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Condyloma Acuminatum

Condyloma Acuminata

Condyloma acuminatum (genital wart, venereal wars) is a sexually transmitted papilloma of viral origin, usually occurring on the external genitals or in the perianal region.


Presentation

The signs and symptoms of condyloma acuminata include the following features:

  • The warts are flesh colored and round in shape. They can take the shape of cauliflower or can appear flat.
  • The warts usually do not cause any pain or discomfort; however they can bleed and even cause pain during sexual intercourse if they are located in the vaginal region.
Hyperthermia
  • Local hyperthermia at 45 C concomitantly increased the mRNA expression of CCL-20 and IL-1α in normal skin.[ncbi.nlm.nih.gov]
Withdrawn
  • Seven patients were withdrawn from the study because of poor compliance or side effects or were lost to follow up. The primary end point for evaluation of efficacy was at 12 weeks. The results are summarised in table 1.[doi.org]
Neglect
  • The reason for extensive exophytic growth was due to delay in therapy because of the patient's self neglect but not due to immune deficiency. The patient was treated with wide surgical excision.[ncbi.nlm.nih.gov]
Genital Lesions
  • Gissman L, Schneider A: Human papillomavirus DNA in preneoplastic and neoplastic genital lesions. In R Peto, H zur Hansen (Eds): Banbury Report 21 . New York: Cold Spring Harbor, 1986, pp. 217–224. Google Scholar 4.[link.springer.com]
  • The complications of Condyloma Acuminata of Vulva include: Recurrence of the infection after treatment Scarring of the genitalia During pregnancy, these genital lesions can become active (may become big), may cause bleeding, or interfere with childbirth[dovemed.com]
  • The complications of Condyloma Acuminata include: Recurrence after treatment The genital area may get disfigured Urethral lesions can cause urine flow obstruction During pregnancy, these genital lesions can become active (may become big), may cause bleeding[dovemed.com]
  • In contrast, most diagnosed external genital lesions are detectable without the aid of magnification or acetic acid, and are therefore, clinically-apparent.[web.archive.org]
Renal Insufficiency
  • During two years of conservative management with transurethral excision, electrocoagulation, and intravesical chemotherapy, the disease progressed to involve the entire bladder and resulted in obstructive renal insufficiency that required anterior exenteration[ncbi.nlm.nih.gov]

Workup

Diagnosis of condyloma acuminata begins with a past medical history of the disease and sexual life of the affected individuals. Following this, the following diagnostic procedures are carried out:

  • Tests for sexually transmitted diseases.
  • Pap smear test to detect acanthosis, nuclear abnormality, koilocytic abnormality and papillomatosis. 
  • Filter hybridization is also required for analyzing the genotype of HPV involved.
  • Biopsy of the warts is required to confirm the diagnosis if the warts harden and appear to be darker than the skin color.
Suppression
  • Effective CD8 T-cell-mediated clearance of HPV-infected cells may be defective in patients with CA, leading to recurrent disease and failure to suppress latent HPV reactivation.[ncbi.nlm.nih.gov]
  • CD4 CD25 regulatory T cells (Tregs) inhibit proliferation and cytokine production by both T-helper (Th)1 and Th2 cells and reversibly suppress CTL-mediated immunity.[ncbi.nlm.nih.gov]
  • Japan Received: July 28, 2014; Accepted: July 30, 2014; Published: Aug 01, 2014 Keywords Condyloma Acuminatum; Rectal tumor; Magnified endoscopy Condyloma acuminatum is caused by human papilloma virus, and occurs more often in homosexual males or immune suppressed[austinpublishinggroup.com]
  • The virus seems to cause visible lesions when a person's immune system is suppressed, but many flare up even without an obvious trigger.[healthcentral.com]

Treatment

It is difficult to cure condyloma acuminatum. The treatment regimes are geared towards effective resolution of the warts and prevent the spread of the viral infection to rest of the body. The following are the various methods employed for treating condyloma acuminatum:

  • Application of imiquimod cream [4] and podofilox gel to the affected area daily for a period of 8 weeks. These work by boosting the immune system to ward off the virus from the body. The medicated creams should be avoided by pregnant women and couples should not wear the cream during sexual activity [4].
  • Cyrotherapy is often the treatment of choice when the warts have enlarged and do not respond to medications. It is the method of freezing warts by use of liquid nitrogen [5].
  • Surgery is required when there are multiple warts causing great discomfort to the patient [6].
  • Laser treatment is employed when there are several warts in the urethra or vaginal region. This carbon dioxide photodynamic option reserves the least recurrence rate for condyloma acuminatum [7].
  • Ultrasound guided harmonic scalpel may be used to remove anorectal lesions [8].

Several treatment cycles would be required for resolving the warts. However, if the warts do not respond to 6 consecutive treatment cycles then the patients are usually given other treatment regime.

Prognosis

Condyloma acuminatum cannot be cured. However, with appropriate treatment the conditions can be managed in about 60 to 90% of cases. Warts may reappear after specific periods, but cannot turn cancerous in nature if managed well with treatment. Failure to initiate appropriate treatment regime can pave way for secondary complications.

Complications

Individuals suffering from condyloma acuminate when fail to receive medical attention are at risk of developing anogenital cancer [2]. Patients pose a potential risk of suffering from esophageal, lung and bladder cancer. Also, there are high chances of developing cancer of the vagina, vulva, anus and penis [3].

Etiology

Infections by HPV are the major causative factor. Two genotypes 6 and 11 are known to trigger majority of the cases of condyloma acuminatum. In addition, genotypes 16 and 18 are also considered to be high risk because these are known to cause cervical and anal cancer. These genotypes however have minimal association with genital warts. The factors that increase the risk of contracting HPV include:

  • Being sexually active with multiple partners
  • Practicing sex without any protection
  • Smoking
  • Delivery through an infected vaginal canal [1]

Epidemiology

In the United States, the prevalence of condyloma acuminatum has been reported to be more than 50%. Teenagers and young adults are more susceptible to develop genital warts; with the rate of incidence been highest for individuals aged 20 to 24 years. It has also been estimated that women are more prone to contract genital warts than males.

Sex distribution
Age distribution

Pathophysiology

The human papillomavirus causes condyloma acuminatum. The virus enters the human system by invading the basal cells of the epidermis. After gaining entry the virus causes development of mucosal microabrasions. Individuals can live with no signs and symptoms for several weeks to months. After the latent phase, the formation of warts takes place. The most commonly affected regions include the vagina, cervix, penis, perianal area, vulva and perineum.

Prevention

Condyloma acuminatum can be prevented by practicing safe sex or abstaining from sexual activity. It is also advised that men or women have only one sexual partner and that they refrain from having sex with multiple partners. HPV cannot be prevented by using condoms during sexual intercourse.

Vaccine known as Gardasil has been introduced that protects against 4 strains of HPV infections [9]. Therefore, about 90% cases of condyloma acuminatum can be prevented with this vaccination.

Summary

Condyloma acuminatum, commonly referred to as genital warts is one of the most common forms of sexually transmitted diseases. It is caused by human papillomavirus (HPV) affecting millions of individuals across the globe. There are over 100 strains of HPV and subtypes 6 and 11 are known to trigger majority of the cases of condyloma acuminatum. Individuals who are sexually active with multiple partners fall easy prey to HPV infections.

Patient Information

Definition

Condyloma acuminatum is a disease characterized by development of warts in the genital region. It is one of the most common types of sexually transmitted diseases and should receive prompt diagnosis and treatment to avoid onset of cancer. It is caused due to human papillomavirus (HPV) that has more than 100 strains. Of these, 2 genotypes 6 and 11 are known to cause the majority of genital warts. It has been estimated that about 75 – 80% of sexually active men and women can fall prey to condyloma acuminatum.

Cause

Infection by HPV is the major cause of condyloma acuminatum. The infections spread by skin to skin contact with an infected person. Factors such as having multiple partners and smoking also increase the risk of contracting genital warts.

Symptoms

Usually genital warts are present with no symptoms. These are round shaped and flesh colored. However, they can sometimes cause discomfort, pain and bleed during intercourse.

Diagnosis

Visual examination of the warts followed by biopsy would help in achieving an appropriate diagnosis. In addition, laboratory tests to identify the strain of HPV involved and Pap smear test would also be carried out.

Treatment

Condyloma acuminatum cannot be cured. The warts can be resolved and the spread of infection avoided with proper and rigorous treatment regime. Application of topical agents on the warts along with various therapies forms the basis of treatment regime. In addition, in case of multiple warts surgical procedures may be required. Also, cryotherapy can be conducted for freezing the warts.

References

Article

  1. Sinal SH, Woods CR. Human papillomavirus infections of the genital and respiratory tracts in young children. Semin Pediatr Infect Dis. Oct 2005; 16(4):306-16.
  2. Nordenvall C, Chang ET, Adami HO, Ye W. Cancer risk among patients with condylomata acuminata. Int J Cancer. 2006; 119(4):888-93 (ISSN: 0020-7136)
  3. Kishimoto T, Mabuchi S, Kato H, Kimura T. Condyloma acuminata induces focal intense FDG uptake mimicking vaginal stump recurrence from uterine cervical cancer: a case report. Eur J Gynaecol Oncol. 2013; 34(1):99-100 (ISSN: 0392-2936)
  4. Haidopoulos D, Diakomanolis E, Rodolakis A, Vlachos G, Elsheikh A, Michalas S. Safety and efficacy of locally applied imiquimod cream 5% for the treatment of condylomata acuminata of the vulva. Arch Gynecol Obstet. 2004; 270(4):240-3 (ISSN: 0932-0067)
  5. Tzathas C, Stavrianeas NG, Triantafyllou K, Triantafyllou G, Ladas SD. Long-term follow-up of endoscopic therapy of anal canal condylomata acuminata with podophyllotoxin. J Eur Acad Dermatol Venereol. 2007; 21(3):364-7 (ISSN: 0926-9959)
  6. Zimmerman EE, Crawford P. Cutaneous cryosurgery. Am Fam Physician. Dec 15 2012; 86(12):1118-24.
  7. Safi F, Bekdache O, Al-Salam S, Alashari M, Mazen T, El-Salhat H. Management of peri-anal giant condyloma acuminatum--a case report and literature review. Asian J Surg. Jan 2013; 36(1):43-52.
  8. Zhu X, Chen H, Cai L, Yu Z, Cai L. Decrease recurrence rate of condylomata acuminata by photodynamic therapy combined with CO2 laser in mainland China: a meta-analysis. Dermatology. 2012; 225(4):364-70.
  9. Colombo-Benkmann M, Tübergen D, Buchweitz O, Senninger N. Ultrasonic technology: a new treatment option for anal condylomata acuminata.Dis Colon Rectum. 2008; 51(11):1681-5 (ISSN: 1530-0358)
  10. FDA News Release - Oct 16, 2009. FDA Approves New Indication for Gardasil to Prevent Genital Warts in Men and Boys. Accessed November 30, 2009.

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Last updated: 2018-06-22 02:37