Chapter 47 Sexually Transmitted Infections: Condyloma Acuminata
INTRODUCTION
Description: Condyloma acuminata are raised, warty lesions caused by infection by the human papillomavirus (HPV).
ETIOLOGY AND PATHOGENESIS
Causes: Caused by infection by HPV (most frequently serotypes 6 and 11; 90%). This DNA virus is found in 2% to 4% of all women, and up to 60% of patients have evidence of the virus when polymerase chain reaction techniques are used. The virus is hardy and may resist even drying, making transmission and autoinoculation common. Some evidence suggests that fomite transmission rarely could occur. The virus is most commonly spread by skin-to-skin (generally sexual) contact and has an incubation period of 3 weeks to 8 months, with an average of 3 months. Roughly 65% of patients acquire the infection after intercourse with an infected partner.
CLINICAL CHARACTERISTICS
Signs and Symptoms
• Painless, raised, soft, fleshy growths on the vulva, vagina, cervix, urethral meatus, perineum, and anus (mild irritation or discharge may accompany secondary infections). Symmetrical lesions across the midline of the genital area common (condyloma may also be found on the tongue or within the oral cavity, the urethra, bladder, or rectum). (Roughly one third of women with vulvar lesions also have vaginal warts or intraepithelial neoplasia [VAIN], and approximately 40% have cervical involvement. Cervical condyloma are generally flatter and may be identified through colposcopic examination; by Pap test; or through the application of 3% to 5% acetic acid to make apparent the raised, white, shiny plaques.)
DIAGNOSTIC APPROACH
Workup and Evaluation
Special Tests: Colposcopic examination; Pap test; or the application of 3% to 5% acetic acid to make apparent the raised, white, shiny plaques. Serotyping is not currently indicated. Biopsy is indicated if the warts are pigmented, indurated, fixed, bleeding, or ulcerated.
