1;Human Papillomavirus History and Epidemiology;14 2;Human Papillomavirus History and Epidemiology;15 2.1;1.1 Introduction;15 2.2;1.2 Historical Perspective;17 2.3;1.3 Epidemiology;18 2.4;1.4 HPV in Women;20 2.4.1;1.4.1 Risk Factors;20 2.5;1.5 HPV in Men;21 2.5.1;1.5.1 Risk Factors;23 2.6;1.6 HPV Transmission Modes;24 2.6.1;1.6.1 HPV Transmission in Children;24 2.6.2;1.6.2 Considerations Regarding Unusual Transmission Routes;26 2.6.2.1;1.6.2.1 Transmission from CO 2 Plume;26 2.7;1.7 Prevention;26 2.7.1;1.7.1 Condoms;26 2.7.2;1.7.2 Vaccines;26 2.7.3;1.7.3 Antiviral Microbicides;27 3;References;27 4;Laboratory Methods for Detection of Human Papillomavirus Infection;34 4.1;2.1 Introduction;34 4.2;2.2 HPV DNA Methods;35 4.3;2.3 HPV RNA Methods;37 4.4;2.4 Serological Assays;38 4.5;2.5 Detecting HPV Infection in Men;39 5;References;39 6;Human Papillomavirus and Urological - Associated Diseases;42 7;Human Papillomavirus and External Genital Lesions;43 7.1;3.1 Introduction;43 7.2;3.2 Overview;44 7.3;3.3 Clinical Manifestations;45 7.3.1;3.3.1 Subclinical Infection;45 7.3.1.1;3.3.1.1 Presentation;45 7.3.1.2;3.3.1.2 Symptoms;45 7.3.2;3.3.2 Clinical Disease;45 7.3.2.1;Condyloma Acuminatum (Anogenital Warts);45 7.3.2.2;3.3.2.1 Presentation;45 7.3.2.2.1;Expert Advice;46 7.3.2.3;3.3.2.2 Multifocality;47 7.3.2.4;3.3.2.3 Symptoms;50 7.3.3;3.3.3 HPV-Related Flat Penile Lesions;50 7.3.3.1;3.3.3.1 Presentation;51 7.3.3.2;3.3.3.2 Symptoms;51 7.3.3.2.1;Expert Advice;55 7.4;3.4 Differential Diagnosis;52 7.4.1;3.4.1 Benign Penile Pearly Papules (Hirsutoid Papillomas) (Fig. 3.20 );52 7.4.2;3.4.2 Fibroepithelial Polyps (Fig. 3.22 );52 7.4.3;3.4.3 Prominent Sebaceous Glands (Ectopic Sebaceous Glands, Fordyce Spots) (Fig. 3.23 );53 7.4.4;3.4.4 Sebaceous Glands (Fig. 3.24 );53 7.4.5;3.4.5 Seborrheic Keratoses (Fig. 3.25a, b );53 7.4.6;3.4.6 Angiokeratoma (Fordyce Angiokeratoma) (Fig. 3.26a-c );53 7.4.7;3.4.7 Verrucous Epidermal Nevi and Pigmented Nevi (Fig. 3.27.a-d );54 7.4.8;3.4.8 Molluscum Contagiosum (Fig. 3.28.a, b );55 7.4.9;3.4.9 Lichen Nitidus;55 7.4.10;3.4.10 Syphilitic Condylomata Lata (Fig. 3.29.a, b );56 7.5;3.5 Detection Methods;57 7.5.1;3.5.1 Clinical Diagnosis;57 7.5.1.1;3.5.1.1 Physical Examination;57 7.5.1.1.1;Expert Advice;57 7.5.1.2;3.5.1.2 Acetic Acid Solution Test (Acetowhite Test);57 7.5.1.2.1;Expert Advice;58 7.5.1.2.2;How to Perform the Acetowhite Test;58 7.5.2;3.5.2 Laboratory Diagnosis;58 7.5.2.1;3.5.2.1 Cytology;58 7.5.2.2;3.5.2.2 Histological Techniques;59 7.5.2.2.1;Expert Advice;59 7.5.2.2.2;When to Recommend Lesion Biopsy and Histological Evaluation;59 7.5.2.3;3.5.2.3 Culture;60 7.5.2.4;3.5.2.4 Serological Testing;60 7.5.2.5;3.5.2.5 Molecular Tests;60 7.5.2.5.1;Expert Advice;60 7.5.2.5.2;Expert AdvicePictures or schematic representations of HPV-associated lesions recorded at each visit are a useful tool for eval;62 7.5.2.5.3;Home-Applied Therapy;62 7.5.2.5.4;Physician-Applied Therapy;62 7.5.2.5.5;Expert AdviceThe treatment method should be changed if: Improvement is not documented after three physician-administered t;62 7.6;3.6 Treatment;62 7.6.1;3.6.1 Antimitotic Therapy;63 7.6.1.1;3.6.1.1 Podophyllin;63 7.6.1.1.1;Mechanism of Action;64 7.6.1.1.2;How to Use;64 7.6.1.1.3;Important;64 7.6.1.2;Indications;64 7.6.1.3;Advantages;64 7.6.1.4;Disadvantages;64 7.6.1.4.1;Adverse Effects;64 7.6.1.4.1.1;Local;64 7.6.1.4.1.2;Systemic;64 7.6.1.5;Combination Therapy;65 7.6.1.6;Podophyllin 25% Used in Combination with Cryotherapy;65 7.6.1.7;3.6.1.2 Podophyllotoxin (Podofilox Solution 0.5%; Condylox Gel and Solution 0.5%)65 7.6.1.7.1;Mechanism of Action;65 7.6.1.7.2;How to Use;65 7.6.1.7.2.1;Podophyllotoxin 0.5% Solution or Gel;65 7.6.1.7.3;Indications;65 7.6.1.7.4;Advantages;65 7.6.1.7.5;Disadvantages;65 7.6.1.8;3.6.1.3 5-Fluorouracil Cream (Efudex®);65 7.6.1.8.1;Mechanism of Action;65 7.6.1.8.2;How to Use;66 7.6.1.8.2.1;5-FU Cream;66 7.6.1.8.2.2;Important;66 7.6.1.8.3;Indications;66 7.6.1.8.4;Advantages;66 7.6.1.8.5;Disadvanta