Genital Warts in Emergency Medicine Follow-up

  • Author: Elizabeth Rubano, MD; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: Aug 16, 2010
 

Further Outpatient Care

  • Ensure follow-up with a dermatologist, OB/GYN (females), or urologist (males) within 1 week.
  • Perform a workup for human papillomavirus (HPV) and other sexually transmitted diseases (STDs) as indicated.
  • Treat the patient using medications; if medications are ineffective, treat with cryotherapy, curettage, electrodesiccation, surgical excision, carbon dioxide laser treatment, or combination therapy.
  • Evaluate and treat sexual partner(s).
  • Search for immunosuppression in patients with treatment failures and recurrences.
  • Perform a tissue biopsy if recurrences or treatment failures occur.
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Inpatient & Outpatient Medications

  • Podofilox (purified podophyllotoxin) is available for home use by the patient.
    • A 0.5% solution is applied twice daily for 3 consecutive days followed by 4 days of no therapy. The cycle can be repeated up to 4 times.
    • Slightly higher cure rates are expected than with podophyllin.
    • Podofilox is useful for prophylaxis.
    • Podofilox is not recommended as the sole treatment for recurrent warts.
  • Imiquimod (Aldara) 5% cream: The cream is applied qhs, 3 times a week for a treatment period of 16 weeks. The treatment area should be washed with soap and water 6-10 hours after application.
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Deterrence/Prevention

  • No treatment is 100% effective.
    • Two HPV vaccines are FDA approved.[3, 4]
    • Sexual abstinence and monogamy are protective.
    • Condoms may discourage transmission.
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Complications

  • Local disfigurement
  • Transformation to genitourinary malignancies in both males and females
  • Transmission to neonate or partners
  • Recurrence: According to Diamantis et al, recurrence rates for anogenital warts ranged from 19% at 3 months to 23% at 6 months.[5]
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Prognosis

  • Many cases of genital warts fail to respond to treatment or recur after adequate response.
  • Recurrence rate of cervical dysplasia in women is not altered by treatment of their sex partners.
  • Recurrence rates exceed 50% after 1 year and have been attributed to the following:
    • Recurrent infection from sexual contact
    • Long incubation period of HPV
    • Location of the virus in superficial skin layers away from lymphatics
    • Persistence of the virus in the surrounding skin, in the hair follicle, or in sites inadequately reached by the intervention
    • Missed or deep lesions
    • Subclinical lesions
    • Underlying immunosuppression
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Patient Education

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Contributor Information and Disclosures
Author

Elizabeth Rubano, MD  Resident Physician, Department of Emergency Medicine, State University of New York Downstate Medical Center, Kings County Hospital Center

Elizabeth Rubano, MD is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Binita R Shah, MD, FAAP  Professor of Clinical Pediatrics and Emergency Medicine, SUNY Health Sciences Center at Brooklyn; Director of Pediatric Emergency Medicine, Departments of Emergency Medicine and Pediatrics, Kings County Hospital Center

Binita R Shah, MD, FAAP is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Specialty Editor Board

Jeffrey Glenn Bowman, MD, MS  Consulting Staff, Highfield MRI

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Mark W Fourre, MD  Program Director, Department of Emergency Medicine, Maine Medical Center; Associate Clinical Professor, Department of Surgery, University of Vermont School of Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD  Attending Physician, Department of Emergency Medicine, Cambridge Health Alliance, Division of Emergency Medicine, Harvard Medical School

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors, A Antoine Kazzi, MD, and Rasha A Hindiyeh, MD, to the development and writing of this article.

References

  1. [Guideline] American College of Obstetricians and Gynecologists (ACOG). Human papillomavirus. Washington (DC): American College of Obstetricians and Gynecologists (ACOG). Apr 2005;ACOG practice bulletin; no. 61. [Full Text].

  2. [Guideline] Centers for Disease Control and Prevention, Workowski KA, Berman SM. HPV infection and genital warts. Sexually transmitted diseases treatment guidelines 2006. MMWR Morb Mortal Wkly Rep. Aug 4 2006;55(RR-11):62-7. [Full Text].

  3. [Guideline] Centers for Disease Control and Prevention. ACIP Provisional Recommendations for the Use of Quadrivalent HPV Vaccine. 2006. Accessed August 18, 2006. [Full Text].

  4. Food and Drug Administration. FDA Approves New Vaccine for Prevention of Cervical Cancer. Oct 16, 2009. Available at http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2009/ucm187048.htm. Accessed January 5, 2010.

  5. Diamantis ML, Bartlett BL, Tyring SK. Safety, efficacy & recurrence rates of imiquimod cream 5% for treatment of anogenital warts. Skin Therapy Lett. Jun 2009;14(5):1-3, 5. [Medline].

  6. [Guideline] FDA licensure of bivalent human papillomavirus vaccine (HPV2, Cervarix) for use in females and updated HPV vaccination recommendations from the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep. May 28 2010;59(20):626-9. [Medline]. [Full Text].

  7. [Guideline] FDA licensure of quadrivalent human papillomavirus vaccine (HPV4, Gardasil) for use in males and guidance from the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep. May 28 2010;59(20):630-2. [Medline]. [Full Text].

  8. American Academy of Dermatology. Genital Warts. 2006. Accessed June 6, 2006. 2006. [Full Text].

  9. [Guideline] Centers for Disease Control and Prevention. Sexually Transmitted Diseases Treatment Guidelines. 2002. Accessed June 6, 2006. [Full Text].

  10. Chan PD, Winkle PJ, Winkle CR. Condyloma acuminata. Current Clinical Strategies - Family Medicine. 2nd ed. 1995: 209-10.

  11. Congilosi SM, Madoff RD. Current therapy for recurrent and extensive anal warts. Dis Colon Rectum. Oct 1995;38(10):1101-7. [Medline].

  12. Garrido JL. Human papilloma virus--H.P.V. condyloma. Current studies in diagnosis, treatment and prognosis. Clin Exp Obstet Gynecol. 1996;23(2):99-102. [Medline].

  13. Kresge KJ. Cervical cancer vaccines. Introduction of vaccines that prevent cervical cancer and genital warts may fore-shadow implementation and acceptability issues for a future AIDS vaccines. IAVI Rep. Nov-Dec 2005;9(5):1-5. [Medline].

  14. Mayeaux EJ, Harper MB, Barksdale W, Pope JB. Noncervical human papillomavirus genital infections. Am Fam Physician. Sep 15 1995;52(4):1137-46, 1149-50. [Medline].

  15. Prasad CJ. Pathobiology of human papillomavirus. Clin Lab Med. Sep 1995;15(3):685-704. [Medline].

  16. Rosen T. Sexually transmitted diseases 2006: a dermatologist's view. Cleve Clin J Med. Jun 2006;73(6):537-8, 542, 544-5 passim. [Medline].

  17. Sykes NL Jr. Condyloma acuminatum. Int J Dermatol. May 1995;34(5):297-302. [Medline].

  18. Vandepapeliere P, Barrasso R, Meijer CJ, et al. Randomized controlled trial of an adjuvanted human papillomavirus (HPV) type 6 L2E7 vaccine: infection of external anogenital warts with multiple HPV types and failure of therapeutic vaccination. J Infect Dis. Dec 15 2005;192(12):2099-107. [Medline].

 
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Genital wart in pubic area.
Genital wart in pubic area.
Genital wart in pubic area.
Genital wart in pubic area (close-up). Note the pearly appearance.
Genital warts. Condyloma acuminatum. Courtesy of Tsu-Yi Chuang, MD, MPH.
Genital warts. Small papilloma of the vulva. Courtesy of Tsu-Yi Chuang, MD, MPH.
Genital warts. "Cauliflower" condyloma of the penis. Courtesy of Tsu-Yi Chuang, MD, MPH.
Genital warts. Small papilloma on the shaft of penis. Courtesy of Tsu-Yi Chuang, MD, MPH.
Genital warts. Small papilloma of the anus. Courtesy of Tsu-Yi Chuang, MD, MPH.
 
 
 
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