Human Papilloma Virus (HPV)

Buschke and Lowenstein (GCBL) is a slow-growing, locally destructive verrucous plaque that typically appears on the penis but may occur elsewhere in the anogenital region. It is a rare sexually transmitted disease, affecting 0.01% of the general population. The virus responsible for GCBL is human papillomavirus (HPV), usually type 6 or 11 and occasionally 16, 18 and 45. In our case study the patient was shown to be infected by multiple HPV strains; HPV6, 11, 55, 58, 59, 68, 73, 83 and cp 6108. GCBL may occur at any age after puberty and is characterized by invasive growth. There is a high rate of recurrence after treatment with 20-30% of cases undergoing malignant transformation. Clinically, most cases of GCBL appear on the glans penis but may occur on any ano-genital mucosal surface, including the vulva, vagina, cervix, anus, scrotum and bladder. If untreated, GCBL can cause destruction of tissues extending into the pelvic organs. In the case presented, GCBL started on the prepuce as a plaque and slowly expanded into a cauliflower-like mass, reaching 9cm in length. GCBL lesions have been shown to grow as large as 15cm. Although neither malignant transformation nor additional complications occurred in this case, it is important to note that these lesions can form extensive local destruction, with ulcerations, bleeding, fistulation and undergo malignant transformation.