged hypoxia and electrolyte imbalances.
Electricity in the water can stimulate muscles strongly enough to give a person severe muscle pain during and after his or her near-drowning experience. Creatine kinase levels sometimes rise for a day or more, being influenced by treatment given, continued hypoxia or hypotension, and other conditions that might influence continuing necrosis of tissue. Many of the determinations of electrical current effects in humans were made by Dalziel.
Therefore, current levels listed in publications may be maximum, average, or minimum levels, depending on the issues being discussed. For safety issues, near-minimum values are often appropriate. In addition, Smoot and Bentel 12 found that 10 mA of current was enough to cause loss of muscle control in water.
They carried out measurements in salt water and did not report voltages that were applied. Much of this is due to the internal body resistance. Thus, immersion eliminates most of the skin resistance. Salt water is very conductive compared with the human body, making electric shock drowning in salt water relatively rare. This is because much of the electric current is shunted around the outside of the body.
If there is a voltage difference, for example, between one arm and the other, then electric current will flow through the body. The amount of current is equal to the voltage divided by the total body resistance. Thus, the current needed and the resistance it must experience are known. It is therefore possible to calculate the voltage needed. For ventricular fibrillation, the calculation is as follows:. Water-related electrical contact often occurs in 2 ways. These mechanisms can happen in bathtubs, swimming pools, and lakes.
The first mechanism of contact involves a person in water reaching out of the water and contacting an energized conductive object. For example, a person is well-grounded by sitting in a bathtub. The resistance of the contact with his hand touching an energized object outside of the tub may be high enough to protect him or her, especially if his or her hand is not wet and the area of contact is small.
The second contact mechanism involves a person in the water being in an electric field because of an energized conductor that is in the water. For example, an electric heater connected to the hot wire of the V AC outlet falls in the water.
The grounded drain is close to the person's shoulders, whereas the heater is near his or her feet. This gives a voltage difference of V AC from shoulders to the feet. In lakes, ponds, and other water bodies, an electrical power source can generate current into the water.
The location of voltages in the water can be measured. Voltages may be present in the water because of the hull of a boat connected to an on-shore power source is energized. Voltages may also be present in the water because of energized conductors in the water that release electrical current into the water. An electric gradient or field can exist that is analogous to the situation described above for step and touch potentials.
The situation is more complex to analyze in the water because a person in the water assumes different postures and orientations in 3 dimensions up, down, and sideways—north, south, east, and west. The transthoracic and translimb voltages will vary as the person moves in relation to the orientation direction of the electric field. Measurements similar to those of Smoot and Bentel 12 were done with approval of the institutional review board of University of Illinois in Urbana-Champaign.
Metal plates were placed inside rubber containers. The metal plates were flat on the bottoms of the containers. A rubber mat with holes was placed on top of each metal plate.
An isolated power source ground wire was connected to one plate, and a Hz AC voltage from the power source was connected to the other plate. Thus, the subject's contact with electric current was primarily through the water contacting the feet through the holes and also through water contacting the legs higher up. This foot-to-foot current path simulated the hand-to-hand and hand-to foot situations that can occur with swimmers in water.
This setup minimized current flow through the chest. The study involved just 1 subject. It was found that electrically induced muscle contractions were greatly modified by leg position in the water. Initial testing has shown that with 3. This flexion could not be overcome with voluntary effort. The involuntary keen flexion occurred when the leg was lifted by hip flexion so that the thigh was horizontal and the knee was at the water level.
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