14/5/2016

CondylomaAcuminataClinicalPresentation:History,Physical,Causes

CondylomaAcuminataClinicalPresentation
Author:DelaramGhadishah,MDChiefEditor:BarryEBrenner,MD,PhD,FACEPmore...
Updated:Jan08,2016

History
Smoking,oralcontraceptives,multiplesexualpartners,andearlycoitalagearerisk
factorsforacquiringcondylomaacuminata.
Generally,twothirdsofindividualswhohavesexualcontactwithapartnerwith
condylomaacuminatadeveloplesionswithin3months.
Thechiefcomplaintusuallyisoneofpainlessbumps,pruritus,ordischarge.
Involvementofmorethan1areaiscommon.Historyofmultiplelesions,ratherthan
1isolatedwart,iscommon.
Oral,laryngeal,ortrachealmucosallesions(rare)presumablyaretransferredby
oralgenitalcontact.
Historyofanalintercourseinbothmalesandfemaleswarrantsathoroughsearch
forperianallesions.
Rarely,urethralbleedingorurinaryobstructionmaybethepresentingcomplaint
whenthewartinvolvesthemeatus.
Thepatient'shistorymayindicatepresenceofpreviousorothercurrentSTDs.
Coitalbleedingmayoccur.Vaginalbleedingduringpregnancymaybedueto
condylomaeruptions.
Latentillnessmaybecomeactive,particularlywithpregnancyand
immunosuppression.
Lesionsmayregressspontaneously,remainthesame,orprogress.
Pruritusmaybepresent.
Dischargemaybeacomplaint.

Physical
Singleormultiplepapulareruptionsmaybeobserved.Eruptionsmayappearpearly,
filiform,fungating,cauliflower,orplaquelike.Theycanbequitesmooth(particularly
onpenileshaft),verrucous,orlobulated.Eruptionsmayseemharmlessormay
haveadisturbingappearance.
Carefullysearchforsimultaneouslyinvolvedmultiplesites.
Eruptions'colormaybethesameastheskin,ortheymayexhibiterythemaor
hyperpigmentation.Checkforirregularityinshape,form,orcolorsuggestiveof
melanomaormalignancy.
Propensityhasbeenestablishedforpenileglansandshaftinmenandfor
vulvovaginalandcervicalareasinwomen.Incontrasttoearlyreports,presenceof
externalcondylomaacuminatainbothmenandwomenwarrantsathoroughsearch
forcervicalorurethrallesions.Suchinternallesionshavebeenfoundinmorethan
onehalfoffemaleswithexternallesions.Onereportindicatesthatinfectedmales
havea20%chanceofhavingsubclinicalurethrallesions.Morethan50%offemale
patientswithexternallesionshavebeenfoundtohavenegativePapanicolaou(Pap)
testsbuttestedpositiveforHPVinfectionusinginsituhybridization.
Urethralmeatusandmucosallesionscanoccur.Somearesubclinical.Hairorthe
inneraspectofuncircumcisedforeskinhidessomelesions.
SearchforevidenceofotherSTDs(eg,ulcerations,adenopathy,vesicles,
discharge).
Lookforperianallesions,particularlyinpatientswithhistoryorriskof
immunosuppressionoranalintercourse.

Causes
Severaloftheepidermotropichumanpapillomaviruses(HPVs)causecondyloma
acuminata.
HPVtypes6and11mostcommonlyareisolated,butmanyofthemorethan60
typesofHPVpotentiallycausecondyloma.
Malesexualpartnersofwomenwithcervicalintraepithelialneoplasiaoftenhave
infectionswiththesameviraltype.

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CondylomaAcuminataClinicalPresentation:History,Physical,Causes

DifferentialDiagnoses

ContributorInformationandDisclosures
Author
DelaramGhadishah,MDPhysician,EmergencyDepartment,KaiserPermanenteWestLosAngelesMedical
Center
DelaramGhadishah,MDisamemberofthefollowingmedicalsocieties:AmericanAcademyofEmergency
Medicine,AmericanCollegeofEmergencyPhysicians
Disclosure:Nothingtodisclose.
SpecialtyEditorBoard
FranciscoTalavera,PharmD,PhDAdjunctAssistantProfessor,UniversityofNebraskaMedicalCenterCollege
ofPharmacyEditorinChief,MedscapeDrugReference
Disclosure:ReceivedsalaryfromMedscapeforemployment.for:Medscape.
BarryJSheridan,DOChiefWarriorinTransitionServices,BrookeArmyMedicalCenter
BarryJSheridan,DOisamemberofthefollowingmedicalsocieties:AmericanAcademyofEmergency
Medicine
Disclosure:Nothingtodisclose.
ChiefEditor
BarryEBrenner,MD,PhD,FACEPProfessorofEmergencyMedicine,ProfessorofInternalMedicine,Program
DirectorforEmergencyMedicine,CaseMedicalCenter,UniversityHospitals,CaseWesternReserveUniversity
SchoolofMedicine
BarryEBrenner,MD,PhD,FACEPisamemberofthefollowingmedicalsocieties:AlphaOmegaAlpha,
AmericanHeartAssociation,AmericanThoracicSociety,ArkansasMedicalSociety,NewYorkAcademyof
Medicine,NewYorkAcademyofSciences,SocietyforAcademicEmergencyMedicine,AmericanAcademyof
EmergencyMedicine,AmericanCollegeofChestPhysicians,AmericanCollegeofEmergencyPhysicians,
AmericanCollegeofPhysicians
Disclosure:Nothingtodisclose.
AdditionalContributors
WilliamKChiang,MDAssociateProfessor,DepartmentofEmergencyMedicine,NewYorkUniversitySchoolof
MedicineChiefofService,DepartmentofEmergencyMedicine,BellevueHospitalCenter
WilliamKChiang,MDisamemberofthefollowingmedicalsocieties:AmericanAcademyofClinicalToxicology,
AmericanCollegeofMedicalToxicology,SocietyforAcademicEmergencyMedicine
Disclosure:Nothingtodisclose.

References
1.PoolmanEM,ElbashaEH,GalvaniAP.Vaccinationandtheevolutionaryecologyofhumanpapillomavirus.
Vaccine.2008Jul18.26Suppl3:C2530.[Medline].
2.SinalSH,WoodsCR.Humanpapillomavirusinfectionsofthegenitalandrespiratorytractsinyoung
children.SeminPediatrInfectDis.2005Oct.16(4):30616.[Medline].
3.[Guideline]CentersforDiseaseControlandPrevention,WorkowskiKA,BermanSM.HPVinfectionand
genitalwarts.Sexuallytransmitteddiseasestreatmentguidelines2006.MMWRMorbMortalWklyRep.
2006.55(RR11):62.[FullText].
4.ZimmermanEE,CrawfordP.Cutaneouscryosurgery.AmFamPhysician.2012Dec15.86(12):111824.
[Medline].
5.SafiF,BekdacheO,AlSalamS,AlashariM,MazenT,ElSalhatH.Managementofperianalgiant
condylomaacuminatumacasereportandliteraturereview.AsianJSurg.2013Jan.36(1):4352.
[Medline].
6.ZhuX,ChenH,CaiL,YuZ,CaiL.Decreaserecurrencerateofcondylomataacuminatabyphotodynamic
therapycombinedwithCO2laserinmainlandChina:ametaanalysis.Dermatology.2012.225(4):36470.
[Medline].
7.FDANewsReleaseOct16,2009.FDAApprovesNewIndicationforGardasiltoPreventGenitalWartsin
MenandBoys.Availableat
http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm187003.htm.Accessed:November
30,2009.
8.VanDammeP,etal.Immunogenicityandsafetyofanovel9valentHPVL1viruslikeparticlevaccinein
boysandgirls915yearsoldcomparisontowomen1626yearsold.Abstract(SS85)presentedat
EUROGIN2014November5,2013.
9.ACIP.FDAlicensureofbivalenthumanpapillomavirusvaccine(HPV2,Cervarix)foruseinfemalesand
updatedHPVvaccinationrecommendationsfromtheAdvisoryCommitteeonImmunizationPractices
(ACIP).MMWRMorbMortalWklyRep.2010May28.59(20):6269.[Medline].
10.JuckettG,HartmanAdamsH.Humanpapillomavirus:clinicalmanifestationsandprevention.AmFam
Physician.2010Nov15.82(10):120913.[Medline].
11.HooryT,MonieA,GravittP,WuTC.Molecularepidemiologyofhumanpapillomavirus.JFormosMed

http://emedicine.medscape.com/article/781735clinical

2/3

14/5/2016

CondylomaAcuminataClinicalPresentation:History,Physical,Causes

Assoc.2008Mar.107(3):198217.[Medline].
12.ChanPD,WinklePJ,WinkleCR.Condylomaacuminata.CurrentClinicalStrategiesFamilyMedicine.
2nded.CurrentClinicalStrategiesPublishingInc1995.209210.
13.CongilosiSM,MadoffRD.Currenttherapyforrecurrentandextensiveanalwarts.DisColonRectum.1995
Oct.38(10):11017.[Medline].
14.FriedmanM,BayerI,LetkoI,DuvdevaniR,ZavaroLevyO,RonB,etal.Topicaltreatmentforhuman
papillomavirusassociatedgenitalwartsinhumanswiththenoveltelluriumimmunomodulatorAS101:
assessmentofitssafetyandefficacy.BrJDermatol.2008Sep19.[Medline].
15.GarridoJL.HumanpapillomavirusH.P.V.condyloma.Currentstudiesindiagnosis,treatmentand
prognosis.ClinExpObstetGynecol.1996.23(2):99102.[Medline].
16.KodnerCM,NasratyS.Managementofgenitalwarts.AmFamPhysician.2004Dec15.70(12):233542.
[Medline].
17.LeungAK,KellnerJD,DaviesHD.Genitalinfectionwithhumanpapillomavirusinadolescents.AdvTher.
2005MayJun.22(3):18797.[Medline].
18.MayeauxEJ,HarperMB,BarksdaleW,PopeJB.Noncervicalhumanpapillomavirusgenitalinfections.Am
FamPhysician.1995Sep15.52(4):113746,114950.[Medline].
19.PrasadCJ.Pathobiologyofhumanpapillomavirus.ClinLabMed.1995Sep.15(3):685704.[Medline].
20.SykesNL.Condylomaacuminatum.IntJDermatol.1995May.34(5):297302.[Medline].
21.Gardasil9(humanpapillomavirus9valentvaccine,recombinant)[packageinsert].WhitehouseStation,NJ:
Merck&Co,Inc.December,2015.Availableat[FullText].
MedscapeReference2011WebMD,LLC

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