CHAPTER 118 Androscopy

Androscopy is an office procedure mainly used to identify condylomata. It examines the male genitalia under magnification after acetic acid has been applied. It can be used to evaluate any dermatologic disorder/lesion in the genital areas and also to ensure complete removal of lesions. Another term for this procedure is penoscopy.

Recent literature documents that the human papillomavirus (HPV) is the cause of cervical dysplasia and cervical cancer. Whether the virus alone leads to cancer is unknown. Yet, HPV is the necessary, if not the single sufficient cause for cervical cancer. HPV is very contagious and it is most readily spread through sexual contact. Intromission is not necessary because skin-to-skin contact is enough. It may also be transmitted in yet-unknown ways in a minority of cases. Fomites do not transmit the disease. Condoms provide only partial protection from HPV but do help prevent spread.

The clinical significance of condylomata and HPV in men is less serious than it is in women, but men act as carriers and may transmit the disease to sexual partners. Although rare, HPV can cause penile carcinoma. Anal-receptive homosexual men have 50 times the rate of anal carcinoma compared to the incidence in the average population. An increased rate of anal carcinoma in anal-receptive women can also be anticipated, but there is no literature to document this.

There are over 100 types of HPV. Eight to 10 of these characteristically infect the genital areas. Condylomata acuminata, the visible lesions that we commonly see, are caused by noncarcinogenic strains, such as types 6 and 11. The subclinical types, identified only by examination under magnification after acetic acid staining, are more likely to cause neoplastic changes; frequently these are types 16 and 18. (See Chapter 137, Colposcopic Examination, Chapter 142, Human Papillomavirus DNA Typing, and Chapter 155, Treatment of Noncervical Condylomata Acuminata.)

There is no evidence that treatment of male partners of women who have dysplasia lessens the likelihood of persistence or recurrence in the woman. It is uncertain why condom use is beneficial because the infection is a regional disease. In men, it is present on the penis, scrotum, perineum, and perianal areas. What is visible is only a focal manifestation of a diffuse involvement. In women, it is present on the cervix, vagina, vulva, and the perineal and perianal areas. Winer and colleagues (2006), however, in a well-designed study showed significant protection in women with consistent condom use by their male partners.

Some clinicians question the value of carrying out an androscopic examination. Identification and treatment of condylomata is not the only reason to perform androscopy. Patient education is perhaps the most valuable aspect of this procedure. The man must be informed of the significance of his disease and the necessity of maintaining a single-partner committed relationship. It is no longer a matter of moral or religious persuasion, but rather a good health practice to be monogamous (as are exercising, not smoking, eating low-fat foods, and so forth). Men spread the disease even when visible lesions are not apparent. Only through education can they change their habits.

Men who have HPV can affect their partners in several ways. Not only do they spread the virus by skin-to-skin contact, but HPV has been shown to be present in the semen and in the sperm cell itself. Men who smoke have nicotine and its byproducts in their ejaculate as well as on their hands (important during manual stimulation), which may be a cofactor in HPV persistence. Those who are subject to passive smoking have lower folate levels—a known risk factor for cervical cancer.

The common factors for penile carcinoma include lack of hygiene, sex outside of marriage, smoking, and HPV infection. Clinically differentiating mild, moderate, and severe dysplasia of the penis (penile intraepithelial neoplasia [PIN]) is nearly impossible without obtaining biopsy samples. Anorectal cancer frequently contains the HPV, and some now recommend obtaining a Papanicolaou (Pap) smear of the pectinate (dentate) line on a regular basis to detect anal dysplasias in high-risk individuals. High-resolution anoscopy (HRA), which uses magnification (usually a colposcope) and acetic acid staining, can identify precursor lesions for treatment (see Chapter 99, High-Resolution Anoscopy).



Although the examination may take only 10 minutes, patients frequently have numerous questions and concerns. Unless the patient is well known to the practitioner, at least 20 minutes should be allotted for this examination—longer if treatment is undertaken.

7 Sample any atypical lesions with an unusual vascular pattern (mosaicism or punctation; see Chapter 137, Colposcopic Examination) or pigmentation. The pigmentation in lesions that predicts dysplasia will look different from that of a freckle or nevus; it will be a nondiscrete, brownish discoloration (Fig. 118-4). If no atypical lesions are seen, sample one or two of the acuminate lesions or the acetowhite areas to document the presence of HPV and that there is no dysplasia (Fig. 118-5). It is very convincing to have the pathology report confirm your clinical diagnosis, which reinforces the findings to the patient. It also is not always possible to tell clinically what the lesions are.

May 14, 2017 | Posted by in GENERAL & FAMILY MEDICINE | Comments Off on Androscopy

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