Condyloma Acuminata Clinical Presentation

  • Author: Delaram Ghadishah, MD; Chief Editor: Barry E Brenner, MD, PhD, FACEP   more...
 
Updated: Apr 15, 2011
 

History

  • Smoking, oral contraceptives, multiple sexual partners, and early coital age are risk factors for acquiring condyloma acuminata.
  • Generally, two thirds of individuals who have sexual contact with a partner with condyloma acuminata develop lesions within 3 months.
  • The chief complaint usually is one of painless bumps, pruritus, or discharge. Involvement of more than 1 area is common. History of multiple lesions, rather than 1 isolated wart, is common.
  • Oral, laryngeal, or tracheal mucosal lesions (rare) presumably are transferred by oral-genital contact.
  • History of anal intercourse in both males and females warrants a thorough search for perianal lesions.
  • Rarely, urethral bleeding or urinary obstruction may be the presenting complaint when the wart involves the meatus.
  • The patient's history may indicate presence of previous or other current STDs.
  • Coital bleeding may occur. Vaginal bleeding during pregnancy may be due to condyloma eruptions.
  • Latent illness may become active, particularly with pregnancy and immunosuppression.
  • Lesions may regress spontaneously, remain the same, or progress.
  • Pruritus may be present.
  • Discharge may be a complaint.
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Physical

  • Single or multiple papular eruptions may be observed. Eruptions may appear pearly, filiform, fungating, cauliflower, or plaquelike. They can be quite smooth (particularly on penile shaft), verrucous, or lobulated. Eruptions may seem harmless or may have a disturbing appearance.
  • Carefully search for simultaneously involved multiple sites.
  • Eruptions' color may be the same as the skin, or they may exhibit erythema or hyperpigmentation. Check for irregularity in shape, form, or color suggestive of melanoma or malignancy.
  • Propensity has been established for penile glans and shaft in men and for vulvovaginal and cervical areas in women. In contrast to early reports, presence of external condyloma acuminata in both men and women warrants a thorough search for cervical or urethral lesions. Such internal lesions have been found in more than one half of females with external lesions. One report indicates that infected males have a 20% chance of having subclinical urethral lesions. More than 50% of female patients with external lesions have been found to have negative Papanicolaou (Pap) tests but tested positive for HPV infection using in situ hybridization.
  • Urethral meatus and mucosal lesions can occur. Some are subclinical. Hair or the inner aspect of uncircumcised foreskin hides some lesions.
  • Search for evidence of other STDs (eg, ulcerations, adenopathy, vesicles, discharge).
  • Look for perianal lesions, particularly in patients with history or risk of immunosuppression or anal intercourse.
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Causes

  • Several of the epidermotropic human papillomaviruses (HPVs) cause condyloma acuminata.
  • HPV types 6 and 11 most commonly are isolated, but many of the more than 60 types of HPV potentially cause condyloma.
  • Male sexual partners of women with cervical intraepithelial neoplasia often have infections with the same viral type.
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Contributor Information and Disclosures
Author

Delaram Ghadishah, MD  Physician, Emergency Department, Kaiser Permanente West Los Angeles Medical Center

Delaram Ghadishah, MD is a member of the following medical societies: American Academy of Emergency Medicine and American College of Emergency Physicians

Disclosure: Nothing to disclose.

Specialty Editor Board

William K Chiang, MD  Associate Professor, Department of Emergency Medicine, New York University School of Medicine; Chief of Service, Department of Emergency Medicine, Bellevue Hospital Center

William K Chiang, MD is a member of the following medical societies: American Academy of Clinical Toxicology, American College of Medical Toxicology, and Society for Academic Emergency Medicine

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

Barry J Sheridan, DO  Chief Warrior in Transition Services, Brooke Army Medical Center

Barry J Sheridan, DO is a member of the following medical societies: American Academy of Emergency 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

Barry E Brenner, MD, PhD, FACEP  Professor of Emergency Medicine, Professor of Internal Medicine, Program Director, Emergency Medicine, Case Medical Center, University Hospitals, Case Western Reserve University School of Medicine

Barry E Brenner, MD, PhD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Chest Physicians, American College of Emergency Physicians, American College of Physicians, American Heart Association, American Thoracic Society, Arkansas Medical Society, New York Academy of Medicine, New York Academy of Sciences, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

References

  1. Poolman EM, Elbasha EH, Galvani AP. Vaccination and the evolutionary ecology of human papillomavirus. Vaccine. Jul 18 2008;26 Suppl 3:C25-30. [Medline].

  2. Sinal SH, Woods CR. Human papillomavirus infections of the genital and respiratory tracts in young children. Semin Pediatr Infect Dis. Oct 2005;16(4):306-16. [Medline].

  3. [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. 2006;55(RR-11):62. [Full Text].

  4. FDA News Release - Oct 16, 2009. FDA Approves New Indication for Gardasil to Prevent Genital Warts in Men and Boys. Available at http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm187003.htm. Accessed November 30, 2009.

  5. ACIP. 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].

  6. Hoory T, Monie A, Gravitt P, Wu TC. Molecular epidemiology of human papillomavirus. J Formos Med Assoc. Mar 2008;107(3):198-217. [Medline].

  7. Chan PD, Winkle PJ, Winkle CR. Condyloma acuminata. In: Current Clinical Strategies - Family Medicine. 2nd ed. Current Clinical Strategies Publishing Inc; 1995:209-210.

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

  9. Friedman M, Bayer I, Letko I, Duvdevani R, Zavaro-Levy O, Ron B, et al. Topical treatment for human papillomavirus-associated genital warts in humans with the novel tellurium immunomodulator AS101: assessment of its safety and efficacy. Br J Dermatol. Sep 19 2008;[Medline].

  10. 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].

  11. Kodner CM, Nasraty S. Management of genital warts. Am Fam Physician. Dec 15 2004;70(12):2335-42. [Medline].

  12. Leung AK, Kellner JD, Davies HD. Genital infection with human papillomavirus in adolescents. Adv Ther. May-Jun 2005;22(3):187-97. [Medline].

  13. 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].

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

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

 
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Genital wart in pubic area
Genital wart in pubic area (close-up view)
Genital wart in pubic area (very close-up view)
Genital wart in pubic area (look at bottom middle of picture)
 
 
 
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