The patient presenting with cauliflower-shaped genital warts leads me to a diagnosis of Human Papillomavirus (HPV) infection due to immunosuppression secondary to previous Human Immunodeficiency Virus (HIV) infection ) untreated. This virus is the only recognized cause of this condition therefore a differential diagnosis with another condition like this is not available. Say no to plagiarism. Get a tailor-made essay on "Why Violent Video Games Shouldn't Be Banned"? Get an original essay What is the diagnosis? The patient is diagnosed with giant condyloma of Buschke and Löwenstein (GCBL). According to MedScape, it is a slow-growing, locally destructive, warty plaque that usually occurs on the penis but can also occur elsewhere in the anogenital region. The symptoms best fit this diagnosis which is secondary to HIV infection which makes the patient's immunity susceptible and vulnerable against foreign pathogens such as HPV which causes GCBL. Furthermore, the laboratory results coincide with this diagnosis. What are the common presenting signs and symptoms of GCBL? GCBL begins as a keratotic plaque that slowly expands into a cauliflower mass like our patient's. A bad odor may be associated with ulceration of the lesion in the penile area. The urethra may also be enlarged. Regional lymphadenopathy such as that in the patient's groin area is evident due to secondary infection. Bleeding can also occur along with abscesses. What are the risk factors and predisposing factors that promote HPV infection resulting in GCBL? The HPV that causes GCBL is transmitted primarily through sexual contact with infected individuals. Those at risk are people with multiple sexual partners who are not checked for sexually transmitted disease infection. Furthermore, people who do not practice safe copulation are also at great risk. More importantly, people with immunosuppression due to HIV infection, like our patient, are more likely to contract the virus. If infected with the strain that causes GCBL, genital warts may manifest with other symptoms. What is the pathophysiology of HPV? HPV invades the basal cells of the epidermis, subsequently penetrating the skin and mucous membranes through abrasions in the genital area. After infection, there is a window period of approximately 3-9 months. Subsequently, virulence factors intensify leading to infection of host cells and the development of atypical koilocytosis of genital warts. Although it is normally sexually transmitted, the infected mother can also infect the baby at birth causing respiratory lesions in the newborn. How does HPV promote the development of carcinoma? The virus, when it remains in the body for years, along with immusesceptibility, allows the conversion of normal cells into cancerous cells. This is called cervical intraepithelial neoplasia. This condition can progress to invasive cervical cancer among women. Women are at high risk of developing cancer due to the progression of HPV-infected cells into cancer cells. What are the immune evasion strategies used by HPV? HPV evades immune surveillance through virulence factor proteins E6 and E7. These modulate the expression of cytokines and chemoattractants, alter antigen presentation, and downregulate IFN pathways and adhesion molecules. These mechanisms enable the successful invasion of the virus into the system. Furthermore, they are opportunistic pathogens for people living with HIV, like our patient, with their compromised immune systems. Keep in mind:.