Sexual Health

Genital Warts (Condylomata Acuminata) - a Sexually Transmitted Infection

Written by
Dr. Suvash Sahu
and medically reviewed by iCliniq medical review team.

07 Sep 2018  -  3 min read

Abstract

Abstract

Current evidence suggests that over 50% of sexually active adults (15 to 25 years of age) have been infected with one or more human papilloma virus - HPV infection. The underlying HPV infection may increase the evidence and prevalence of genital warts.

Genital Warts (Condylomata Acuminata) - a Sexually Transmitted Infection

Condyloma, a Greek word with the meaning of round tumor, has been recognized as a distinct entity since ancient times. Mucosal HPV infections are the most common sexually transmitted infections (STIs). It can occur on anogenital or oral mucosa or skin. HPV present in the birth canal can be transmitted to a newborn during vaginal delivery and it may persist for years in a dormant state and become infectious intermittently.

Causative Organism

The causative organism is human papilloma virus. The most common subtypes are 6, 11, 16 and 18. Less common subtypes are 31, 33, 35, 39 and 51 to 59.

Transmission of Virus

Genital HPV infections are transmitted primarily through sexual contact such as genital to genital, oral to genital or genital to anal, but digital and perinatal transmission can also occur. The incubation period is several weeks to months.

Clinical Features

The most common sites affected are frenulum, coronal sulcus, inner surface of prepuce, urethral meatus, cervix, vagina and vulva. It can also affect the anal region of the homosexuals. It is usually asymptomatic, single or multiple, soft, pink or whitish, sessile tumor (immobile) with fine papillary projections. It may bleed on friction or slight trauma.

Clinical Variants

  1. Small papular.
  2. Cauliflower like floret.
  3. Sessile.
  4. Flat-topped papules or plaques.
  5. Giant condyloma (Buschke-Lowenstein tumor).

Complications

  • It may enlarge to an enormous size and hamper the physiological function.
  • Sometimes, there will be bleeding, ulceration and secondary infection.
  • Local malignancy (oncogenic - type 16 and 18) associated with oncogenic atypia and less frequently with invasive carcinoma in HIV.
  • Anogenital warts flourish in pregnancy. The size as well as the number will increase, may be due to the influence of increased hormone levels, vascularity, and immune deficiency.
  • Genital warts in children may result from perinatal route (mother to newborn during delivery) or autoinoculation from finger warts and non-sexual transmission from family member or through sexual abuse. Genital warts present at delivery are associated with a risk of juvenile laryngeal papilloma.

Investigations

Clinical examination is sufficient to diagnose most of the external genital warts. Laboratory examinations are also used in a few cases. They are as follows:

  1. Acetowhite test for subclinical genital HPV.
  2. Pap smear.
  3. Skin biopsy for koilocytes, mature squamous cells with a large clear perinuclear zone and smudgy nuclei.
  4. Detection of HPV DNA.
  5. Serology test.

Treatment

  • Spontaneous regression may happen in 10% to 15% cases.
  • 20% Podophyllin (a resin extracted from Podophyllum peltatum) in alcohol or tincture Benzoin is applied to the lesion with an applicator, covering the surrounding area with Vaseline. It is left on the surface for 4 to 6 hours and then cleaned. It may be repeated every third day till lesions are completely cured. This is contraindicated in pregnancy as it can lead to fetal death and abortion.
  • Trichloroacetic acid of 50% to 70% can be used.
  • Podophyllotoxin cream 0.5% solution or 0.15% cream twice daily for three days followed by four days gap. This has to be given for three cycles.
  • 5% 5-Fluorouracil cream applied locally to the lesion for three to seven days.
  • Surgical methods such as cauterization, excision under local anesthesia and cryocautery or carbon dioxide laser are also beneficial.

Counseling

Clear information and counseling must be given to accomplish proper management. Female individuals, who have HPV infection, should get counseling about regular participation in cervical cytology screening programs. He or she should be encouraged to use barrier protection with new sexual contacts until successful treatment has been completed.

To know more about genital warts and its treatment, consult a venereologist online --> https://www.icliniq.com/ask-a-doctor-online/venereologist

Last reviewed at:
07 Sep 2018  -  3 min read

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