Introduction:
Sexually transmitted disorder refers to a disease acquired through sexual contact with an affected individual or contaminated needles. The bacteria, viruses, or parasites in blood, semen, and other body fluids pass from one person to another and cause such disorders. It results in various signs and symptoms in the affected individual. One such sexually transmitted disorder is Bowenoid papulosis; this article gives detailed information on its causes, symptoms, diagnosis, and management.
What Is Bowenoid Papulosis?
As described above, Bowenois papulosis is a sexually transmitted infection; Kopf and Bart were the first to document bumps on the penis in 1977.
The other names of the condition include:
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Vulvar intraepithelial neoplasia - It affects the vulva (female genital organ).
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Penile intraepithelial neoplasia - It affects the penis (male genital organ).
What Causes Bowenoid Papulosis?
Bowenoid papulosis is said to be a human papillomavirus (HPV) infection. There are several types of human papillomavirus, and HPV-16 is highly associated with causing lesions in Bowenoid papulosis. Less frequently, the HPV types 18, 31, 33, etc., may also result in bumps in the anogenital area. It may also occur in individuals with compromised immunity due to organ transplantation or other factors. In addition, the affected mother transmits the infection to the offspring during childbirth.
Is Bowenoid Papulosis Common?
Bowenoid papulosis is a rare disorder that affects anyone between 3 to 80 years of age. However, individuals between 30 to 50 years of age are more commonly affected.
Regarding gender, Bowenoid papulosis may occur in both men and women. But studies show a slight women predilection; about five in 100000 women are affected.
What Are the Characteristic Features of Bowenoid Papulosis?
The classic features of Bowenoid papules are enlisted below:
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The most commonly affected site in males includes the glans, shaft, and foreskin of the penis and anus.
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In females, it involves the vagina, clitoris, labia major, labia minor, and anus.
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The lesion appears small (1 cm in size), round, reddish-brown, or violet in color.
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Females have darker lesions than males.
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Multiple lesions with a smooth or flat surface or wart-like may appear. These lesions may combine to form a large plaque.
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The lesion remains benign (non-cancerous), but there are chances for it to turn cancerous.
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These lesions do not cause pain and last for two weeks to many years. But may produce itchiness and soreness in the affected region.
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Rarely, extra genital areas like fingers, face, neck, etc., are affected.
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Viral infections like HIV (human immunodeficiency virus) and herpes simplex may also be present in a few others.
How Does the Doctor Diagnose Bowenoid Papulosis?
The various steps involved in the diagnosis of Bowenoid papulosis are as follows:
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Physical Examination - The doctor may examine the genital, oral, and anal areas to evaluate the extent of human papillomavirus infection.
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Skin Biopsy - A sample of tissue from the lesion is removed to examine under the microscope. It shows features similar to that of Bowen’s disease. However, the characteristic findings include multiple papules with plaque-like patterns and abnormal cell structure.
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HPV Subtyping - Samples from the cervix are obtained using a brush or tiny spatula to evaluate the type of human papillomavirus present.
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Anoscopy - In the case of a patient’s history revealing anal sex, a small tubular instrument called an anoscope is used to examine the anus and rectum to evaluate any lesion.
Which Disorders Are Similar to Bowenoid Papulosis?
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Bowen’s Disease - A rare disorder that affects the skin's epidermis (upper layer). It results in reddish plaques or patches on the sun-exposed areas of the skin. These lesions are not painful and may cause itchiness. The treatment is similar to that of Bowenoid papulosis.
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Lichen Planus - A disorder that causes skin and mucous membrane inflammation. It causes purplish lesions on the forearms, ankles, and nails and rarely on the genital areas.
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Psoriasis - A chronic skin disorder that causes itchy and scaly patches. Factors like infection, injury, and certain medications may trigger psoriasis. However, drugs like corticosteroids may reduce the symptoms.
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Condyloma Acuminata - Human papillomavirus (HPV) causes plaque-like lesions on the genital and anal region, referred to as condyloma acuminata. Several diagnostic tests, like gene typing, differentiate the condition from other genital lesions.
How to Treat Bowenoid Papulosis?
Interestingly, the lesions of Bowenoid papulosis may subside within eight weeks in a few individuals.
Therefore conservative management is preferred in treating such lesions; it includes:
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Laser Vaporization - This procedure utilizes a carbon dioxide laser to destroy the genital lesion. The main advantage is the pain and scarring are less.
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Cryotherapy - An instrument called a cryoprobe delivers cold liquid to freeze and remove the lesions. The lesions heal quickly after cryotherapy.
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Electrocoagulation - The electric current delivers the required heat to destroy the genital lesions. The procedure aids in controlling the bleeding.
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Photodynamic Therapy - Light-sensitive compound like 5-Aminolevulinic acid is used along with a light source to destroy lesions. It is a less-invasive procedure.
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Topical creams such as Imiquimod 5 % are also effective in treating genital papules. The doctor may suggest using it on alternate days for one month.
Is Bowenoid Papulosis Preventable?
The primary mode of transmission of Bowenoid papulosis is through sexual contact. Therefore education among the population about the human papillomavirus in causing sexually transmitted infection may prevent the spread of Bowenoid papulosis to some extent.
In addition, studies show that smoking cessation may prevent the recurrence of Bowenoid papulosis. Moreover, vaccines (Gardasil-9) against HPV also avoid such infections.
What Are the Complications of Bowenoid Papulosis?
Rarely, the lesions of Bowenoid papulosis may turn cancerous, mostly into squamous cell carcinoma (an aggressive form of skin cancer that rapidly spreads to other areas of the body). In addition, women are at high risk of developing vulvar carcinoma due to HPV infection.
Conclusion:
Bowenoid papulosis is a rare disorder that may persist for several years in immunocompromised individuals. Therefore, it is essential to consult a gynecologist or dermatologist for any new lesions. In addition, the healthcare specialist may schedule a follow-up every three to six months to examine the genital and extragenital lesions. It is also necessary for women to undergo regular cervical screening to avoid complications and to prevent the malignant transformation of genital lesions.
