Updated: 1/25/2019

[Blocked from Release] Condyloma Acuminatum

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Snapshot
  • PhotoA 43-year-old man presents to his primary care physician in a panic stating that his wife is going to kill him! The doctor calms him down and learns that during a recent trip to Las Vegas he had sexual relations with a prostitute. He now has raised groupings of lesions on the shaft of his penis. He asks if there is anything you can do.
Introduction
  • Condylomata acuminata, also known as genital warts, is a viral skin infection
  • Caused by human papilloma virus (HPV) strains 6 and 11
  • Epidemiology
    • usually presents in adults
    • If child presents with genital warts, must investigate possibility of child abuse
    • highly prevalent in immunocompromised individuals
  • Risk factors
    • majority of cases are transmitted by sexual contact or intercourse
Presentation
  • Symptoms
    • painless lesions on the genitalia
      • often appearing in clusters or groups
  • Physical exam
    • raised, cauliflower-like lesions on the genitals
    • may identify additional lesions in other areas including
      • peroneum
      • oral cavity/throat
Evaluation
  • Diagnosis is usually based on clinical observations
  • Biopsy
    • for definitive diagnosis
Differential
  • Condylomata lata, verruca vulgaris, and vurruca plana
Treatment
  • Non-operative
    • chemical exposure is indicated for first-line therapy
      • TCA
      • podophyllin
      • 5-FU
      • podofilox
    • immunologic agent
      • imiquimod
  • Operative
    • indicated for large/recalcitrant lesions if chemical/immunologic therapy is ineffective
    • several interventions available including
      • laser removal
      • local excision
      • cryosurgery
Prognosis, Prevention, and Complications
  • Prognosis
    • there is no definitive treatment for HPV warts, so most cases recur and require multiple, repeat excision procedures
  • Prevention
    • use barrier protection during sexual contact or intercourse
    • vaccines for several strains of HPV are available for prevention of transmission
  • Complications
    • AIDS patients have higher risk of developing warts and more frequent occurrences
    • AIDS patients are also at higher risk of developing cervical cancer from HPV strains 16 and 18, which often travel with strains 6 and 11
 

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