Condylomata acuminata, also known as genital warts or venereal warts, are lesions in the epidermis that are caused by the human papillomavirus (HPV). HPV is able to penetrate the skin through microabrasions that result from sexual contact. Condylomata acuminata most commonly affects the penis, vagina, vulva, cervix, perianal area, and perineum. Rarely the oropharyngeal, laryngeal, and tracheal regions may be affected. Treatments include topical application of cytotoxic agents, cryotherapy, and surgical excision.
This disease is caused by various HPV strains and is considered the most common of the sexually transmitted diseases. The most common strains implicated are HPV 6 and 11, but other subtypes may lead to the same manifestation. Condylomata acuminata can occur in clusters, as either tiny discrete lesions or as large masses in the anogenital area. This explains why they are also called anogenital warts. When limited to the anal area, they are called anal warts.
In males, they frequently occur on the prepuce of the penis, while in females, they often occur on the vulva. On microscopy, the infected cells usually exhibit koilocytosis, wherein the nucleus becomes large and atypical. Another typical microscopic feature of the cells is the formation of a cytoplasmic perinuclear halo or cytoplasmic vacoulation.
Despite differences in location, the pathophysiology of condylomata acuminata is the same. Tiny lacerations or abrasions are made during sexual contact, providing a portal of entry for the human papillomavirus. The virus then infects the basal cells of the epidermis. Latency occurs, and an infected person may not have any manifestation for months to years. When latency ends, the active production of viral deoxyribonucleic acid (DNA) and other essential particles occurs, leading to warty lesions.
An affected person typically goes to the doctor due to the presence of painless bumps in the genital or perianal areas, itching, or discharge. There is no specific laboratory test for condylomata acuminata because the appearance of the warts is often enough to make a diagnosis. Tests for other viral diseases or sexually transmitted diseases, such as human immunodeficiency virus (HIV), syphilis, gonorrhea, and chlamydia, may be performed. In women, a pap smear is recommended to look for cellular abnormalities that may increase the risk for cervical cancer.
Once condylomata acuminata is diagnosed, treatments like podophyllum resin, podofilox, trichloroacetic acid, and imiquimod may be offered. When the perianal area is involved, cryotherapy may be preferred. Among the treatment options, surgical excision of the warts gives the highest success rate and the lowest recurrence rate. The prevention of HPV-associated cancers and genital warts is possible through the administration of the HPV quadrivalent vaccine.
