Updated: 6/30/2020

Condyloma Acuminata

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Snapshot
  • A 26-year-old woman presents to her dermatologist for skin problems in her genital area. She reports having “bumps” on her genitals for the past few weeks that have increased in number. She states that having sexual intercourse is sometimes painful because of these lesions. She has a past medical history of acne vulgaris, treated as a teenager with tretinoin, and atopic dermatitis. She has had unprotected sex with multiple partners over the past 6 months but is now monogamous with a single partner. On physical exam, there is a cluster of 6 1-2 mm, flesh-colored, verrucous papules on the vulva. She is counseled on the various therapies available to treat these lesions, in the office or at home.
Introduction
  • Clinical definition
    • anogenital warts caused by human papilloma virus (HPV)
    • transmission via oral, anal, and genital sexual contact
  • Epidemiology
    • demographics
      • young adults
    • risk factors
      • unprotected sexual intercourse
      • multiple sexual partners
      • immunosuppression
  • Pathogenesis
    • HPV-6 and -11 cause genital warts but are unlikely to cause cancer
    • causes epithelial cells to change
  • Associated conditions
    • anogenital squamous cell carcinoma
      • HPV 16 and -18
Presentation
  • Symptoms
    • may be painful, itchy, or have a burning sensation
    • may have bleeding or irritation with sexual intercourse
  • Physical exam   
    • clusters of flesh-colored papules on external genitalia
    • variable morphologies, including cerebriform or verrucous
Studies
  • Diagnostic testing
    • diagnostic approach
      • diagnosis is usually based on clinical history and exam
      • biopsy is not usually indicated
    • studies
      • acetic acid application
        • may help visualize warts
      • biopsy
        • atypical keratinocytes or koilocytes
Differential
  • Condylomata lata
    • distinguishing factors
      • found on mucous membranes, appearing as warty gray-white plaques
      • secondary syphilis
Treatment
  • Management approach
    • next best step is observation, unless the lesions are large or irritating
      • many lesions spontaneously resolve
    • there are no current recommendations for first-line therapies
  • Prevention
    • HPV vaccine
  • Other treatments
    • podophyllotoxin or imiquimod
      • patient-administered
    • cryotherapy, electrosurgery, or trichloroacetic acid
      • provider-administered
Complications
  • Hypopigmentation or hyperpigmentation

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