A 34-Year-Old Man Came to the Office Due to White

question 22

Multiple Choice

A 34-year-old man came to the office due to white plaques on his buccal mucosa that he incidentally discovered while brushing his teeth.  After appropriate workup, he was found to be HIV positive, with a CD4+ T lymphocyte count of 280/mm³.  He was referred to an infectious diseases specialist for follow-up but was noncompliant with appointments.  The patient returns 3 years later due to several months of pain and itching in the perirectal area.  He also has intermittent rectal bleeding and often sees bright red blood on the tissue after wiping.  The patient did not seek medical care because he thought he had hemorrhoids.  On examination, a single, hard mass with superficial ulceration measuring approximately 2x2 cm is noted in the anal canal.  No hemorrhoids are present.  There is no palpable regional lymphadenopathy.  Which of the following pathogens is most likely responsible for this patient's current anal pathology?

• A)Adenovirus
• B)Candida albicans
• C)Chlamydia trachomatis
• D)Cytomegalovirus
• E)Epstein-Barr virus
• F)Herpes simplex virus type 2
• G)Human papillomavirus