Condylomata acuminata or anogenital warts are skin lesions caused by human papillomavirus (HPV) infection.
Of the more than 150 strains of HPV, 40 affect the skin and mucous membranes of the anogenital region and mouth. Condylomas usually manifest as pink warts or cauliflower-like lesions. In most cases, the infection is asymptomatic meaning that there are no visible lesions although the virus is present in the skin / mucous membrane.
The significance of Human papillomavirus infection is that certain strains, like HPV16, 18 and 31, in long-term infections can lead to the development of cervical and anal cancer, and less often squamous cell carcinoma of the penis, vagina, mouth and throat.
How can one become infected with HPV?
Genital infection is most often transmitted through intimate physical contact. Other body parts can get infected through direct skin-to-skin contact, but also indirectly when in contact with infected surfaces (swimming pools, gyms).
What do condylomas look like?
On the external genitalia, perineum, around the anus and groin:
– they usually appear as tiny, soft, reddish, skin-coloured or brown bumps and spiky warts. Their size can vary, but it is usually about a few millimetres. If the condylomas merge with each other, warty plaques can form, a few centimetres in diameter.
Bowenoid Papulosis is an infection caused by Human papillomavirus that presents as tiny reddish, brownish bumps on the external genitalia, around the anus and on the perineum. It usually affects younger people. Although the lesions look like ordinary warts, they can represent the initial stage of squamous cell carcinoma, which is why biopsy, histopathological analysis and treatment with radiofrequency or surgical excision are indicated.
Giant condyloma (Buschke-Lowenstein tumour) is a semi-malign form of vertebral tumour that rarely metastasizes, but has local invasive and destructive growth. The lesions are usually present on the external genitalia and around the anus, in the form of large cauliflower-like masses with fistulas and abscesses. Treatment consists of deep surgical excision.
Condyloma of the oral mucosa:
– looks like small pink or whitish, soft growths, with flat surface
– may be present on the mucous membrane of the cheeks, lips, palate, tongue or oropharynx
– is most often associated with Human papillomavirus types 6 and 11.
Oral florid papillomatosisis a form of HPV infection that manifests as numerous, interconnected warts in the oral cavity or nasal mucosa. Repeated biopsies are needed in these cases to rule out the presence of cancer.
Risk factors for condyloma development:
* greater number of lifetime sexual partners
* sexual contacts at a younger age
* unprotected sexual intercourse
* condoms do not represent a complete protection against condyloma infection, because they do not cover all parts of the skin
How is condyloma diagnosed?
In most people, the diagnosis is made based on a clinical examination and clinical picture of the lesions. Condyloma can be made more visible if it is coated with a weak solution of acetic acid causing it to turn white. In women with genital warts, colposcopy is indicated, as well as rectal examination. Also, Papanicolaou test is recommended for an early detection of cervical cancer.
The diagnosis is most reliably made based on a pathohistological examination of the lesion that is surgically removed.
How are anogenital warts treated?
Asymptomatic HPV infections (the virus is present in the skin, but there are no visible lesions) cannot be treated.
HPV infections are often spread around a large area of the anogenital region, which is why, the rate of recurrence of condyloma is quite high, about 25% – 60%, regardless of the type of treatment which requires patience and persistence.
Following methods and preparations can be used to treat condyloma:
* Aldara (imiquimod) Cream 5%, works by helping to activate the immune system to fight the infection. The use of this cream may cause the Inflammation and sores. It can be used by a patient at home, under the supervision of a dermatologist.
* Podophyllotoxin 0.5% solution can be used by a patient at home, as physician prescribed it. The use of this cream may cause wounds and irritation at the application site. It must not be used during pregnancy.
* Trichloroacetic acid 80% solution causes the destruction of warts. Treatment is performed in medical facility.
* Cryosurgery (with liquid nitrogen) is a very effective and safe therapy, which can be performed in pregnant women. It usually takes several cycles for the complete removal of condyloma.
* Electrocautery is performed using a radiovawes or Hyfrecator and it is considered a method of choice. Condyloma are removed by burning them with a low-voltage electrified probe. It is always performed under anaesthesia.
* Surgical excision is indicated for large, widespread lesions.
* Laser therapy is also a method of choice like electrocautery.