Clinical presentation
HPV infection results in common warts (verruca vulgaris), plantar warts, filiform, condylomata accuminata (CA) and mucocutaneous warts, which can occur in the oral, ocular and anogenital mucosa.[49] CA is the most common clinical form of anogenital warts.[50] Although warts may be larger, multiple, recalcitrant to therapy and disfiguring, with a significant psychological burden, most commonly the warts look like those found in the general population. While most cases are asymptomatic, some patients may experience pruritus, mild burning or bleeding.[51]
In general, HPV infections are considered benign. In the anogenital areas however, it can be more difficult with both common genital warts (usually HPV types 6 and 11) occurring, as well as other lesions due to other wart types.[52] The well-defined plaques of erythematous lesions of both low-grade and high-grade disease are often due to HPV 16 and 18. Anal squamous carcinoma can arise de novo or from pre-existing areas of dysplasia.[53]
HPV types 16, 18 and several others have oncogenic potential and have been shown to be associated with malignant transformation.[54] Cutaneous squamous cell carcinoma neoplastic transformation can occur in association HPV infection of the skin, oral mucosa, pharyngeal, cervix, vulva, and anogenital mucosa. Bowen disease can occur. These can be ether in situ or invasive carcinoma.[55]