Condyloma Acuminatum

What is Condyloma Acuminatum?

Condyloma acuminatum is a type of sexually transmitted disease that may occur in the internal or external of the male and female genitalia. Management of this condition is important to avoid the spread to other individuals ^{[1, 2]}.

Condyloma acuminatum, or genital warts, are small growths that may sometime resembles a cauliflower that grows near the genital or anal area. It usually grows in the anal area, inside the upper vagina and cervix and in the urethra of males. These lesions are raised and pinkish in color. They tend to develop in moist areas and their growth can be intensified in the presence of other infections.

Figure 1 shows an example of a condyloma acuminatum in the male reproductive organ ^{[1, 2, 3]}.

ICD10

The ICD-10-CM diagnosis code used for individuals with a venereal warts is A63.0 ^[4].

Causes

These genital warts are attributed to the virus human papillomavirus (HPV). There are more than 100 virus varieties, but there are 2 specific types that account around 90% of all the total cases. Particular types of this virus are even associated with around 90% of all cervical cancers. They are also associated to have played a role in malignancies of the vagina, anus, vulva and penis. The growth of genital warts increases during pregnancy and in states of a compromised immune system. The warts are considered to be the tip of the iceberg because the virus is also present in the normal skin surrounding the wart ^{[1, 2]}.

The virus is primarily transmitted through sexual contact from an infected person. It may take around 3 months after the contact. The warts may be transmitted from mother to newborn when the newborn is delivered normally through the infected birth canal ^{[1, 2]}.

Signs and Symptoms

The primary signs and symptoms will be the presence of warts in the genital or anal area and this is usually detected by the patient itself. Genital warts that have developed inside the vagina and cervix. These warts may cause itch and discomfort. Urinary obstruction or bleeding may occur if the wart developed in the urinary meatus. These warts may also bleed with sexual intercourse [1, 2, 5].

Diagnosis

Health History and Physical Examination

The patient will seek consultation after discovering the growth of warts in the genital area. Health history will focus on the sexual practice history and history of other sexually transmitted infections (STI). The physical examination will include examination of the genitals, perianal area, thigh, adjacent skin and the oral cavity ^[6].

Colposcopy

The physician who conducts the physical examination may use a colposcope in order to examine the inside of the cervix to identify any warts inside of the cervix. This type of test is very important in looking for flat lesions which can be hard to see without a colposcope ^[1].

Pap Smear

A Papanicolau test (Pap smear) may also be performed by the physician after the physical examination. An abnormal Pap smear result can indicate a HPV infection ^[1].

Biopsy

The gold standard in establishing a HPV infection diagnosis is to perform a biopsy. This test is advisable for warts that are atypical and resistant to treatments. Patients who have a high risk for neoplasia and those that have a compromised immune system should have their genital warts tested as well ^{[1, 2]}.

Treatment

There are several treatment options to remove the genital warts but nothing is considered to be the perfect cure for condyloma acuminatum. All of these treatment must be done to each individual wart. Topical creams may be prescribed by the physician and these will be able to remove the warts. Patients should be advised that they may experience pain, burning sensation, inflammation and itching on the area where the cream is applied to. These creams are contraindicated in pregnant women for they can cause birth defects ^{[1, 2]}.

Wart growths that are visible can be removed either by excision or using cold and heat. These techniques can be uncomfortable and there is a high chance that the warts will grow again because the virus is still present in the surrounding skin cells ^{[1, 2]}.

For pregnant women who have condyloma acuminatum, it is advisable to resolve the wart growth prior to vaginal delivery. If the newborn will be delivered in an infected birth canal, avoid doing a vigorous oropharyngeal suction to prevent inoculation of the respiratory tree ^[7].

Pictures

References

1. Health Central. (2015). Condyloma (Genital Warts). Retrieved from Health Central: http://www.healthcentral.com/encyclopedia/hc/condyloma-3168666/
2. Ghadishah, D. (2016, January 8). Condyloma Acuminata. Retrieved from eMedicine: http://emedicine.medscape.com/article/781735-overview
3. Dermatology Information System. (2015). Condyloma Acuminatum. Retrieved from Dermatology Information System: http://www.dermis.net/dermisroot/en/14295/diagnose.htm
4. (2015). Anogenital (venereal) warts. Retrieved from ICD10Data: http://www.icd10data.com/ICD10CM/Codes/A00-B99/A50-A64/A63-/A63.0
5. European Academy of Dermatology and Venereology. (2013, July). Genital Condylomata. Retrieved from European Academy of Dermatology and Venereology: http://www.eadv.org/patient-corner/leaflets/eadv-leaflets/genital-condylomata/
6. (2015, October 14). Condyloma Acuminatum. Retrieved from DoveMed: http://www.dovemed.com/diseases-conditions/condyloma-acuminatum/
7. Trofatter, K. J. (2015). Anogenital Warts (Condylomata acuminata) and Pregnancy. Retrieved from Healthline: http://www.healthline.com/health-blogs/fruit-womb/anogenital-warts-condylomata-acuminata-and-pregnancy