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Genital warts (condylomata acuminata) (Clinical presentation (Warts …
Genital warts
(condylomata acuminata)
Definition
Sexually transmitted infection with HPV
causing benign, proliferative growths of
the genital, perineal, anal, perianal area
Epidemiology
10% lifetime risk
Mostly heterosexual
YAs (F 20-24y, M 25-34y)
Pathophysiology
Agent
HPV subtypes 6 and 11
Mechanism
Infection of genital, perineal, anal, perianal skin
Urethra, vagina, cervix, anal canal
Incubation period 3-18m (can be longer)
Forms hard, keratinsed warts on hairy skin, soft non-keratinised warts on hairless skin
Transmission
Sexual contact (skin to skin, oral-genital)
Contaminated surfaces/objects, autoinnoculation
Clinical
presentation
Warts
Anogenital region
Painless/painful, bleeding, local irritation
Discharge
Urethral,vaginal
Bleeding
Vaginal - IMB, PCB
Anal
Dysuria
Asymptomatic
Most people
Diagnosis
(clinical)
History
PMH
Previous STIs and treatment
Chronic medical conditions
DH
Current medications, allergies
SxH
Partner (casual/regular, origin, age, gender)
Type of sex (vaginal, anal, oral, receptive/passive)
Partners (last 3m, last 12m)
Contraception (barrier or not)
BBV risk (HIV tests, IVDU, paid for sex, blood transfusion)
SH
Occupation, social support, alcohol, smoking, drugs
PC/HPC
anogenital growth, dysuria, bleeding, discharge
Reproductive history
Gynae: menses, bleeding, contraception, smears
Obs: gravity/parity, delivery, complications
Examination
External genital examination
Warty cauliflower growths, non-tender, broad-based,
hard/soft, may be keratinised
Speculum
Internal warts
Investigations
Swabs
Genital/FPU (NG/CT NAAT)
Bloods
HIV, HBV/HCV, syphilis
Biopsy
If unclear diagnosis
Management
Medical
Topical podophyllotoxin
Indication: soft, non-keratinised external warts
E.g. condyline cream, warticon cream
CI: pregnancy, nut allergy
Topical imiquimod
Indication: keratinised or non-keratinised wart
E.g. aldara cream
CI: pregnancy
Topical sinecatechin
Indicaton: external warts and immunocompromised
E.g. catephen ointment
Surgical
Excision
Electrocautery
Cryotherapy
Conservative
Referral to GUM (treatment)
Information and advice
Watch and wait (30% dissapear <6m)
Complications
Co-infection high-risk HPV
Anogenital cancer, cervical cancer
Disfiguring
Large warts
Psychosocial
Anxiety and distress
Treatment complications
Phypo/hyperpigmentation
Scarring
Bleeding, infection
Prognosis
Benign, often asymptomatic
Resolve spontaneously in 10-30% in 3-6m
Mostly transient (not detected after 2y in 95%)
Prevention
HPV vaccination
School-aged females 11-17y
Bivalent (16+18), quadrivalent (16, 18, 6, 11)