What are the other Names for this Condition? (Also known as/Synonyms)

• Anal Warts
• Condyloma Acuminata
• Venereal Warts

What is Condyloma Acuminatum? (Definition/Background Information)

• Condyloma Acuminatum is one of the most common sexually transmitted disease (STD). The disease is transmitted from one individual to another through direct sexual contact including genital, anal, or oral sex practices with an infected partner. It is also variously known as Genital Wart or Anogenital Wart
• Condyloma Acuminatum is caused by the human papilloma virus (HPV) type 6 or less commonly by HPV type 11. The infection is a benign (non-cancer) skin and mucous membrane growth (tumor) occurring on the genital and perianal region. The warts appear as multiple, soft, skin-colored lumps on the genitalia and adjacent areas
• Most individuals need no treatment, but informing and educating the infected individuals on the importance of safe sex is essential to prevent the spread of HPV infection
• Many treatment options are available, however there is a possibility for the infection to return, even after a successful treatment

Who gets Condyloma Acuminatum? (Age and Sex Distribution)

• It is estimated by the US Centers for Disease Control and Prevention (CDC) that around 50% of all sexually-active individuals may become infected with the genital human papilloma virus
• Condyloma Acuminata most commonly occurs in sexually-active individuals that include teenagers and young adults; but, it can also occur in older individuals
• Although the condition occurs with equal incidence in men and women, women seem to have the infection more often (including subclinical infection), and so present with symptoms more often than men
• The infection occurs worldwide; there is no ethnic or racial preference observed

What are the Risk Factors for Condyloma Acuminatum? (Predisposing Factors)

The risk factors of Condyloma Acuminata include:

• Unprotected sex or sexual contact
• Multiple partners
• Early age of sexual contact
• Having sexual contact with an individual whose sexual history is not known
• Smoking and alcohol
• A weak immune system increases one’s risk
• The use of birth-control pills
• Pregnancy

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Condyloma Acuminatum? (Etiology)

Condyloma Acuminata is caused by human papilloma virus (type 6 and 11). The HPV is a very small microorganism that is transmitted sexually.

• The subtypes of the virus commonly associated with Condyloma Acuminata are type 6 and 11, and less commonly types 16,18,31,33, and 35
• It is transmitted from one individual to another through direct sexual contact including genital, anal, or oral practices with an infected partner
• Direct skin to skin contact of genital areas is sufficient enough to get Genital Warts. This implies that a penetrative intercourse is not really necessary for infection spread
• The use of sex play-toys can help spread the infection

What are the Signs and Symptoms of Condyloma Acuminatum?

There can be various presentations with Condyloma Acuminata. It may take anywhere from 1-8 months following exposure to be affected by Genital Warts. The signs and symptoms of Condyloma Acuminata may include:

• Individuals may have the infection, but may not have visible warts. This is called subclinical infection, or the individuals are called carriers (not having signs or symptoms). A subclinical infection is common. These individuals have the potential to infect other non-infected individuals
• Frequently, the lesions or warts are present in multiple numbers; less commonly they may occur as only a single lesion/wart. The Genital Warts usually have the color of the skin (flesh-colored)
• In most individuals, the Genital Warts do not cause any discomfort such as pain or itching
• The warts are generally present as small to large lumps in the genital areas. These may occur in clusters. Some of these clusters give the appearance of a cauliflower. Sometimes, the warts are very small that they are not visible to the naked eye
• The lesions are usually soft to touch in regions where it is moist (vulva), and firm in areas where it is dry (thigh, penis shaft, etc.)
• In men, the warts are generally noticed on the tip and shaft of the penis, under the prepuce, on the coronal sulcus (under the glans head), urethra, on the scrotum, or thighs
• In women, it is usually seen inside and outside of the vagina (vulva), on the opening of the womb (cervix), or urethra
• In both men and women, it may be seen in and around the anus (perianal)
• Condyloma Acuminata can also be found inside the mouth or throat, when the infection is transmitted through oral sexual contact
• Some individuals may have itching or burning sensation
• Women may complain of bleeding or pain during intercourse

How is Condyloma Acuminatum Diagnosed?

The following procedures may be used to diagnose Condyloma Acuminata:

• Thorough evaluation of the individual’s medical history and a complete physical examination, which includes examination of the penis, scrotum, vagina, vulva, thigh, anus, perineum, adjacent skin, and oral cavity
• During history taking the physician may want to know the following:
  • When the symptoms began and whether they are becoming worse
  • About one’s personal history of sexual practices, barrier methods used, history of other sexually transmitted diseases, etc.             
• Infectious disease specialist consultation may be necessary, if the warts are associated with other STDs
• Condyloma Acuminata are usually diagnosed by their characteristic appearance during the physical examination. The physician may also look for signs and/or tests to confirm the presence of other STDs, precancerous or cancerous lesions, etc.
• Colposcopy, a device to look closely into the vulva, vagina, and cervix for the presence of abnormal areas is used
  • Acetic acid test: During colposcopy (or by using a magnifying lens), a small amount of mild acid is placed on the suspected area to distinguish the wart (which gives a whitish color) from surrounding normal regions. Sometimes, infected areas that are not visible to naked eye may be made visible though this test
  • Biopsy may be taken during a colposcopy
  • HPV testing may also be performed           
• Pap smear: Cells are collected from the tip of the womb (cervix) and examined under the microscope for associated precancerous or cancerous lesions
• Human papilloma virus tests: These tests are performed on the cells taken during a Pap smear examination, to check for the presence of HPV
• Tissue biopsy and histopathology: In this procedure, the physician removes a sample of the wart tissue and sends it to the laboratory for a histopathological examination. The pathologist examines the biopsy under a microscope and arrives at a definitive diagnosis after a complete evaluation of the clinical and microscopic findings, as well as by correlating the results of special studies, such as HPV DNA testing, ISH, or PCR on tissues (if required).

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Condyloma Acuminatum?

The complications of Condyloma Acuminata include:

• Recurrence after treatment
• The genital area may get disfigured
• Urethral lesions can cause urine flow obstruction
• During pregnancy, these genital lesions can become active (may become big), may cause bleeding, or interfere with childbirth
• Some of the individuals may have a lot of distress with the presence of these lesions on their genitalia
• Genital Warts usually do not become cancerous. Nevertheless, they may have associated cancer-causing HPV infection that may later cause cancer

How is Condyloma Acuminatum Treated?

Not all Genital Warts do require treatment. In some individuals, if the lesions are asymptomatic, then having no treatment is an option. The treatment options for Condyloma Acuminata include:

• Medications: It is important to note that the medications available for over-the-counter ‘wart’ treatment are meant for the non-genital areas only. The physician may try one of the prescription topical medications based on your clinical situation. These medications are to be applied directly over the warts. It may take several months before the warts completely disappear. The topical medications include:
  • Imiquimod: It acts by increasing the body’s immunity to fight the warts. It is advised to avoid sexual contact while using this medication, as it can dampen the condoms’ effect, or it may irritate the partner’s skin
  • Podophyllin: It acts by destroying the wart tissue. This application ointment is not to be applied internally and is not to be used during pregnancy
  • Trichloroacetic acid: It acts by destroying the wart tissue and is applied by the physician
• Surgical treatment: Surgery may be warranted if the wart is big, not responding to medication, or if the individual is pregnant. The surgery may cause a swelling, pain, redness, or even a scar. The options available include:
  • Cryotherapy: Liquid nitrogen is used to freeze the wart tissue and form a blister on the skin. The wart sloughs-off as the blister heals
  • Surgical excision: The wart can be removed using simple surgical tools as an outpatient procedure in the health center
  • Electrocautery: It involves burning-off the wart tissue using an electrical current   
  • CO2 laser treatment for destroying the wart
• Counselling and treatment of one’s partner is important to prevent spread of the disease
• Follow-up is necessary to see if treatment options are working favorably and for follow-up, in case of other associated conditions
• Despite a variety of treatment options available to remove the warts, there is a possibility for it to recur, because the treatments available are mostly aimed at removing the warts and not the underlying infection, which caused the warts

The healthcare provider will recommend the best treatment options based upon each individual’s health circumstances.

How can Condyloma Acuminatum be Prevented?

The preventative measures of Condyloma Acuminata include:

• As with any other sexually transmitted disease, the warts can be prevented to a great extent by the use of condoms (practicing safe sex)
  • It is important note that your partner may not have visible warts, but he/she may have the infection and thus can infect you
  • Even non-condom areas can have subclinical infection and you may be infected       
• Avoid multiple partners; try to maintain monogamous relationships
• If possible, avoid sexual contact with individuals having Genital Warts
• Vaccines are available against HPV (for both women and men between the ages 9 and 26 years) to help prevent cervical cancer and Genital Warts
• Duly inform your partners if you are being treated for the condition, as they might have the same infection and require treatment

What is the Prognosis of Condyloma Acuminatum? (Outcomes/Resolutions)

• Condyloma Acuminata has a variable prognosis; it varies from one individual to another
• The infection may subside on its own with or with treatment
• It may recur (come back) after successful treatment, or many years after a successful treatment
• Men, in comparison to women, have fewer symptoms, although both can have the infection

Additional and Relevant Useful Information for Condyloma Acuminatum:

It is important to note that other HPV types especially 16 and 18 cause cervical cancer. And other types, apart from 6, 11, 16, and 18 cause warts in other parts of the body.