Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Warts, Genital


Related Terms

  • Condylomata Acuminata
  • HPV
  • Venereal Verruca
  • Venereal Wart
  • Verruca Acuminata

Differential Diagnosis

Specialists

  • Dermatologist
  • Family Physician
  • Gynecologist
  • Urologist

Comorbid Conditions

  • AIDS
  • Immunosuppression from chemotherapy
  • Other sexually transmitted diseases

Factors Influencing Duration

Length of disability may be influenced by the size of the wart, severity of condition, location of lesions, or type of treatment required.

Medical Codes

ICD-9-CM:
078.11 - Diseases Due to Viruses and Chlamydiae, Other; Condyloma Acuminatum; Condyloma NOS; Genital warts NOS

Overview

Genital warts are viral skin infections caused by a few of the many types of human papillomavirus (HPV). These infections affect warm, moist areas of the genitalia and around the anus.

The most common sexually transmitted disease (STD), genital warts are spread by sexual contact with an infected partner. HPV is very contagious and causes an infection that may not have visible symptoms (silent infection) like many sexually transmitted organisms. Individuals may not even be aware of their infection or the potential risk of transmission to others. Almost half of the women infected with HPV have no obvious symptoms. HPV can also spread to different areas on the same individual.

Both men and women can have genital warts. It is more common in individuals with multiple sexual partners and in those who do not use condoms; however, even condoms do not guarantee protection from the virus. Up to 45% of individuals with genital warts also have coexisting sexually transmitted diseases such as candidiasis, gonorrhea, and chlamydia. The incubation period for the virus can range from 2 months to 2 years. HPV infections increase the risk of genital cancers.

Incidence and Prevalence: Studies indicate that the annual incidence is 1%, with an estimated prevalence of more than 50% of sexually active individuals (Kazzi). There is a 60% chance of becoming infected during a single sexual contact with an infected partner (Zislis). The infection rate has increased 700% in the past 20 to 25 years (Stenchever).

Source: Medical Disability Advisor



Causation and Known Risk Factors

HPV is most common between the ages of 17 and 33 and peaks at the ages of 20 to 24 (Kazzi).

Source: Medical Disability Advisor



Diagnosis

History: Individual may complain of single or multiple painless, flesh-colored, flat- or cauliflower-like warts in the genital area, as well as itching and discharge. Warts can occur in the mouths of individuals who have had oral sexual contact with infected individuals. The history may or may not include sexual contact with a known infected individual. Individuals may complain of bleeding or problems with urination if a wart obstructs the urinary opening (urethra).

Physical exam: In women, the warts occur on the vulva, labia, or around the anus. A pelvic examination using a device that opens the vagina for visual inspection (speculum) may reveal warts inside the vagina or on the opening to the uterus (cervix). In men, genital warts usually appear on the tip of the penis. Warts may also be found on the shaft of the penis, scrotum, and around the anus. Genital warts often occur in clusters. They can be tiny or accumulate into large masses. If left untreated, genital warts can develop into a fleshy, cauliflower-like lesion. Since up to 45% of individuals with genital warts also have coexisting sexually transmitted diseases, other disease symptoms may also be present.

Tests: Testing for other STDs, such as blood tests for HIV and syphilis or cultures for gonorrhea and chlamydia, should be performed. An abnormal Pap smear (microscopic examination of cells taken from the cervix) may indicate possible warts. It is important for women with an abnormal Pap smear to undergo further testing to diagnose cervical problems. A procedure called colposcopy uses a magnifying instrument to view the vaginal wall and cervix. A vinegar (acetic acid) solution applied to suspicious areas causes the infected areas to whiten, making them more visible. A small sample of tissue (biopsy) can then be taken from this area and examined under the microscope. DNA typing of the sample may indicate the specific subtype of HPV causing the infection.

Source: Medical Disability Advisor



Treatment

Genital warts may sometimes disappear without treatment (spontaneously). However, because there is no way to predict whether warts will grow or disappear, they need to be treated. Small warts and warts in pregnant women can be removed by freezing (cryocauterization), burning (electrocauterization), or ablation (laser surgery). Large warts or warts that have not responded to other treatment may need to be removed by open or laser surgery.

Several newer, nonsurgical treatments for genital warts are now popular. These include topical and injectable medications. These methods however, are approved only for individuals over 18 and are not indicated for pregnant women or nursing mothers because they can be absorbed into the body and cause damage to the fetus or child. Although topical medication can cause localized skin irritation in the surrounding skin, these medications are highly effective for genital warts. A group of injectable medications called interferons can be injected into the base of each wart. These injections are reserved for warts that do not respond to other treatments.

Women who have had genital warts or whose partners have had genital warts should have frequent Pap smears for early identification of precancerous cervical diseases.

Source: Medical Disability Advisor



Prognosis

Although removing the wart or treating it with injections or creams usually eliminates the skin lesion, it does not thoroughly destroy (eradicate) the virus. Warts often reappear after treatment at a rate of 50% after 1 year (Kazzi). The prognosis is favorable if a precancerous cervical condition is discovered and treated early.

Source: Medical Disability Advisor



Complications

Associations have been found between several types of HPV and the development of cancers of the cervix, vulva, anus, and, in rare cases, the penis. Genital warts may cause complications in pregnancy such as making the vaginal wall less elastic or causing obstruction during delivery. Infants born to women with genital warts can develop a condition in their throats called laryngeal papillomatosis. This can be a life-threatening condition for the child and requires frequent laser surgery to prevent obstruction of the airway. In immunodeficient individuals (those with AIDS or undergoing chemotherapy), warts may grow dramatically.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Work restrictions or accommodations are not necessary for individuals with genital warts unless they were treated with open surgery. An individual who has had open surgery may require sedentary or light work for a short period of time.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Does individual have multiple sexual partners? Does individual use condoms?
  • Does individual have other STDs?
  • Does individual complain of painless, flesh-colored, flat- or cauliflower-like warts on the genitals?
  • On exam, were warts present on the vulva or labia, around the anus, inside the vagina, or on the cervix in females? On the tip or shaft of the penis, on the scrotum, or around the anus in males?
  • Are the warts in a cluster? Large or small?
  • Has individual had an abnormal Pap smear? Was colposcopy done? Biopsy?
  • Were conditions with similar symptoms ruled out?

Regarding treatment:

  • Has individual had small warts treated with cryocauterization, electrocauterization, or ablation?
  • Was it necessary to treat larger warts with open or laser surgery?
  • Were warts injected with interferons into the base of each wart?
  • Does individual with warts or a partner with warts have regular Pap smears?

Regarding prognosis:

  • Does individual have any conditions that may affect recovery?
  • Have any complications developed, such as development of cancers of the cervix, vulva, anus, and in rare cases, the penis?
  • Has individual had complications in pregnancy?

Source: Medical Disability Advisor



References

Cited

Kazzi, Amin Antoine. "Warts, Genital." eMedicine. Eds. Jeffrey Glenn Bowman, et al. 17 Dec. 2004. Medscape. 25 Oct. 2004 <http://emedicine.com/emerg/topic640.htm>.

Stenchever, Morton. "Infections of the Vulva." Comprehensive Gynecology. 4th ed. St. Louis: Mosby, Inc., 2001. 650-655. MD Consult. Elsevier, Inc. 25 Oct. 2004 <http://home.mdconsult.com/das/book/37963294-2/view/1089?sid=273667124>.

Zislis, Jan, and Thomas Nowicki. "Genital Warts." eMedicine Health. Eds. Scott H. Plantz, et al. 18 Nov. 2004. WebMD, LLC. 25 Oct. 2004 <http://www.emedicinehealth.com/articles/19703-1.asp>.

Source: Medical Disability Advisor






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