A 23-year-old, sexually active man has been treated for Neisseria gonorrhoeae infection 6 times during the past 5 years. He now comes to the physician because of the increasing number and size of warty lesions slowly enlarging on his external genitalia during the past year. On physical examination, there are multiple 1- to 3-mm sessile, nonulcerated, papillary excrescences over the inner surface of the penile prepuce. These lesions are excised, but 2 years later, similar lesions appear. Which of the following conditions most likely predisposed him to the development of these recurrent lesions?
A 23-year-old, sexually active man has been treated for Neisseria gonorrhoeae infection 6 times during the past 5 years. He now comes to the physician because of the increasing number and size of warty lesions slowly enlarging on his external genitalia during the past year. On physical examination, there are multiple 1- to 3-mm sessile, nonulcerated, papillary excrescences over the inner surface of the penile prepuce. These lesions are excised, but 2 years later, similar lesions appear. Which of the following conditions most likely predisposed him to the development of these recurrent lesions?
💡 Explanation
**Core Concept**
Human papillomavirus (HPV) infection is a common sexually transmitted infection that can cause various lesions, including genital warts. The persistent HPV infection can lead to the development of recurrent lesions, especially in individuals with compromised immune systems or those who experience frequent exposure to the virus.
**Why the Correct Answer is Right**
The patient's presentation of multiple sessile, nonulcerated, papillary excrescences on the inner surface of the penile prepuce is characteristic of genital warts, which are caused by HPV infection. The recurrent nature of these lesions after excision suggests a persistent HPV infection. HPV is known to evade the host's immune system, leading to chronic infection and recurrent lesions. The virus can also integrate into the host's genome, making it difficult to eradicate completely.
**Why Each Wrong Option is Incorrect**
**Option A:** Candida albicans infection is a common fungal infection that can cause genital lesions, but it does not typically present as multiple sessile, nonulcerated, papillary excrescences. Candida albicans infection is usually associated with a thick, white discharge and itching.
**Option B:** Circumcision is actually a protective factor against the development of genital warts, as it reduces the area of skin exposed to the virus. The patient in this case is uncircumcised, which increases his risk of HPV infection.
**Option D:** Neisseria gonorrhoeae infection is a bacterial infection that can cause symptoms such as discharge and pain, but it does not typically present as genital warts. While the patient has a history of Neisseria gonorrhoeae infection, it is not directly related to the development of his recurrent lesions.
**Clinical Pearl / High-Yield Fact**
HPV infection is a significant public health concern, and vaccination is now recommended for both males and females to prevent the development of genital warts and other HPV-related cancers. The HPV vaccine is most effective when administered before exposure to the virus, making it an important tool in preventing the spread of this infection.
**✓ Correct Answer: C. Human papillomavirus infection**
✓ Correct Answer: C. Human papillomavirus infection
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