eMedicine Specialties > Emergency Medicine > Infectious Diseases

Condyloma Acuminata: Follow-up

Author: Delaram Ghadishah, MD, Staff Physician, Encino Tarzana Emergency Department
Contributor Information and Disclosures

Updated: Dec 22, 2008

Follow-up

Further Inpatient Care

  • Generally, no further inpatient care is necessary unless the patient has malignant transformation of lesions to carcinoma.

Further Outpatient Care

  • Patient should have a follow-up visit with OB/GYN (female) or with urology (male) within 1 week.
    • Treat patient using medications and, if ineffective, with cryotherapy, curettage, electrodesiccation, surgical excision, carbon dioxide laser treatment, or combination therapy.
    • Evaluate and treat sexual partner(s).
    • Perform workup for HPV and other STDs.
  • Search for immunosuppression in patients with treatment failures and recurrences.
  • Look for biopsy recurrences and treatment failures.

Inpatient & Outpatient Medications

  • Podofilox (purified podophyllotoxin) is available for home use by the patient.

Deterrence/Prevention

  • No medications are 100% effective. A vaccine for HPV has been recently approved by the FDA.
  • Sexual abstinence and monogamy are protective.
  • Condoms may discourage transmission.

Complications

  • Local disfigurement
  • Transformation to genitourinary malignancies in both males and females
  • Transmission to neonate or partners
  • Recurrence of condyloma acuminata

Prognosis

  • Many patients either fail to respond to treatment or condyloma acuminata recurs after adequate response.
  • Recurrence rate of cervical dysplasia in women is not altered by treatment of sexual partners.
  • Recurrence rates exceed 50% after 1 year and have been attributed to the following:
    • Repeat infection from sexual contact
    • Long incubation period of HPV
    • Location of virus in superficial skin layers away from lymphatics
    • Persistence of virus in surrounding skin, hair follicles, or sites not adequately reached by intervention used
    • Missed or deep lesions
    • Subclinical lesions
    • An underlying immunosuppression

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Failure to inform patient of potential risk of malignant transformation of lesions
  • Failure to indicate necessity for follow-up care, even after treatment eradicates lesions
  • Failure to indicate possibility of subclinical combined with intravaginal or cervical lesions and need to search for them
  • Failure to indicate treatment availability and follow-up care
  • Failure to inform patient of risk of HPV transmission to sexual partners and neonates
  • Failure to inform patient of necessity of treating partners
  • Failure to search for immunosuppression in patients with treatment failures and recurrences

Special Concerns

  • Pregnant patients
    • Latent infection may become activated with numerous large lesions.
    • Lesions often present or increase during pregnancy.
    • Lesions may make vaginal delivery difficult if in cervix, vagina, or vulva.
    • Lesions tend to bleed easily.
    • Lesions often spontaneously regress after delivery.
    • The American College of Obstetrics and Gynecology currently does not recommend cesarean sections simply due to positive HPV status.
  • Pediatric patients
    • Neonates may become infected during passage through an infected birth canal.
    • Incidence of perinatal transmission to the infant pharynx is as high as 50% and occurs most frequently with HPV types 6 and 11. Incidence of genital infection in the neonate is 4%.
 


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References
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References

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  4. 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].

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  8. 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].

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

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Further Reading

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Keywords

condyloma acuminata, genital wart, human papillomavirus infection, HPV infection, HPV type 6, HPV-6, HPV type 11, HPV-11, bowenoid papulosis, seborrheic keratoses, Buschke-Löwenstein tumors, giant condyloma, carcinoma in situ, sexually transmitted disease, STD, genitourinary cancer, vulvar condyloma acuminata, warts of penile urethral meatus, acute urethral obstruction, smoking, oral contraceptives, multiple sexual partners, painless bumps, coital bleeding, papular eruptions, Papanicolaou tests, Pap tests

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Contributor Information and Disclosures

Author

Delaram Ghadishah, MD, Staff Physician, Encino Tarzana Emergency Department
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.

Medical Editor

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.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Barry J Sheridan, DO, Chief, Department of Emergency Medical 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.

CME Editor

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, University Hospitals, Case Medical Center
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.

 
 
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