Genital Papillomatosis
Kenneth Calimlim
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However, there are clear differences between vestibular papillomatosis and genital warts. For example, the individual base of each vestibular papillomatosis papule is separate, whereas warts tend to join together at the bottom.
In females, genital warts can develop on the vulva, cervix, or anus. Vestibular papillomatosis usually remains confined to the vulva, inner labia minora, and vaginal introitus, which is the vaginal opening.
Certain types of HPV infection cause contagious genital warts. They can spread through skin-to-skin contact during sex. Genital warts do not come from the same type of HPV that has links to cervical cancer.
Genital warts are not dangerous and will usually go away on their own. However, people sometimes opt for treatment if the warts are uncomfortable. The warts can also pose difficulties during delivery, so pregnant women may wish to seek treatment.
Sometimes, doctors may mistake vestibular papillomatosis for genital warts and do extra tests. It is important for doctors to be aware of vestibular papillomatosis so that they do not recommend unnecessary treatment.
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A condition called vulvar vestibulitis sometimes coexists with vestibular papillomatosis. This condition can cause itching and pain around your vaginal opening. The pain can be mild or severe and can occur during intercourse or when the vestibule of your vulva is touched. You may also see redness in the vulvar vestibule. These symptoms are due to vulvar vestibulitis and not vestibular papillomatosis.
Often vestibular papillomatosis is misdiagnosed as genital warts. A case report from 2010 describes the characteristics that can be used to tell the difference between vestibular papillomatosis and warts.
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Possible involvement of human papillomaviruses (HPV) in the development of vulvar and vestibular papillomatosis was investigated by using PCR to determine whether HPV DNA was present in lesions. Fourteen of 272 (5.1%) young women studied were found on gross and histological examination to have vulvar or vestibular papillomatosis. HPV DNA sequences were detected in cervicovaginal lavage specimens of 2 of 14 (14.3%) papillomatosis patients and 1 of 17 (5.9%) matched individuals in the control group without lesions. The difference in HPV prevalence between these two groups was not statistically significant (x2 = 0.51, p > 0.2). Furthermore, none of the 14 vulvar or vestibular papillomatosis biopsy tissues contained HPV DNA. The results suggest that vulvar and vestibular papillomatosis has an etiology other than HPV infection.
Most people who encounter HPV never develop a related illness. However, in a small number of people exposed to the HPV 6 or 11 virus, respiratory tract papillomas and genital warts can form. Although scientists do not fully understand why some people develop the disease and others do not, the virus is thought to be spread through sexual contact or when a mother with genital warts passes the HPV 6 or 11 virus to her baby during childbirth.
RRP may occur in adults (adult-onset RRP) as well as in infants and small children (juvenile-onset RRP) who may have contracted the virus during childbirth. The RRP Foundation estimates that there are roughly 20,000 active cases in the United States. According to the Centers for Disease Control and Prevention (CDC), estimates of the incidence for juvenile-onset RRP are imprecise but range from two or fewer cases per 100,000 children under age 18. Even less is known about the incidence of the adult form of RRP. Estimates of the incidence for adult-onset RPP range between two to three cases per 100,000 adults in the U.S.
RRP symptoms tend to be more severe in children than in adults. Because the tumors grow quickly, young children with the disease may find it difficult to breathe when sleeping, or they may have difficulty swallowing. Some children experience some relief or remission of the disease when they begin puberty. Both children and adults may experience hoarseness, chronic coughing, or breathing problems. Because of the similarity of the symptoms, RRP is sometimes misdiagnosed as asthma or chronic bronchitis.
A direct laryngoscopy is conducted in the operating room with the use of general anesthesia. This method allows the otolaryngologist to view the vocal folds and other parts of the larynx under high magnification. This procedure is usually used to minimize discomfort, especially with children, or to enable the doctor to biopsy tissue samples from the larynx or other parts of the throat to obtain a diagnosis of RRP.
Once RRP develops, there is currently no cure. Surgery is the primary method for removing tumors from the larynx or airway. Because traditional surgery can cause problems due to scarring of the larynx tissue, many surgeons now use laser surgery. Carbon dioxide (CO2) or potassium titanyl phosphate (KTP) lasers are frequently used for this purpose. Surgeons also commonly use a device called a microdebrider, which uses suction to hold the tumor in place while a small internal rotary blade removes the growth.
Once the tumors have been removed, they can still return. It is common for patients to require multiple surgeries. With some patients, surgery may be required every few weeks in order to keep the breathing passage open, while others may require surgery only once a year or even less frequently.
Some patients may be required to keep a trach tube indefinitely in order to keep the breathing passage open. Because the trach tube re-routes all or some of the exhaled air away from the vocal folds, the patient may find it difficult to use his or her voice. With the help of a voice specialist or speech-language pathologist who specializes in voice, the patient can learn to use his or her voice with the use of a speaking valve.
In severe cases of RRP, therapies in addition to surgery may be used. Drug treatments may include antivirals such as interferon and cidofovir, which block the virus from making copies of itself; indole-3-carbinol, a cancer-fighting compound found in cruciferous vegetables such as broccoli and brussels sprouts; or bevacizumab, which targets the blood vessel growth of papilloma. To date, the results of these and other nonsurgical therapies have been mixed or not yet fully proven.
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