Introduction
Condyloma is also known as a genital or anal wart. It appears externally on the genitalia, in the anal area, internally in the upper vagina, and in the male urethra. It is caused by the human papillomavirus (HPV). HPV 6 and 11 are the most common strains that cause genital warts. HPV, a double-stranded DNA virus, mainly spreads through sexual contact. It is a sexually transmitted disease. The susceptibility to the disease is influenced by one’s age, way of life, and sexual habits. Condyloma leads to sexual issues, psychological distress, and genital discomfort. When wounded, condyloma becomes infected and exhibits symptoms, including itching, discomfort, and discharge with an unpleasant odor. There are chances of recurrence, which may turn malignant.
What Causes Condyloma?
Human papillomavirus (HPV) is the root cause of condyloma. It is transmitted in three ways:
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Sexual activity with an infected person. They appear within three months of contact.
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A direct encounter with an infected person’s anal or genital region. This might occur through hand contact or contact with an infected person’s genital or anal fluids.
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It is also possible for a pregnant woman with active HPV or warts on the genital mucous membrane to transmit the virus to the child during birth or to transmit the infection intrauterine.
There are several different HPV strains. The center for disease control estimates that HPV 6 and HPV 11 are responsible for 90 percent of condyloma. These strains are not commonly linked to cancer. Other strains are responsible for the remaining 10 percent of the condylomas. Prolonged HPV infection increases the chances of malignant transformation.
How Does Condyloma Appear?
Genital warts initially appear as little, rounded lumps. They are pale brown, yellow, pink, or flesh-colored and might discharge fluid. Warts can grow swiftly and cluster into big, cauliflower-like masses. Anal warts may not be felt or visible if located inside the rectum, where waste accumulates.
What Are the Symptoms of Condyloma?
Symptoms are not always present. It is possible for HPV to remain dormant (inactive) in the body and may not produce any symptoms. Sometimes they may produce symptoms. Some may present as soft bumps in or around the anus and genitalia, pale brown, yellow, pink, or flesh-colored lumps that may cluster, itch, bleed, and discharge from the anus (caused by internal warts).
Who Is More Likely to Develop Condyloma?
People more susceptible to the disease are those who have sex or come close to HPV-positive persons, have sexual intercourse without protection, have multiple partners, and possess a compromised immune system.
How to Diagnose Condyloma?
Condyloma is frequently diagnosed after a comprehensive visual inspection, a definitive history, and a clinical examination. Additional tests can confirm the diagnosis. The lesion can be magnified with a colposcope for better viewing. Colposcopy is useful for finding flat lesions invisible to the human eye; however, only two-thirds of white patches observed in colposcopy are caused by HPV infection. DNA (deoxyribonucleic acid) detection tests like polymerase chain reaction can be used for confirmatory tests and gene typing. Sometimes, a biopsy is needed to confirm the diagnosis. In a biopsy, a small piece of tissue is removed from the infected site under local anesthesia and examined in the laboratory. In addition, an acetic acid test is done to assess the lesion. In this test, 5 percent acetic acid is applied to the lesion. HPV lesions appear white. The acetic acid test cannot be used as a valuable test since the chances of false positive results are high.
An abnormal pap smear can occasionally detect a cervical HPV infection. A woman should see the doctor if there is any abnormality in the pap smear.
What Are the Treatments for Condyloma?
Patients with condyloma have various treatment options. Treatment can be postponed in young, healthy adults, adolescents, and children because lesions usually go away on their own over months to years. Treatment should be considered in lesions that have been present for more than two years and are symptomatic or for cosmetic purposes. Treatment options include topical therapy, cryotherapy, and surgical excision. There is no standard algorithm for therapy; instead, it is based on the patient’s preference, shape, and location of the lesion.
Generally, treatment falls under three categories:
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Topical preparations that destroy wart tissue.
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Surgical method that involves the removal of condyloma using sharp tools.
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Biological therapies that focus on the virus causing the condition.
1) Topical Treatment:
Condyloma, located on the skin around the anus and in small size, is treated using topical ointments. The treatment includes:
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Podophyllotoxin 0.5 percent solution and 0.15 cream.
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Imiquimod cream 5 percent.
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Sinecatechins 15 percent.
Podophyllotoxin is used to treat fleshy papules (a small swelling). It is applied twice daily for three days, followed by a four-day pause. Lesions may disappear after three weeks. Another topical treatment is Imiquimod 5 percent, which has a lesser recurrence rate than Podophyllotoxin. It is applied three times weekly, every other day, with a noticeable result in 16 weeks. Sinecatechins 15 percent is used three times daily for up to 16 weeks.
Some topical treatments burn or freeze the condyloma and cause little side effects like pain and swelling. They are:
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Cryotherapy: In cryotherapy, liquid nitrogen is applied to the margins of the lesion, it freezes the lesion, and the wart falls off.
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Trichloroacetic Acid: Trichloroacetic acid is used to treat smaller lesions. After application, an ulcer is formed and heals without any scar formation.
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Electrocautery: Electrocautery involves the use of heat to burn warts.
2) Surgical Treatment:
It is used if condyloma appears big and does not respond to any other treatment. It includes electrosurgery, curettage, scissors excision, and laser therapy. A newly developed treatment for condyloma is the application of 5-aminolevulinic acid (ALA) with photodynamic therapy. Compared to the carbon dioxide laser, this method is more efficient, less complicated, and less prone to recurrence. ALA with photodynamic therapy is a helpful complement to other traditional treatment techniques.
3) Biological Therapies:
Interferon therapy attacks the virus that causes the condition, but it is typically expensive and does not affect how rapidly warts reappear. Studies are being conducted to determine the efficacy of dendritic cell-activated cytokine-induced killer cells (DC-CIK) combined with interferon in treating condyloma. When administered to the patient, DC cells stimulate the immune response, and CIK cells exert oncolytic activity.
What Is the Differential Diagnosis of Condyloma?
It includes acrochordon, psoriasis, lichen planus, malignancy, pearly penile papules, sebaceous cyst, and molluscum contagiosum.
What Is the Prognosis?
Though it is difficult to treat condyloma, it is curable. It may require multiple or combinations of treatment methods over time. There are chances of recurrence with all the treatment modes, but surgical excision is the only approach with a clearance rate near 100 percent.
What Are the Complications of Condyloma?
Patients with condyloma may experience considerable psychological effects such as stress, guilt, and aggression. They may also have concerns about cancer and loss of fertility. However, rarely does condyloma turn into a malignant (cancerous) lesion. Bleeding, uneven pigmentation, and ulceration are some factors that indicate malignant transformation.
Conclusion
Condyloma is caused by HPV (human papillomavirus) in the anogenital region. Physicians should examine condyloma since some strains of HPV might turn condyloma into cancer. Though it is rare, it is always better to be safe. Although, there is no requirement for treatment. Typical treatment includes topical ointments, cryotherapy, laser ablation, or surgical methods. Consult physicians to learn which treatment method suits you the best. If unresponsive to treatment, it may be protracted and recurring. In such cases, vigilant monitoring for malignant changes is best advised.
