Family Nurse Practitioner Exam

How can subclinical lesions of HPV infection on the penile skin be revealed?

1. Perform a KOH exam

2. Scrape off some of the affected skin and send it for a culture

3. Apply acetic acid to the penile shaft and look for acetowhite changes

4. Order a serum herpes virus titer

The correct answer is: Apply acetic acid to the penile shaft and look for acetowhite changes

Subclinical lesions of HPV infection can often be subtle and may not be visible upon a routine examination. The use of acetic acid is a specific diagnostic technique that enhances the visibility of HPV-related skin changes. When acetic acid is applied to the skin, it causes the keratinized or dysplastic cells infected with HPV to appear white, known as "acetowhite changes." This makes it easier to identify lesions that may not be clinically apparent otherwise. This method leverages the principle that HPV-infected tissue may undergo alteration in the keratin structure, making it react differently to acetic acid. The appearance of this acetowhite effect is relatively specific to HPV and can aid in diagnosing infections in cases where physical examination alone might not suffice. The other methods listed do not specifically target or enhance the visibility of HPV lesions. KOH exams are typically used for fungal infections, culture samples are less effective for viral infections like HPV, and ordering a serum herpes virus titer pertains to diagnosing herpes simplex virus infections, which is unrelated to HPV. Thus, the application of acetic acid serves as a relevant and effective technique for uncovering subclinical HPV lesions on the penile skin.