An obese 28-year old male presents to the clinic with complaints of a ‘bump’ in his mouth (see image). He claims that the lesion first appeared 7 weeks ago and is getting bigger. He has no pain, fever or other symptoms. However, when he brushes the teeth, the area is traumatized and often results in mild bleeding. He is a smoker, drinks alcohol, smokes marijuana and is sexually active. He also leads a sedentary lifestyle. On exam, the lesion has a firm consistency and appears like an irregular thickened plaque with whitish areas. Biopsy reveals epidermal acanthosis with undulated rounded papillomatosis. The upper epidermal layer reveals vacuolated keratinocytes with koilocytes. What is the next step in his management?
A. Carbon dioxide laser treatment
B. Assess for presence of water-soluble vitamin deficiency
C. Check for sexually transmitted diseases
D. Serology for antigliadin and antiendomysial autoantibodies
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CLUE: papillomatosis. The upper epidermal layer reveals vacuolated keratinocytes with koilocytes. What virus does this? Think and the rest is easy