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2.1.5 Condylomata Acuminata
ICD-11
1A95
Synonyms
Anogenital warts; venereal warts; verrucae anogenitales; genital warts; verruca acuminata.
Epidemiology
Probably under-reported with a high annual incidence between 100-300 per 100 000. 4% have sub-clinical infection and 10% have positive DNA tests. Higher incidence in those with high numbers of sexual partners.
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The incidence and prevalence of anogenital warts are probably under-reported as many studies have shown poor awareness of the presence of lesions by patients. There is a high annual incidence between 100-300 per 100,000 providing a large pool for onward infection. 2% of those infected have clinical lesions; 4% have sub-clinical infection and 10% have positive DNA tests. There is a much greater incidence in those with high numbers of sexual partners.
Definition
Hyperplastic epidermal and mucosal lesions caused by HPV 6, 11 and oncogenic HPV subtypes.
Aetiology & Pathogenesis
Sexual transmission of virus via micro-trauma to the skin or mucous epithelia; 50% of partners are infected after 6 months. Non-sexual transmission is also possible. Incubation time weeks to months.
NB.: In children presenting with genital warts, the possibility of sexual abuse should be considered.
Signs & Symptoms
Pale to livid, sometimes hyperpigmented, narrow-based accuminated papules with a papillomatous surface. Lesions start as tiny papules, usually asymptomatic, which may be initially overlooked and can develop into large "cauliflower" tumors.
Localisation
Peri/intra-anal, glans penis, prepuce, labia, introitus vulvae, urethral meatus, oral cavity. Note: some genital HPV types (16, 18, 31 and 33) cause bowenoid papulosis (clinically benign) as well as precancerous lesions and carcinomas of the cervix, vulva, penis and anus, sometimes in combination with co-factors such as HIV infection and immunosuppression.
Classification
According to HPV subtype.
Laboratory & other workups
Pap smear test in females potentially including PCR for oncogenic subtypes.
Dermatopathology
Usually indistinguishable histologically from common warts.
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Rarely, histology may be required to distinguish condylomata acuminata from other conditions such as squamous cell carcinomas. However, the features are not specific and may be indistinguishable from common warts. Immunostaining with specific antibodies against oncogenic subtypes can be performed.
Course
Most are self-limiting; some persist and some evolve.
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Most lesions will spontaneously resolve over time, however, some persist and some may evolve or rarely transform into a cancer.
Complications
Development of carcinoma in oncogenic subtypes. May cause sexual, mechanical and psychologic dysfunction.
Diagnosis
Usually clinical. Exclusion of different STI`s by blood tests and smears. Sometimes a skin biopsy is required to exclude other diagnoses.
Differential Diagnosis
Condylomata lata, squamous cell carcinoma, aggregated molluscum contagiosum.
Prevention & Therapy
Prevention and treatment: consider immunization before puberty. Barrier methods of contraception do not always prevent infection.
Electro- or laser coagulation, cryosurgery in non-mucosal lesions, podophyllotoxin, imiquimod. Do not forget to treat contact(s) if infected. Beware over-treatment of exophytic lesions and the possibility of peri-meatal scarring.
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Prevention of lesions can be achieved by immunization before the first sexual contact in girls and boys and where a large proportion of those who are sexually active are immunized, herd immunity may even protect those not immunized. Although effective for most other sexually transmitted diseases, barrier methods of contraception do not always prevent infection with HPV.
Treatment of clinically evident lesions may be undertaken with cryotherapy or other treatments such as podophyllotoxin, imiquimod and trichloracetic acid (TCA). Electro- or laser coagulation are second line options (however, the fumes from treatment may be infectious and the surgeon is advised to protect her/his airway). As with other sexually transmissible diseases, sexual contacts of the index case should be investigated and treated if possible. Beware over-treatment of exophytic lesions. Peri-meatal scarring may occur with (over)treatment in that area and may cause urological problems.
Tests
- True or false?
- True or false?
- True or false?
- Statement 1 Condylomata acuminata can lead to cervical carcinoma in situ
- Statement 1 Condylomata acuminata generally heal without therapy within 3-4 months
- What are the usual sites for condylomata acuminata?
- Which clinical description best fits condylomata acuminata?
- What is the causative agent of condylomata acuminata?
Further images / DOIA
References
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