What are the key signs and symptoms of HPV-related conditions that I should be aware of during routine examinations?

During routine examinations, key signs and symptoms of human papillomavirus (HPV)-related conditions to be aware of include the presence of anogenital warts, abnormal cervical appearances, and symptoms suggestive of cervical or other anogenital cancers. Anogenital warts typically present as soft, flesh-coloured or grey growths on the external genitalia, perianal area, or cervix, and may be keratinized or non-keratinized lesions. These warts can be asymptomatic or cause itching, discomfort, or bleeding. Women should be examined with a vaginal speculum to detect warts or lesions on the cervix, and proctoscopy considered if there is a history of anal receptive sex ⁴[(Katabathina et al., 2024)].

On cervical examination, look for abnormal changes such as acetowhite areas after application of acetic acid, irregular or ulcerated lesions, or visible masses, which may indicate cervical intraepithelial neoplasia (CIN) or invasive cervical cancer. Symptoms that may raise suspicion include unexplained vaginal bleeding, post-coital bleeding, or abnormal vaginal discharge, especially in women aged 25–64 years who are eligible for cervical screening ¹,³,⁵.

Other HPV-related cancers may present with vulval or anal lumps, ulcers, or bleeding. Unexplained vulval lumps or ulcerations and anal masses should prompt consideration of HPV-related malignancy and referral via suspected cancer pathways ⁵[(Spitzer and Krumholz, 1992)].

It is important to note that many HPV infections are asymptomatic and detected only through screening programmes such as the NHS cervical screening programme, which identifies precancerous lesions before symptoms develop ¹,².

In summary, during routine examinations, be vigilant for anogenital warts, abnormal cervical appearances (including acetowhite changes), unexplained bleeding or discharge, and any vulval or anal masses or ulcers. These findings warrant further investigation or referral to specialist services ¹,⁴,⁵[(Katabathina et al., 2024)].