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A 40-year-old man requests treatment for lesions on his groin. The lesions have been present for 2 years and have grown bigger in both size and number. They are asymptomatic but psychologically distressing. The patient has been divorced for 5 years and admits to multiple condom-protected sexual encounters. On examination, the left intertriginous crural fold exhibits linear, pink, exophytic lesions. No similar growths are noted elsewhere.
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Condyloma acuminata, also known as genital warts, is caused by the human papilloma virus (HPV).1 HPV is a double-stranded DNA virus that belongs to the Papovaviridae family. There are more than 120 subtypes of HPV, although HPV-6 and HPV-11 cause 90% of cases of condyloma acuminata.2
HPV is highly contagious and is transmitted through oral, anal, and genital sexual contact. Transmission can be asymptomatic, with an incubation period that ranges from 3 weeks to 8 months.3
The differential diagnosis of smaller lesions includes lichen nitidus and pearly penile papules.3 Pigmented condyloma acuminata may resemble bowenoid papulosis or seborrheic keratosis.4
Treatment options for condyloma acuminata include topical therapies podophyllotoxin, imiquimod, and sinecatechins or provider-administered treatments including cryotherapy, electrosurgery, and surgical scissor excisions. Counseling is recommended to mitigate psychological distress and emphasize the contagious and preneoplastic nature of these lesions.5
The most prevalent HPV subtypes, including those that are oncogenic, can be prevented by vaccination.6
John Pappas is a medical student at the Geisinger Commonwealth School of Medicine in Scranton, Pennsylvania. Stephen Schleicher, MD, is an associate professor of medicine at the Commonwealth Medical College in Scranton, Pennsylvania, and an adjunct assistant professor of dermatology at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia. He practices dermatology in Hazleton, Pennsylvania.
References
- Workowski KA, Bolan GA, Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep. 2015;64:1-137.
- Yanofsky VR, Patel RV, Goldenberg G. Genital warts: a comprehensive review. J Clin Aesthet Dermatol. 2012;5:25-36.
- Scheinfeld N, Lehman DS. An evidence-based review of medical and surgical treatments of genital warts. Dermatol Online J. 2006;12:5.
- Shimizu A, Kato M, Ishikawa O. Pigmented condyloma acuminatum. J Dermatol. 2014;41:337-339.
- Gilson R, Nathan M, Sonnex C, Lazaro N, Keirs T; British Association of Sexual Health and HIV (BASHH). UK National Guidelines on Management of Anogenital Warts 2015. https://www.bashhguidelines.org/media/1075/uk-national-guideline-on-warts-2015-final.pdf. April 2015. Accessed March 8, 2017.
- Offit PA. Should Children Who Have Received the Full Series of HPV4 Vaccine Also Get HPV9? Medscape Infectious Diseases. http://www.medscape.com/viewarticle/875233. February 9, 2017. Accessed March 8, 2017.
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