13/10/2015

CondylomaAcuminataClinicalPresentation:History,Physical,Causes

CondylomaAcuminataClinicalPresentation
Author:DelaramGhadishah,MDChiefEditor:BarryEBrenner,MD,PhD,FACEPmore...
Updated:Aug14,2015

History
Seethelistbelow:
Smoking,oralcontraceptives,multiplesexualpartners,andearlycoitalage
areriskfactorsforacquiringcondylomaacuminata.
Generally,twothirdsofindividualswhohavesexualcontactwithapartner
withcondylomaacuminatadeveloplesionswithin3months.
Thechiefcomplaintusuallyisoneofpainlessbumps,pruritus,ordischarge.
Involvementofmorethan1areaiscommon.Historyofmultiplelesions,
ratherthan1isolatedwart,iscommon.
Oral,laryngeal,ortrachealmucosallesions(rare)presumablyaretransferred
byoralgenitalcontact.
Historyofanalintercourseinbothmalesandfemaleswarrantsathorough
searchforperianallesions.
Rarely,urethralbleedingorurinaryobstructionmaybethepresenting
complaintwhenthewartinvolvesthemeatus.
Thepatient'shistorymayindicatepresenceofpreviousorothercurrent
STDs.
Coitalbleedingmayoccur.Vaginalbleedingduringpregnancymaybedueto
condylomaeruptions.
Latentillnessmaybecomeactive,particularlywithpregnancyand
immunosuppression.
Lesionsmayregressspontaneously,remainthesame,orprogress.
Pruritusmaybepresent.
Dischargemaybeacomplaint.

Physical
Seethelistbelow:
Singleormultiplepapulareruptionsmaybeobserved.Eruptionsmayappear
pearly,filiform,fungating,cauliflower,orplaquelike.Theycanbequite
smooth(particularlyonpenileshaft),verrucous,orlobulated.Eruptionsmay
seemharmlessormayhaveadisturbingappearance.
Carefullysearchforsimultaneouslyinvolvedmultiplesites.
Eruptions'colormaybethesameastheskin,ortheymayexhibiterythema
orhyperpigmentation.Checkforirregularityinshape,form,orcolor
suggestiveofmelanomaormalignancy.
Propensityhasbeenestablishedforpenileglansandshaftinmenandfor
vulvovaginalandcervicalareasinwomen.Incontrasttoearlyreports,
presenceofexternalcondylomaacuminatainbothmenandwomenwarrants
athoroughsearchforcervicalorurethrallesions.Suchinternallesionshave
beenfoundinmorethanonehalfoffemaleswithexternallesions.One
reportindicatesthatinfectedmaleshavea20%chanceofhavingsubclinical
urethrallesions.Morethan50%offemalepatientswithexternallesionshave
beenfoundtohavenegativePapanicolaou(Pap)testsbuttestedpositivefor
HPVinfectionusinginsituhybridization.
Urethralmeatusandmucosallesionscanoccur.Somearesubclinical.Hair
ortheinneraspectofuncircumcisedforeskinhidessomelesions.
SearchforevidenceofotherSTDs(eg,ulcerations,adenopathy,vesicles,
discharge).
Lookforperianallesions,particularlyinpatientswithhistoryorriskof
immunosuppressionoranalintercourse.

Causes
Seethelistbelow:
Severaloftheepidermotropichumanpapillomaviruses(HPVs)cause
condylomaacuminata.
HPVtypes6and11mostcommonlyareisolated,butmanyofthemore
than60typesofHPVpotentiallycausecondyloma.
Malesexualpartnersofwomenwithcervicalintraepithelialneoplasiaoften
haveinfectionswiththesameviraltype.
DifferentialDiagnoses

ContributorInformationandDisclosures
Author
DelaramGhadishah,MDPhysician,EmergencyDepartment,KaiserPermanenteWestLosAngelesMedical
Center

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13/10/2015

CondylomaAcuminataClinicalPresentation:History,Physical,Causes

DelaramGhadishah,MDisamemberofthefollowingmedicalsocieties:AmericanAcademyofEmergency
Medicine,AmericanCollegeofEmergencyPhysicians
Disclosure:Nothingtodisclose.
SpecialtyEditorBoard
FranciscoTalavera,PharmD,PhDAdjunctAssistantProfessor,UniversityofNebraskaMedicalCenterCollege
ofPharmacyEditorinChief,MedscapeDrugReference
Disclosure:ReceivedsalaryfromMedscapeforemployment.for:Medscape.
BarryJSheridan,DOChiefWarriorinTransitionServices,BrookeArmyMedicalCenter
BarryJSheridan,DOisamemberofthefollowingmedicalsocieties:AmericanAcademyofEmergency
Medicine
Disclosure:Nothingtodisclose.
ChiefEditor
BarryEBrenner,MD,PhD,FACEPProfessorofEmergencyMedicine,ProfessorofInternalMedicine,
ProgramDirectorforEmergencyMedicine,CaseMedicalCenter,UniversityHospitals,CaseWesternReserve
UniversitySchoolofMedicine
BarryEBrenner,MD,PhD,FACEPisamemberofthefollowingmedicalsocieties:AlphaOmegaAlpha,
AmericanHeartAssociation,AmericanThoracicSociety,ArkansasMedicalSociety,NewYorkAcademyof
Medicine,NewYorkAcademyofSciences,SocietyforAcademicEmergencyMedicine,AmericanAcademyof
EmergencyMedicine,AmericanCollegeofChestPhysicians,AmericanCollegeofEmergencyPhysicians,
AmericanCollegeofPhysicians
Disclosure:Nothingtodisclose.
AdditionalContributors
WilliamKChiang,MDAssociateProfessor,DepartmentofEmergencyMedicine,NewYorkUniversitySchool
ofMedicineChiefofService,DepartmentofEmergencyMedicine,BellevueHospitalCenter
WilliamKChiang,MDisamemberofthefollowingmedicalsocieties:AmericanAcademyofClinicalToxicology,
AmericanCollegeofMedicalToxicology,SocietyforAcademicEmergencyMedicine
Disclosure:Nothingtodisclose.

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