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.

Emergency Department Care

Type of workup, treatment regimens, and necessary follow-up care for condyloma acuminatum 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 acuminatum. 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.^[4]

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.^[5]

Initial cure rates are 63-91%.

Carbon dioxide laser treatment

Use carbon dioxide laser treatment for extensive or recurrent condyloma acuminatum.^[6]

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.

Consultations

No emergent ED consultation generally is indicated.

Outpatient OB/GYN or urologic follow-up care is appropriate.

Medication

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