Sexually Transmitted Infections: Condylomata Acuminata

Introduction

• Description: Condylomata acuminata are raised, warty lesions caused by infection by the human papillomavirus (HPV, singular: condyloma acuminatum).

• Prevalence: Most common sexually transmitted infection (STI), 500,000 cases per year. Women account for two-thirds of cases. HPV is responsible for >20,500 virus-related cancers in women each year. At least 75% of sexually active adults in the United States have been infected.

• Predominant Age: 16–33 years; peak 20–24 years.

• Genetics: No genetic pattern.

Etiology and Pathogenesis

• Causes: Caused by infection by HPV (most frequently serotypes 6 and 11; 90%). This double-stranded nonenveloped DNA virus is found in 2%–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 even resist 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. Approximately 65% of patients acquire the infection after intercourse with an infected partner.

• Risk Factors: Skin-to-skin contact with an infected person; multiple sexual partners; the presence of other vaginal infections such as candidiasis, trichomoniasis, or bacterial vaginosis; smoking; and oral contraceptive use.

Signs and Symptoms

• Asymptomatic (<2% have condyloma)

• Painless, raised, soft, fleshy growths on the vulva, vagina, cervix, urethral meatus, perineum, and anus (mild irritation or discharge may accompany secondary infections). Symmetric lesions across the midline of the genital area are common (condyloma also may be found on the tongue or within the oral cavity, urethra, bladder, or rectum). Approximately 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%–5% acetic acid to make apparent the raised, white, shiny plaques.

• Abnormal cervical cytologic changes are common.

• Condyloma are occasionally pruritic or may manifest through bleeding, burning, tenderness, vaginal discharge, pain, obstruction of the vagina, or dyspareunia.

Diagnostic Approach