Condyloma Acuminata Treatment & Management

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

Prehospital Care

Generally, prehospital care is unwarranted and inappropriate; however, reassure the patient and search for the possibility of another underlying reason prehospital care was requested.

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Emergency Department Care

Type of workup, treatment regimens, and necessary follow-up care for condyloma acuminata generally are far beyond the scope of ED practice. However, the following procedures may be implemented if indicated:

  • Use pressure to stop any bleeding.
  • Relieve urethral obstruction in rare cases.
  • Reassure the patient.
  • Search for evidence of other coexistent STDs and treat if found.
  • Do not begin treatment of condyloma in the ED.

Although not ED treatments, the following are listed strictly for educational purposes and to assist readers in understanding and managing potential presenting complications of condyloma acuminata. Further details on management are included in the Centers for Disease Control and Prevention sexually transmitted diseases treatment guidelines.[3]

Cryotherapy

Cryotherapy may be performed using an open spray or cotton-tipped applicator for 10-15 seconds and repeated as needed. Lift away mobile skin from underlying normal tissue before freezing.

Cryotherapy is an excellent first-line treatment, particularly for perianal lesions.

Response rates are high with few adverse sequelae.

Adverse reactions include pain at time of treatment, erosion, ulceration, and postinflammatory hypopigmentation of skin.

Cryotherapy is safe during pregnancy

Electrodesiccation

Smoke plume potentially may be infective.

Curettage

This may also be used.

Surgical excision

Excision has highest success rate and lowest recurrence rate.

Initial cure rates are 63-91%.

Carbon dioxide laser treatment

Use carbon dioxide laser treatment for extensive or recurrent condyloma acuminata.

Potentially infectious HPV-6 DNA has been detected in the carbon dioxide laser plume.

Local, regional, or general anesthesia is required. Eutectic mixture of local anesthetics (EMLA) cream may be used as an alternative anesthetic.

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Consultations

  • No emergent ED consultation generally is indicated.
  • Outpatient OB/GYN or urologic follow-up care is appropriate.
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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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