What is Condyloma Acuminata (Anogenital Warts)?
Condylomata acuminata, also known as anogenital warts, are caused by the human papillomavirus (HPV). The virus is usually either type 6 or 11. HPV is a virus that mainly spreads through sexual activities. Factors such as age, lifestyle, and sexual habits can contribute to the likelihood of developing these warts. There are several treatments available which can be applied directly onto the warts, including solutions and creams containing podophyllotoxin, imiquimod cream, and sinecatechins ointment. Alternatives include freezing the warts (cryotherapy), applying a trichloroacetic acid solution, or various surgical methods. It’s worth noting that these warts can come back after using topical treatments. The most effective treatment, with nearly a 100% success rate, is surgical removal. It’s crucial for patients to understand their treatment options, maintain follow-up appointments, and practice safe sex.
What Causes Condyloma Acuminata (Anogenital Warts)?
Condyloma acuminata, a type of genital wart, is caused by an infection from the Human Papillomavirus (HPV). Out of the over 100 types of HPV that exist, around 40 strains are responsible for affecting the area around the genitals and anus. The most common strains of HPV that lead to condyloma acuminata are types 6 and 11.
Other strains of HPV can cause plantar warts, which are warts on the hands and feet. Some types of HPV can lead to cell changes that eventually result in certain cancers, such as cervical cancer in women and penile or rectal cancer in men. Particularly, HPV types 16 and 18 are highly associated with the development of these cancers and other types like mouth and throat cancers.
There are also several other strains of HPV – 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, 68, 73, and 82- that are known to be present in mucus membrane related cancers. Some non-melanoma skin cancers have been linked to HPV types 1, 5, 8, 9, 17, 20, 23, and 38.
Skin condition Bowen’s Disease is linked with HPV types 16, 18, 31, 32, and 34. Similarly, an uncommon skin disorder, Epidermodysplasia verruciformis, has been connected to a large number of HPV types which include 5, 8, 9, 12, 14, 15, 17,19-25, 36-38, 46, 47, 49, and 50.
It’s crucial to note that HPV types 6 and 11, although cause around 90 percent of genital warts, present a low risk for developing cancer. Regular skin warts are associated with HPV types 1, 2, 3, 4, 27, and 57.
Risk Factors and Frequency for Condyloma Acuminata (Anogenital Warts)
HPV, or Human Papillomavirus, is the most common sexually transmitted infection worldwide, affecting 9 to 13 percent of people globally. It’s most common in individuals aged between 20 and 39. Getting HPV is linked with a number of risk factors.
- More sexual partners in your lifetime can increase the chance of getting HPV.
- Previous infections like chlamydia and gonorrhea make you more susceptible.
- Smoking boosts the likelihood of you contracting the virus.
- Having HIV can also increase the risk of getting an HPV infection.
Tracking the incidence of anogenital warts, a symptom of HPV, is difficult because they’re not a reportable disease. However, it’s thought that there are 1.1 to 1.2 cases per 1000 people each year in the United States.
Signs and Symptoms of Condyloma Acuminata (Anogenital Warts)
Condyloma acuminata is a condition where wart-like growths appear on the body, typically in the anogenital region. Most of the time, these growths don’t cause any physical discomfort, but they can sometimes lead to bleeding, itching, and pain. More often, people tend to seek medical attention because of how these growths look. The appearance and location of these growths can affect a person’s mental and emotional well-being, causing distress.
Doctors sometimes discover these growths unintentionally during regular health checks, such as women’s gynecological exams. Interestingly, these growths appear not just in the anogenital region but can also occur in the oral cavity such as on the tongue or lip. If growths are found in both the anogenital and oral regions, it might suggest that the condition was sexually transmitted. However, these growths can also be caused by coming into contact with infected objects or surfaces.
The appearance of these growths can vary. They can appear as a group or they can be solitary. They usually look like raised skin-colored bumps, or papules, that can be flat or pediculed (growing on a stalk). Sometimes, they can take on a cauliflower-like appearance. They generally measure anywhere from one to five millimeters in diameter.
If a large tumor-like growth spreads across the whole anogenital area, it could be a Buschke-Lowenstein tumor. This is a severe complication of condyloma acuminata, which involves the transformation of the warts into a cancerous growth.
- Mostly asymptomatic (can cause bleeding, itching, and pain)
- Causes psychological distress
- Can appear in the anogenital region and oral cavity
- The appearance can be grouped or solitary
- skin-coloured, fleshy papules
- Can be a flat or stalk-like growth, or cauliflower-like appearance
- If a large growth appears, it could be a malignant Buschke-Lowenstein tumor
Testing for Condyloma Acuminata (Anogenital Warts)
Condyloma acuminata, commonly known as genital warts, are usually diagnosed by doctors through a detailed medical history and a close visual inspection of the warts. To help with the diagnosis, additional tests can be done. A colposcope, a special magnifying instrument, can be used to get a closer look at the warts. Some tests, like the polymerase chain reaction (PCR), can even check the warts for specific types of DNA.
Another test involves applying a five percent acetic acid solution to the warts. If areas of the wart turn white, this could suggest irregular cell growth or dysplasia. However, this acid test isn’t always reliable for screening purposes because it can produce false positives. In cases where dysplasia is suspected, the appropriate next step is to do a biopsy of the wart, which involves taking a small sample of tissue for further examination.
In children with genital warts, doctors should keep in mind the possibility of sexual abuse. Although these warts are often sexually transmitted, they can also be spread in other ways. As children get older, suspicions of sexual abuse should understandably increase. In the United States, doctors are legally required to report any suspected cases of sexual abuse. They should rely on their professional judgment when deciding whether to report potential abuse.
Treatment Options for Condyloma Acuminata (Anogenital Warts)
If you are diagnosed with condyloma acuminata, also known as genital warts, there are several treatment options available. It’s important to know that for children, teenagers, and healthy young adults, treatment can sometimes be delayed because the warts often disappear on their own over a period of months to years. However, if these genital warts persist for more than two years, or if they produce symptoms or involve aesthetic concerns, it’s time to explore treatment options.
You can choose from multiple therapy options, which include creams and solutions applied directly to the warts, freezing treatments, and even surgical removal. The selection of a specific treatment depends on the nature and location of the warts, as well as your personal preference.
Some of the available treatments include a podophyllotoxin 0.5% solution or a 0.15% cream, applied twice a day for three days, with a break of four days in between. This regimen is typically followed for about four weeks. Imiquimod cream 5% is another treatment which has lower chances of the warts returning, and is applied three times a week for up to sixteen weeks. Sinecatechins 15% ointment is an additional option, applied three times a day for sixteen weeks.
If you prefer in-office treatments, you could consider cryotherapy which uses liquid nitrogen to freeze the warts, or trichloracetic acid (TCA) that causes a small ulcer to form and heal without leaving a scar. These treatments are administered on a weekly basis for several weeks. Cryotherapy is noted for being safe, inexpensive, and even suitable during pregnancy. If the warts do not respond to other treatments or the condition is advanced, surgical options are available. Surgical removal has a nearly 100% success rate.
A newer treatment option called photodynamic therapy in combination with 5-aminolevulinic acid (ALA) is also gaining popularity. This method seems to be more effective, simpler, and has lower recurrence rates compared to laser treatments and might be a valuable addition to the other treatment options.
What else can Condyloma Acuminata (Anogenital Warts) be?
When diagnosing a particular condition, healthcare experts take into account various other similar conditions. Some of these might include:
- Condyloma lata
- Molluscum contagiosum
- Lichen planus
- Psoriasis
- Certain types of cancer (malignancy)
- Pearly penile papules
- Acrochordon, also known as skin tags
- Sebaceous cysts, small bumps that contain sebum, an oily substance
- Buschke-Lowenstein tumor, a rare type of genital wart
To ensure an accurate diagnosis, the healthcare professional will conduct necessary tests keeping these possibilities in consideration.
What to expect with Condyloma Acuminata (Anogenital Warts)
Condyloma acuminata, while difficult to treat, is curable. However, curing this condition might require multiple different treatment methods spread out over a period of time. Surgery is the treatment with the highest success rate, almost 100%, but the condition can return even after effective treatment. In fact, the condition reappears about 20% to 30% of the time after being successfully treated.
When genital warts are treated with a topical treatment called podophyllotoxin, the condition is cleared 45% to 83% of the time, but can reoccur anywhere from 6% to 100% of the time. Another treatment, Imiquimod, has both a lower likelihood of successful treatment and a lower reoccurrence rate, successfully treating the condition 35% to 68% of the time and reoccurring 6% to 26% of the time.
Sinecatechins ointment successfully treats the condition 47% to 59% of the time, with a lower likelihood of the condition reoccurring, typically between 7% and 11% of the time. Cryotherapy with liquid nitrogen clears genital warts between 44% and 75% of the time, with a reoccurrence rate of 21% to 42%. Using a trichloroacetic acid solution clears the condition 56% to 81% of the time, with a reoccurrence rate of about 36%.
Possible Complications When Diagnosed with Condyloma Acuminata (Anogenital Warts)
Condyloma acuminata, also known as genital warts, has significant emotional impacts, including anxiety, guilt, and anger. There’s also the worry about potential infertility and cancer. Genital warts can sometimes become precancerous or even cancerous. It’s very important to keep an eye out for things like bleeding, change in color, sore formation, and hard-to-touch lesions, as they could be signs of the warts turning malignant. We should also remember that Buschke-Lowenstein tumors are a complication of genital warts.
Preventing Condyloma Acuminata (Anogenital Warts)
Doctors should explain to patients the reason why they have developed sores. Patients with genital warts should be advised to share this information with all their recent and past sexual contacts from the last six months. Safe sex practices, like using a condom, are crucial and can help to prevent infections like HPV, which cause genital warts. Condoms can also prevent other diseases from being passed on.
Primary care doctors and nurses have to keep patients informed about how useful the HPV vaccine can be. The vaccine can prevent infection by HPV, which is responsible for genital warts in most cases. This vaccine can also protect against types of the virus that cause cervical cancer. The HPV vaccine works best if given before the person is exposed to the virus. Hence, the current advice is to vaccinate girls and boys when they are 11 to 12 years old. Moreover, anyone under 26 should get this vaccine.
The American Cancer Society offers guidelines for cervical cancer screening, which aren’t changed based on whether a patient has genital warts or not. Women younger than 21 do not need to be screened for cervical cancer. However, between the ages of 21 to 29, a woman should have a pap smear test every three years. When a woman is aged 30 to 65, she should have a pap smear test every three years or a test for both HPV and pap smear every five years. Screening for cervical cancer is not suggested for women over 65 if they have had regular negative tests earlier.
Lastly, patients should be advised on safe sex behaviors, which means using barrier protection, avoiding anal sex, and not having multiple partners. Patients should also be encouraged to get tested for other sexually transmitted diseases and to keep doing regular check-ups.