Definition

Condyloma acuminata, also known as genital warts, are small growths or bumps around the genitals and anus. Condyloma acuminata is usually painless, but can cause itching, redness, or discomfort, and may bleed.

Condyloma acuminata is one of the most common sexually transmitted infections (STIs). This condition is caused by the infection of several types of Human Papillomavirus (HPV). The HPV virus itself has many types and not all of them cause condyloma acuminata. It is estimated that only about 10% of cases of HPV infection cause symptoms, and the rest can be infected with HPV but not cause symptoms. Condyloma acuminata is a benign wart, not a malignancy (cancer).

Cases of condyloma acuminata are quite common in late adolescence or young adulthood, in late teens and twenties, with an estimated incidence of 400,000 cases each year.

Causes

Condyloma acuminata is caused by Human Papillomavirus (HPV) infection. About 90% of cases are caused by low-risk viruses, namely types 6 and 11 of HPV. These viruses are highly contagious through skin-to-skin contact, especially during sexual intercourse. However, the virus does not always cause symptoms like genital warts. In fact, in most cases, the virus will go away on its own without causing any health problems.

Condyloma acuminata is usually caused by a different type of HPV than the type of HPV that causes warts on the hands or other parts of the body. Therefore, you will not contract genital warts by touching yourself or others with hands or feet that have warts.

Transmission of condyloma acuminata is spread through:

• Sexual intercourse, including anal, vagina-penis, and vagina-vagina intercourse.
• Genital touching (skin-to-skin contact without ejaculation).
• Giving oral sex to someone who has HPV or condyloma acuminata.
• Receiving oral sex from someone who has HPV or who has condyloma acuminata on the mouth, lips, or tongue.

Some patients may develop symptoms within a few weeks of infection. However, it often takes months or years for the infection to cause symptoms. Therefore, it is quite difficult to determine when you were infected with the HPV virus. You may also have been infected with HPV without developing any symptoms.

Risk Factors

Most people who are sexually active will get infected with condyloma acuminata at some point. Factors that may increase your risk of infection include:

• Had unprotected sexual intercourse (condoms) with many different partners
• Have other sexually transmitted infections
• Had sexual intercourse with a partner whose sexual history you do not know
• Being sexually active at a young age
• Having a compromised immune system, such as from HIV infection or immunodeficiency drugs
• Smoking

Symptoms

In women, condyloma acuminata can grow on the vulva (vaginal lips), vaginal wall, the area between the external genitals and anus, anal canal, and cervix. In men, acuminate condyloma can occur on the tip or shaft of the penis, scrotum (testicle sacs), or anus. Condyloma acuminata can also be found in the mouth or throat of someone who has had oral sexual contact with an infected person. Signs and symptoms of condyloma acuminata include:

• Small, brown or pink bumps in your genital area
• It has several warts close together and has a cauliflower-like shape.
• Itching, burning sensation or discomfort in your genital area
• Bleeding during intercourse
• Genital warts can be so small and flat that they are invisible. However, in rare cases, genital warts can develop into a large cluster in someone with a compromised immune system.

Diagnosis

In diagnosing condyloma acuminata, the doctor would start by conducting a medical interview with you. They could ask you about your symptoms as well as your sexual history, such as whether you have had sexual intercourse, including oral sex, unprotected sex, and changing partners. Then your provider would perform a physical examination, especially in the area around the growth of condyloma acuminata. The doctor will inspect the growth directly and assess the shape of the growing warts. In general, the diagnosis of condyloma acuminata can be established based on the results of a medical interview and the clinical appearance of the warts. However, your provider may also perform supporting examinations to confirm the diagnosis of condyloma acuminata, such as:

• Acetowhite (IVA) test. The doctor will apply a mild acid solution to your affected skin to help make the genital warts more visible. This may cause a slight burning sensation.
• Pelvic examination. Female patients may get a Pap test (Pap's smear) as part of a pelvic exam to check for cervical (cervix) changes caused by genital warts. The doctor may also perform a colposcopy (examination of the cervix) to examine the vagina and cervix and perform a biopsy.
• Blood test. The doctor may also check for other STIs that are often associated with condyloma acuminata, such as gonorrhea,syphilis, and chlamydia.
• Anus and rectal examination. The doctor will use an instrument called an anoscope to look inside the anus to check for warts.
• Biopsy. The doctor may perform a biopsy (cutting and removing a small piece of wart tissue the size of a pencil lead) if he is in doubt about the diagnosis.

Management

In some cases, condyloma acuminata may go away on its own, or it may get bigger and multiply. There are various ways to remove genital warts and you may require multiple treatments to remove the warts. In most treatment options, you will first be given anesthesia to numb the area that will be treated. During the treatment process you will undergo, you should abstain from sexual contact. Doctors may use any of the following methods to treat condyloma acuminata, such as:

• Electrocauter, which uses an electric current to cauterize the wart.
• Cryotherapy, where the doctor will use liquid nitrogen to freeze and destroy the wart.
• Laser therapy, which destroys the tiny blood vessels within the wart and cuts off the wart's blood supply.
• Loop Electrosurgical Excision Procedure (LEEP), where the doctor will use an electrically charged wire loop to remove the wart, especially warts on the cervix.
• Topical medicine is a type of medicine applied to the wart once a week for several weeks. The provider may apply a TCA (trichloroacetate) solution to the wart or may give you a prescription that you can apply yourself, such as Imiquimod cream.
• Surgery, where the doctor may cut out large warts surgically or warts that do not respond to other treatments.

Complications

Condyloma acuminata, found on the cervix or inside the vagina, can cause changes in the cervix (dysplasia) that can lead to cervical cancer. There is also an increased risk of developing cancer of the penis and anus.

Prevention

If you are sexually active, you can take these steps to prevent yourself from getting infected or passing on HPV infections and other sexually transmitted infections:

• Use condoms during sexual intercourse.
• Get the HPV vaccine.
• Get regular medical check-ups and necessary treatment for STIs.
• Inform your sexual partners if you’re currently infected with HPV or have genital warts so they can also be checked and treated.
• Be monogamous with one sexual partner or limit your number of sexual partners

When to See a Doctor?

Consult a doctor if you or your partner have warts in the genital area.

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