Condyloma Acuminata

Benign epithelial proliferations (anogenital warts) caused by human papillomavirus (HPV) infection

Aetiology

Causative virus:
  • Human papillomavirus (HPV), non-enveloped DNA virus
Common HPV types:
  • Low-risk: HPV 6, 11 (condyloma acuminata)
  • High-risk (oncogenic): HPV 16, 18, 31, 33 (usually not causing visible warts)
Virological features:
  • Double-stranded DNA virus
  • Infects basal epithelial cells through microabrasions
  • Causes epithelial hyperplasia

Clinical presentation

Morphology of Lesions

  • Soft, fleshy, papillomatous or verrucous growths
  • May be:
    • Filiform
    • Papular
    • Flat
  • Often described as “cauliflower-like”
  • Usually painless but may itch or bleed
notion image

Common Sites

  • Men: glans penis, prepuce, frenulum, shaft
  • Women: vulva, vagina, cervix, perianal area
  • Both sexes: anus, perineum
  • Oral cavity: lips, tongue (oral–genital contact)

Variants

  • Giant condyloma (Buschke–Löwenstein tumor)
    • Large, locally invasive
    • Low metastatic potential
  • Flat condyloma (especially on cervix)

Investigations

Clinical Diagnosis

  • Typical morphology and location
  • Positive acetowhite test (screening aid, not diagnostic)

Histopathology (if needed)

  • Papillomatosis
  • Acanthosis
  • Parakeratosis
  • Koilocytosis (HPV cytopathic effect)

HPV Testing

  • Not routinely required for visible warts
  • Used for cervical cancer screening

Management

Patient-Applied Therapies

  • Podophyllotoxin 0.5% BID for 3 days → CI in pregnancy

Provider-Applied Therapies

  • Trichloroacetic acid 80-90% → Safe in pregnancy
  • Podophyllin 25% → CI in pregnancy
  • Chemical cautery
  • Cryotherapy
  • Electrosurgery
  • Laser ablation
  • Surgical excision