Genital warts (also known as venereal warts or condylomata acuminata) consist of papillomas with fibrous tissue overgrowth from the dermis and thickened epithelial coverings. They’re uncommon before puberty or after menopause. Certain types of human papillomavirus (HPV) infections have been strongly associated with genital dysplasia and, over a period of years (depending on the viral strain), with cervical neoplasia.
Infection with one of the more than 70 known strains of HPV causes genital warts, which are transmitted through sexual contact. The warts grow rapidly in the presence of heavy perspiration, poor hygiene, or pregnancy and commonly accompany other genital infections.
After a 1- to 6-month incubation period (usually 2 months), genital warts develop on moist surfaces: in males, on the subpreputial sac, within the urethral meatus and, less commonly, on the penile shaft; in females, on the vulva and on vaginal and cervical walls. In both sexes, papillomas spread to the perineum and the perianal area. These painless warts start as tiny red or pink swellings that grow (sometimes up to 10 cm) and become pedunculated. Typically, multiple swellings give them a cauliflower-like appearance. If infected, the warts become malodorous.
Most patients report no symptoms; a few complain of itching or pain.
Dark-field examination of scrapings from wart cells shows marked vascularization of epidermal cells, which helps to differentiate genital warts from condylomata lata associated with second-stage syphilis. Applying 5% acetic acid (white vinegar) to the warts turns them white. Warts usually are diagnosed early by visual inspection; biopsy is indicated only when neoplasia is strongly suspected.
Treatment is mostly for cosmetic reasons and should be guided by the patient’s preference. Treatment aims to remove exophytic warts and to ameliorate signs and symptoms. Topical drug therapy (10% to 25% podophyllum in compound benzoin tincture, trichloroacetic acid, or dichloroacetic acid) removes small warts. (Podophyllum is contraindicated in pregnancy.) Warts larger than 2.5 cm are generally removed by carbon dioxide laser treatment, cryosurgery, or electrocautery. Other treatments include Podofilox, Imiquimod, interferon, and combined laser and interferon therapy. No therapy has proved effective in eradicating HPV; relapse is common.
❑ Tell the patient to remove the podophyllum with soap and water 4 to 6 hours after applying it.
❑ Encourage the patient’s sex partners to be examined for HPV, human immunodeficiency virus, and other sexually transmitted diseases (STDs).
❑ Advise the female patient to have a Papanicolaou test every year.
❑ Recommend the use of condoms, and tell the patient that abstinence is the only sure way to avoid genital warts and other STDs.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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More About This Book:
Title: Professional Guide to Diseases (Eighth Edition) Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2005 ISBN: 1-58255-370-X 
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