GENITAL WARTS

Human Papillomavirus: Genital Warts (Condylomata acuminata)

 Genital warts are the most common viral STD

 Genital warts, are usually caused by HPV types 6 and 11, but may also
be caused by 16, 18, and 30s, 40s, 50s, and 60s groups
 HPV subtypes primarily infecting vulvar epithelium include types 6 and
11.
 Types 16, 18, 31, 33, 35, 39, 41, 42, 43, 44, 51, 52, and 56 are less
common in vulvar disease but are involved in cervical dysplasia and
invasive cervical cancer, in which they play a pathogenic role.
 Many patients with HPV also have other sexually transmitted infections.

Treatment

 Treatment of the warts is determined by the site and extent of wart

growth.
 Self-administered topical drugs include imiquimod 5% applied 3
times/wk until resolution for up to 16 wk (for recurrence, treatment can
be repeated for an additional 16 wk) and podofilox 0.5% applied bid for
3 days followed by 4 days of no therapy (this sequence can be repeated 3
more times).
 Trichloroacetic acid 75 to 90% can be applied by a health care
practitioner weekly.
 Standard treatment is to cover the wart with bichloroacetic or
trichloroacetic acid every week until the wart is gone.
 Alternative forms of treatment include cryosurgery, electrosurgical
destruction, excision, and laser vaporization
 If no resolution is apparent after six applications, cryotherapy,
electrocautery, or laser therapy may be used.
 These options require anesthesia.
 Biopsy is appropriate if resolution is delayed.
 A Papanicolaou smear should be obtained to rule out cervical dysplasia.
 Warts recur in 65% of patients.

Pregnancy:
 Trichloroacetic or bichloracetic acid, 80 to 90 percent, applied
topically once a week, is an effective regimen for external warts.
 Some clinicians prefer cryotherapy or laser ablation of lesions in
pregnancy
 Condylomatous warts may grow rapidly during pregnancy.
 Podophyllin resin, 5-fluorouracil cream, imiquimod cream, and
interferon therapy should not be used in pregnancy because of concerns
about maternal and fetal toxicity