Condyloma Acuminatum Clinical Presentation

Updated: Jan 05, 2017
  • Author: Delaram Ghadishah, MD; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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Presentation

History

Smoking, oral contraceptives, multiple sexual partners, and early coital age are risk factors for acquiring condyloma acuminatum.

Generally, two thirds of individuals who have sexual contact with a partner with condyloma acuminatum 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 acuminatum 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 acuminatum.

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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