I

INTRODUCTION
I.1 Definition
Condyloma acuminatum refers to an epidermal manifestation attributed to the epidermotropic
human papillomavirus (HPV). More than 100 types of double-stranded HPV papovavirus have
been isolated. Many of these have been related directly to an increased neoplastic ris in men
and !omen.
1
"ppro#imately $0% of condyloma acuminata are related to HPV types & and 11. 'hese ( types
are the least liely to have a neoplastic potential. )is for neoplastic conversion has been
determined to be moderate (types **+ *,+ *$+ -0+ -*+ -,+ ,1-,&+ ,.) or hi/h (types 1&+ 1.)+
(
!ith
many other isolated types. 'he picture is complicated by proven coe#istence of many of these
types in the same patient (10-1,% of patients)+ the lac of ade0uate information on the onco/enic
potential of many other types+ and on/oin/ identification of additional HPV-related clinical
patholo/y.
I.2 Prevalence
"nnual incidence of condyloma acuminatum is 1% in 1nited 2tates. 3t is considered the most
common se#ually transmitted disease (2'4). Prevalence has been reported to e#ceed ,0%.
Hi/hest prevalence and ris is amon/ youn/ adults in the third decade and in older teena/ers. "
--fold or more increase in prevalence has been reported in the last ( decades.
3nternational prevalence has been reported variably. "vailable data from 5n/land+ Panama+ 3taly+
the 6etherlands+ and other developed and underdeveloped countries report HPV infections to be
at least as common as in the 12.
I.3 Mortality and Morbidity
Mortality is secondary to mali/nant transformation to carcinoma in both males and
females. 'his onco/enic potential has been reported to triple the ris of /enitourinary
1
cancer amon/ infected males. 7ortunately+ this is rare !ith HPV types & and 11+ !hich
are the most commonly isolated viruses.
HPV infection appears to be more common and !orse in patients !ith various types of
immunolo/ic deficiencies. )ecurrence rates+ si8e+ discomfort+ and ris of oncolo/ic
pro/ression are hi/hest amon/ those patients. 2econdary infection is uncommon.
9atent illness often becomes active durin/ pre/nancy. Vulvar condyloma acuminata may
interfere !ith parturition. 'rauma then may occur+ producin/ crustin/ or erythema.
:leedin/ has been reported in lar/e lesions that can occur durin/ pre/nancy.
3n males+ bleedin/ has been reported due to flat !arts of the penile urethral meatus+
usually associated !ith HPV-1&. 9esions may lead to disfi/urement of area(s) involved.
7inally+ acute urethral obstruction in !omen also may occur.
I.4 Distribtion
2e#; both se#es are susceptible to infection. <vert disease may be more common in men
(reported in =,% of patients)> ho!ever+ infection may be more prevalent in !omen.
"/e; prevalence is /reatest in persons a/ed 1=-** years+ !ith incidence peain/ in
persons a/ed (0-(- years.
)ace; most studies indicate that no racial predilection e#ists for the ac0uisition of /enital
!arts. 4inh and associates analy8ed data from the 1$$$-(00- 6ational Health and
6utrition 5#amination 2urveys !hich collect data from a random sample of the 1nited
2tates civilian population. 'hese investi/ators reported that non-Hispanic !hites had a
hi/her prevalence of /enital !arts !hen compared !ith other racial?ethnic /roups.
*
2
II
CONT!NT
II.1 !tiolo"y
Condylomata acuminata (C") is a common se#ually transmitted disease.
-
Condyloma acuminata
are usually cauliflo!erlie masses found on the urethra+ penis+ female /enitalia+ perianal area+ or
rectum. 'he lesions are typically limited to a fe! centimeters in diameter at the time of
presentation to physicians.
,
Condyloma are caused by the Human Papilloma Virus (HPV).
Human papillomaviruses+ or HPV+ nonenveloped+ double-stranded+ circular 46" viruses of the
family Papovaviridae are the etiolo/ic a/ents of all types of !art.
&
'here are over 100 subtypes
of HPV based on differences in 46" se0uences. "ppro#imately -0 subtypes are associated !ith
/enital tract infection. 'hese are divided into lo!-ris types (e./.+ HPV & and 11)+ !hich are
most commonly found in patients !ith condyloma acuminatum (i.e.+ /enital !arts) and hi/h-ris
types (e./.+ HPV 1& and 1.) associated !ith appro#imately =0% of invasive cervical cancers and
over $0% of hi/h-/rade intraepithelial lesions.
=+.
3n adults+ types 1 to - are associated !ith
common sin !arts+ types & and 11 !ith ano/enital !arts (that is+ condylomata acuminata) and
types 1& and 1. !ith cervical carcinoma.
&
Condyloma are usually transmitted se#ually+ that is+ passed throu/h direct se#ual contact !ith
someone !ho has the !arts. 'here are certain strains of the virus !hich are not necessarily
se#ually transmitted> that is+ they may be contracted merely by /ettin/ the virus on your hands
and then transmittin/ it to the /enital area. "ll se#ual partners need to be e#amined to rule out
the virus. 'he male partner has a =0% chance of havin/ !arts after repeated se#ual relations !ith
an infected female partner.
-
"nother study found that (0% of uncircumcised and ,.,% of
circumcised se#ually active men had penile HPV by PC) (polymerase chain reaction).
=
Perinatal transmission of HPV+ occurrin/ in utero and durin/ passa/e of the neonate throu/h an
HPV-infected birth canal+ probably accounts for most cases of condylomata acuminata in
children youn/er than ( years of a/e. 3n prepubertal children+ other potential transmission
3
mechanisms include autoinoculation and heteroinoculation from non/enital cutaneous !arts and
from contaminated fomites. "lthou/h ano/enital !arts are considered to be se#ually transmitted
in adults+ this may not be the case for children. 2ubtype specificity is less distinct in children
than it is in adults. 'he most common types of HPV in condylomata from prepubertal children
!ith or !ithout proven se#ual abuse are types & and 11+ follo!ed by type (.
&
II.2 Pat#o"enesis
" !art is an epidermal tumor caused by HPV+ one of the papovavirus family. 3t is no! no!n
that there are more than &0 specific types of HPV> nucleic acid hybridi8ation studies are re0uired
to identify the type by its 46". 'he differentiation has some clinical si/nificance+ such as the
e#ternal ano/enital sin is usually infected !ith types & and 11 (that is condyloma acuminata).
$
HPV infection occurs throu/h inoculation of virus into the viable epidermis throu/h defects in
the epithelium. "lthou/ht the cellular receptors for HPV has not been identified+ cell surface
heparan sulfate+ !hich is encoded by proteo/lycans and binds PV particles !ith hi/h affinity+ is
re0uired for entry. 'o establish persisitent infection+ it is probably necessary to enter an
epidermal basal cell that is either a stem cell or is converted by the virus to one !ith stem cell-
lie properties. 3t is believed that a sin/le copy or at most a fe! copies of the /enome are
maintained as an e#trachromosomal plasmid !ithin the infected epithelial basal cells. @hen
these cells divide+ the viral /enome is also replicated and partitioned to each pro/eny cell+ then
transported !ithin the replicated cells as they mi/rate up!ard to form diffrentiatin/ layers.
'he rou/h surface of !art may disrupt adAacent sin and enable inoculation of virus into adAacent
sites+ !ith the debelopment of ne! !arts ober a periods of !ees to months.
Viral )6" e#pression (transcription) is e#tremely lo! until the upper Malphi/ian layer+ Aust
before the /ranular layer+ !here viral 46" synthesis typically results in hundreds of copies of
viral /enomes per cell. 'he viral capsid proteins are synthesi8ed viral 46" is paca/ed into the
virions in the nuclei of these differentiated Malphi/ian cells. " viral protein called 51-5- may
induce colapse of the cytoplasmic eratin filaments net!or. 'his postulated to facilitate release
of the virions from the crossed-lined cytoseleton of eratiniocytes so that virus can be
inoculated into another site or des0uamated into the environtment.
4
PV do not bud from the nuclear or plasma membrane+ as do many viruses. PV virions are
resistant to desiccarion and to the deter/ents nono#ynol-$+ althou/ht e#posure of of virions to
formalin+ stron/ deter/ents such as sodium dode#yl sulfate+ or prolon/ed reduce their infectivity.
PVs can remain infectious for years !hen stored in /lycerol at room temperature. 3ndeed+ 91 and
9( from ti/htly paca/ed+ very stable protein capsid.
'he states of differentiation of the infected epithelial cell influences viral transcription+ si/nals
initiation of viral 46" synthesis+ and permits virion assembly. 7urther support for the belief that
the production of virus particles depends on the states of epithelial differentiation is the fact that
the virion production decreases as beni/n papilomas pro/ress to!ard dysplasia.
:ecause viral replication occurs in upper levels of the epithelium composed of replicatin/
eratinocytes+ PVs must bloc terminal differentiation and stimulate cell division to provide the
en8ymes and co-factor necessary for replication of viral 46". 5#perimental evidence from cell
culture systems has sho!n that PV proteins can alter cell proliferation and inhibit cell death via
apoptosis.
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II.3 Clinical $eatre
2moin/+ oral contraceptives+ multiple se#ual partners+ and early coital a/e are ris factors for
ac0uirin/ condyloma acuminata. Benerally+ t!o thirds of individuals !ho have se#ual contact
!ith a partner !ith condyloma acuminata develop lesions !ithin * months. 'he chief complaint
usually is one of painless bumps+ pruritus+ or dischar/e. 3nvolvement of more than 1 area is
common. History of multiple lesions+ rather than 1 isolated !art+ is common.
1

<ral+ laryn/eal+ or tracheal mucosal lesions (rare) presumably are transferred by oral-/enital
contact. History of anal intercourse in both males and females !arrants a thorou/h search for
perianal lesions. )arely+ urethral bleedin/ or urinary obstruction may be the presentin/ complaint
!hen the !art involves the meatus. 'he patientCs history may indicate presence of previous or
other current 2'4s. Coital bleedin/ may occur. Va/inal bleedin/ durin/ pre/nancy may be due
to condyloma eruptions. 9atent illness may become active+ particularly !ith pre/nancy and
immunosuppression. 9esions may re/ress spontaneously+ remain the same+ or pro/ress. Pruritus
may be present. 4ischar/e may be a complaint.
1
5
2in/le or multiple papular eruptions may be observed. 5ruptions may appear pearly+ filiform+
fun/atin/+ cauliflo!er+ or pla0uelie. 'hey can be 0uite smooth (particularly on penile shaft)+
verrucous+ or lobulated. 5ruptions may seem harmless or may have a disturbin/ appearance.
1
Carefully search for simultaneously involved multiple sites. 5ruptionsC color may be the same as
the sin+ or they may e#hibit erythema or hyperpi/mentation. Chec for irre/ularity in shape+
form+ or color su//estive of melanoma or mali/nancy. 2earch for evidence of other 2'4s (e/+
ulcerations+ adenopathy+ vesicles+ dischar/e). 9oo for perianal lesions+ particularly in patients
!ith history or ris of immunosuppression or anal intercourse.
1
Benital !arts often occur in clusters and can be very tiny or can spread into lar/e masses in the
/enital or penis area. 3n other cases they loo lie small stals. 3n !omen they occur on the
outside and inside of the va/ina+ on the openin/ (cervi#) to the !omb (uterus)+ or around (or
inside) the anus. 'hey are appro#imately as prevalent in men but the symptoms may be less
obvious. @hen present+ they usually are seen on the tip of the penis. 'hey also may be found on
the shaft of the penis+ on the scrotum+ or around (or inside) the anus. )arely+ /enital !arts also
can develop in the mouth or throat of a person !ho has had oral se# !ith an infected person.
1
'he viral particles are able to penetrate the sin and mucosal surfaces throu/h microscopic
abrasions in the /enital area+ !hich occur durin/ se#ual activity. <nce cells are invaded by HPV+
a latency (0uiet) period of months to years (decades) may occur. HPV can last for several years
!ithout a symptom. Havin/ se# !ith a partner !hose HPV infection is latent and demonstrates
no out!ard symptoms still leaves one vulnerable to becomin/ infected. 3f an individual has
unprotected se# !ith an infected partner+ there is a =0% chance that he or she !ill also become
infected. 'he immune system eventually clears the virus throu/h interleuins+ !hich
recruit interferons+ !hich slo! viral replication.
1
II.4 Dia"nosis
II.4.1 %istory
Most patients see medical care !hen they notice lumps on the vulva+ perianal area+ or
periclitoral area.'hese lesions are /enerally not painful+ but they can be associated !ith
6
pruritus.:leedin/ can be observed if the lesions become confluent and are irritated by
clothin/.
1
II.4.2 P#ysical
3nspection of the female /enital area re0uires /ood li/htin/.<n /ross inspection+ typical
condyloma is usually a discrete papillary /ro!th that arises from a sin/le stal.Condyloma
acuminata can involve a lar/e area in a sessile fashion.2ubclinical infection is another
common presentation of condyloma. 'iny+ sli/htly raised areas can be felt or visuali8ed on
the va/ina or cervi#.'hese flat !arts are best visuali8ed usin/ *-,% acetic acid and a
colposcope. "rea infected !ith HPV appear aceto!hite.<ften+ a biopsy is needed to
distin/uish these lesions from cervical s0uamous intraepithelial lesions or va/inal
intraepithelial lesions.'he se#ual partner or partners of a !oman !ith condyloma should be
e#amined by a physician and treated if indicated.<ften the e#amination of the male fails to
reveal any visible condyloma.
1
II.4.3 Cases
"ppro#imately *0 different types of HPV can infect the ano/enital tract.3nfection caused by
the.HPV virus results in local infections and appears as !arty papillary condylomatous
lesions. HPV infections in the /enital area are se#ually transmitted.
1
II.4.4 Dia"nosis Differential
Chanchroid.Herpes 2imple# + Mali/nant Vulvar 9esions + Pa/et 4isease Condyloma lata+
Hymenal remnants+ 3mmature s0uamous metaplasia+ Micropapillomatosis labialis+
Molluscum conta/iosum+ 2eborrheic eratosis+ 2in ta/s+ 20uamous hyperplasia+ Verrucous
carcinoma+ Vulvar dysplasia.
1
II.4.& 'ab (tdies
Patients !ho present !ith condyloma acuminata do not necessarily need other laboratory
studies.Patients !ho are dia/nosed !ith condyloma are at an increased ris for other 2'4s.
Consider testin/ for chlamydia+ /onorrhea+ syphilis+ hepatitis :+ hepatitis C+ herpes+ H3V
dependin/ on the clinical situation. 7indin/ a cauliflo!er-lie /ro!th on the /enitals is
reason to see a doctor !ho can tell if it is or a different ind of /ro!th.'he practitioner may
7
use a type of microscope called a colposcope to e#amine a !omanCs cervi# to see if there are
internal outbreas.@hen acetic acid (vine/ar) is s!abbed on the cervi# or penis+ HPV
lesions appear !hitish. Colposcopy can be valuable in detectin/ flat lesions that are not
visible to the unaided eye+ but only t!o-thirds of !hite areas seen in a colposcope are due to
HPV infection. 2amplin/ cells !ith a biopsy and testin/ for HPV /enetic material+ may be
necessary to confirm a dia/nosis. 'hese patients need a Papanicolaou (Pap) test of the cervi#
if one has not been performed in the last 1( months. 3n both of these scenarios+ HPV typin/
can detect lo!-ris and hi/h-ris HPV types found in the cervi#. Currently+ the ( most
accurate methods use ( consensus primer polymerase chain reaction (PC)) systems. 'he
commercially available system is the Hybrid Capture 33 system !ith differential testin/ for $
hi/h-ris HPV types and , lo!-ris HPV types.'estin/ for HPV confirmation of e0uivocal
vulvar histolo/y results provides an obAective method for confirmin/ a dia/nosis of
condyloma acuminate.
1
II.& T#era)y
II.&.1 Pre#os)ital Care
Benerally+ prehospital care is un!arranted and inappropriate> ho!ever+ reassure the patient
and search for the possibility of another underlyin/ reason prehospital care !as re0uested.
11
II.&.2 !*er"ency De)art*ent Care
'ype of !orup+ treatment re/imens+ and necessary follo!-up care for condyloma
acuminata /enerally are far beyond the scope of 54 practice. Ho!ever+ the follo!in/
procedures may be implemented if indicated;
11
o 1se pressure to stop any bleedin/.
o )elieve urethral obstruction in rare cases.
o )eassure the patient.
o 2earch for evidence of other coe#istent 2'4s and treat if found.
8
o 4o not be/in treatment of condyloma in the 54.
"lthou/h not 54 treatments+ the follo!in/ are listed strictly for educational purposes and
to assist readers in understandin/ and mana/in/ potential presentin/ complications of
condyloma acuminata. 7urther details on mana/ement are included in the Centers for
4isease Control and Prevention se#ually transmitted diseases treatment /uidelines.
11
o Cryotherapy
Cryotherapy may be performed usin/ an open spray or cotton-tipped
applicator for 10-1, seconds and repeated as needed. 9ift a!ay mobile
sin from underlyin/ normal tissue before free8in/.
Cryotherapy is an e#cellent first-line treatment+ particularly for perianal
lesions.
)esponse rates are hi/h !ith fe! adverse se0uelae.
"dverse reactions include pain at time of treatment+ erosion+ ulceration+
and postinflammatory hypopi/mentation of sin.
Cryotherapy is safe durin/ pre/nancy.
o 5lectrodesiccation; 2moe plume potentially may be infective.
o Curetta/e
o 2ur/ical e#cision
5#cision has hi/hest success rate and lo!est recurrence rate.
3nitial cure rates are &*-$1%.
o Carbon dio#ide laser treatment
1se carbon dio#ide laser treatment for e#tensive or recurrent condyloma
acuminata.
9
Potentially infectious HPV-& 46" has been detected in the carbon
dio#ide laser plume.
9ocal+ re/ional+ or /eneral anesthesia is re0uired. 5utectic mi#ture of local
anesthetics (5M9") cream may be used as an alternative anesthetic.
II.&.3 Medication
Cytoto+ic a"ents
3nhibit proliferation of cells at various sta/es of the cell cycle.
11
Podo)#yll* resin ,Podocon-2&. Pod-/en-2&0
5#tract of various plants+ !hich are cytoto#ic. 5ffective in arrestin/ mitosis in
metaphase. 5#pect cure rate of (0-,0% if used as sin/le a/ent.
11
Podofilo+ ,Condylo+0
Purified podophylloto#in that is antimitotic+ cytoto#ic+ and available for patientCs home
use. @hile e#act mechanism of action on condyloma is unno!n+ podofilo# results in
necrosis of /enital condyloma acuminata. Condylo# is one a/ent containin/ podofilo#.
2li/htly hi/her cure rates can be e#pected !ith podofilo# than !ith podophyllin.
"dditionally+ useful for prophyla#is. 3n adult+ apply 0.,% solution bid for * consecutive
day and discontinue for - day+ not to e#ceed - !. 1se D0., m9 of solution or 0., / of
/el?d> treat D10 cm
(
of tissue per day> !ash hands thorou/hly after each application.
11
Tric#loroacetic or bic#loracetic acids
6o lon/er recommended for routine use. Has antimetabolic and?or antineoplastic and
immunostimulative activity. 1seful in prevention of recurrence after condyloma ablation
if started !ithin - !+ especially in immunocompromised patients.3n adult+ administer
,% cream 0d or periodically for 10 !> apply 1% cream bid for (-& !> mild local
discomfort can be treated !ith cortisol cream> topical ,-71 is best option for preventin/
10
recurrence in immunocompromised patients> in /eneral+ no systemic adverse effects
e#ist> ho!ever+ prolon/ed use results in erosive dermatitis and mucositis> additionally+
ris of va/inal adenosis and clear cell adenocarcinoma e#ists.
11
/leo*ycin ,/leno+ane0
Composed of cytoto#ic /lycopeptide antibiotics+ !hich appear to inhibit 46" synthesis
!ith some evidence of )6" and protein synthesis inhibition to a lesser de/ree> used in
mana/ement of several neoplasms as a palliative measure> may cause a variety of adverse
effects> observe patients fre0uently and carefully durin/ and after treatment. 3n adult+
reconstitute :leno#ane 1,-1 vial !ith 1-, m9 of sterile !ater or 62 for inAection>
administer intralesionally.
11
I*i1i*od ,2ldara0
3nduces interferon production and is a cell-mediated immune response modifier. Has
minimal systemic absorption but causes erythema+ irritation+ ulceration+ and pain.
:urnin/+ erosion+ flain/+ edema+ induration+ and pi/mentary chan/es may occur at
application site. 3mi0uimod ,% cream comes in sin/le-use pacets. 3n adult+ apply at
bedtime for * day+ then rest - day> alternatively+ may apply 0od for * applications> may
repeat !eely cycles up to 1& ! (Patients should apply thin layer to e#ternal+ visible
!arts+ then rub in cream until vanishes. "rea is !ashed !ith soap and !ater &-10 h after
treatment.)
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Interferons
3nterferons are not recommended as a primary treatment modality.

6aturally produced
proteins !ith antiviral+ antitumor+ and immunomodulatory actions. "lpha+ beta+ and
/amma interferons e#ist and may be administered topically+ systemically+ and
intralesionally. 'opical+ systemic+ and intralesional interferons are not efficacious.
11
11
Interferon alfa-n3 ,2lferon N0
"lpha interferon has been approved by 74" for inAectional use in refractory condyloma
acuminata !ith some possible benefit. "lferon 6 is interferon alpha-n*+ !hich has been
used effectively for this purpose. )ecurrence rate of (0--0% e#ists !ith intralesional
interferon+ but recurrence rate after successful treatment is lo!er than !ith other
treatment modalities. "dditionally+ intralesional interferon is e#pensive and re0uires
repeat office visits. 7urthermore+ numerous adverse reactions may occur+ includin/
myal/ias+ fever+ chills+ B3 symptoms+ transient leuopenia+ thrombocytopenia+ 97'
abnormalities+ serum lipid abnormalities !ith intramuscular interferon+ and theoretical
ris of viral transmission !ith natural interferon products. Viral symptoms do abate !ith
time+ and all adverse effects resolve once therapy is stopped. Viral symptoms can be
treated !ith acetaminophen or 62"34s in the interim. 3n adult+ administer interferon
alpha-n* (,0+000 1?!art intralesionally t!ice?! for up to . !> not to e#ceed (.,
million 1 per treatment session. 3n pediatric if the patient D1. years; 6ot recommended>
E1. years; "dminister as in adults.
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Miscellaneos to)ical oint*ent
"nother topical product that has /ained 74" approval for /enital !arts includes
unecatechins.
11
3necatec#ins ,4ere"en0
:otanical dru/ product for topical use consistin/ of e#tract from /reen tea leaves. Mode
of action unno!n but does elicit antio#idant activity in vitro. 3ndicated for topical
treatment of e#ternal /enital and perianal !arts (condylomata acuminatum) in
immunocompetent patients. 3n adult+ apply topically tid> use appro#imately a 0.,-cm
strand of ointment topically for each e#ternal /enital or perianal !art.
11
4accines
12
" human papillomavirus vaccine is no! available for prevention of HPV-associated
dysplasias and neoplasia includin/ cervical cancer+ /enital !arts (condyloma acuminata)+
and precancerous /enital lesions. 'he immuni8ation series should be completed in boys+
/irls+ and youn/ men and !omen a/ed $-(& years.
11
Pa)illo*avirs vaccine ,5ardasil0
Fuadrivalent human papillomavirus (HPV) recombinant vaccine.
7irst vaccine indicated to prevent cervical cancer+ /enital !arts (condyloma acuminata)+
and precancerous /enital lesions (e/+ cervical adenocarcinoma in situ> cervical
intraepithelial neoplasia /rades 1+ (+ and *> vulvar intraepithelial neoplasia /rades ( and
*> va/inal intraepithelial neoplasia /rades ( and *) due to HPV types &+ 11+ 1&+ and 1..
Vaccine efficacy mediated by humoral immune responses follo!in/ immuni8ation series.
3ndicated for prevention of condyloma acuminata caused by HPV types & and 11 in boys+
men+ /irls+ and !omen a/ed $-(& years. 3n adult+ D(& years; 0., m9 3M administered as
* separate doses> administer second and third doses ( and & mo after first dose+
respectively E(& years; 6ot established. 3n pediatric if the patient D$ years; 6ot
established> E$ years; "dminister as in adults.
11
13
III
CONC'UTION
Condyloma acuminata or Benital !arts is a hi/hly conta/ious se#ually transmitted disease. 3t is
refers to an epidermal manifestation attributed to the epidermotropic human papillomavirus
(HPV). "ppro#imately $0% of condyloma acuminata are related to HPV types & and 11 !hich
have neoplastic potential. 'his disease usually cauliflo!er lie masses found on the urethra+
penis+ female /enitalia+ perianal area+ or rectum. 3n perinatal transmission+ these diseases
transmit throu/h utero and durin/ passa/e of the neonate throu/h an HPV-infected birth canal.
7or prepubertal children+ other potential transmission mechanisms include autoinoculation and
heteroinoculation from non/enital cutaneous !arts and from contaminated fomites. Mortality is
secondary to mali/nant transformation to carcinoma in both males and females. HPV infection
appears to be more common and !orse in patients !ith various types of immunolo/ic
deficiencies. 'he dia/nosis of condyloma acuminate can be done by tain/ full medical history+
14
complete anamnesis+ physical e#amination+ and laboratory e#amination. 3nspection of the area
that has been suspect !ith this disease is really /ood approach. 7indin/ a cauliflo!er lie
/ro!ths on the /enitals indicate that person suspected !ith the condyloma acuminate then maybe
need to /et another laboratory e#amination to roll out other 2'4s. 1sually individual !hich
already e#posed to the disease !ill developed the symptom !ithin * month after the contacted.
Painless bumps+ pruritus+ or dischar/e usually is the common chief compliant of the early
symptoms of condyloma acuminata. 2in/le or multiple papular eruptions may appear pearly+
filiform+ fun/atin/+ cauliflo!er+ or pla0uelie !hich can be 0uite smooth+ verrucous+ or
lobulated. 2moin/+ oral contraceptives+ multiple se#ual partners+ and early coital a/e are ris
factors for ac0uirin/ condyloma acuminata. :asically is no cure for HPV+ but there are methods
to treat visible !arts+ !hich could reduce infectivity. 4ependin/ on the si8es and locations of
!arts there is several !ays to treat them. Podofilo# is the first-line treatment due to its lo! cost.
Cytoto#ic a/ents usually use to inhibit proliferation of cells at various sta/es of the cell cycle lie
Podophyllum resin. "n 3mi0uimod ("ldara) and 'richloroacetic or bichloracetic acids also has
been use in treatment of candyloma acuminata. 3nterferon alfa-n* ("lferon 6) are usin/ in
treatment for adult and in a children. 9i0uid nitro/en cryosur/ery is safe for usin/ in pre/nancy.
'he only !ay to prevent HPV infection is to avoid direct contact !ith the virus+ !hich is
transmitted by sin-to-sin contact.
15
R!$!R!NC!(
1. 5#adis#a# D. Condyloma "cuminata. 5medicine; (00$. available at ;
http://emedicine.medscape.com/article/781735 (last access 1* <t (010).
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human papillomavirus. Vaccine. Gul 1. (00.>(& 2uppl *;C(,-*0.
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