2.1.5 Condylomata Acuminata

Grading & Level of Importance: C

Review:
2021

W. Burgdorf, Munich; F. Bakr, A.Salam, J. McGrath, London
Revised by J. White, V. del Marmol, Brussels

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. 

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. 

Course

Most are self-limiting; some persist and some evolve. 

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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