<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .Q:A 36-year-old woman comes to the physician because of growths around her anus that developed over the past 4 weeks. They are not painful and she does not have blood in her stool. She is sexually active with two male partners and uses condoms inconsistently. She appears healthy. Vital signs are within normal limits. Examination shows nontender, irregular, hyperkeratotic sessile lesions in the perianal area around 47 mm in diameter. There is no lymphadenopathy. The application of a dilute solution of acetic acid turns the lesions white. Which of the following is the most likely cause of the lesions?? A: Poxvirus, B: Treponema pallidum, C: Malignant transformation, D: Benign fibroepithelial growth, E: Human papilloma virus,  <response>: This is a patient with perianal growths that developed over the past 4 weeks. She is sexually active with multiple partners and uses condoms inconsistently, raising suspicion for a sexually transmitted infection. The lesions are described as nontender, irregular, hyperkeratotic sessile lesions around 4-7 mm in diameter. They turn white with application of dilute acetic acid. Based on the clinical presentation, the most likely cause is human papillomavirus HPV infection. The lesions are described as hyperkeratotic, which refers to thickening of the outer layer of skin that occurs with warts. Their turning white with acetic acid application acetowhitening is another classic finding with HPV lesions. The patients sexual history also raises suspicion for an STI like HPV. The other options are less likely. Poxviruses typically cause more diffusewidespread lesions. Syphilis Treponema pallidum does not usually present with isolated perianal growths. Malignant transformation and benign fibroepithelial growths would be unlikely to develop and grow so quickly over just 4 weeks.E: Human papilloma virus 