Condyloma acuminatum, or genital warts, is a sexually transmitted infection caused mainly by low-risk human papillomavirus types 6 and 11. It is one of the most common STIs, and the HPV vaccine prevents most cases.
Key symptoms
- Soft, painless bumps on the genitals, groin or around the anus
- Itch, irritation or bleeding with friction
- Discomfort during sex
- Often no symptoms; noticed by the patient or a partner
What you find on exam
- Skin-colored to pink papules, flat, dome-shaped or cauliflower-like
- Check the penis, scrotum, vulva, perineum and perianal skin
- Speculum exam for vaginal and cervical warts; anoscopy if anal symptoms
- Look for signs of other STIs such as ulcers, discharge or swollen lymph nodes
Tests
- Clinical diagnosis by inspection
- Biopsy if atypical, pigmented, bleeding, ulcerated or not responding to treatment
- Screening for other STIs: HIV, syphilis, gonorrhea and chlamydia
- Routine cervical cancer screening; HPV typing of the warts is not useful
Treatment basics
- Patient-applied: imiquimod cream, podofilox solution or sinecatechins ointment
- In the office: cryotherapy, trichloroacetic acid, surgical removal or laser
- Avoid podofilox, imiquimod and sinecatechins in pregnancy
- HPV vaccination at the recommended ages; condoms lower the risk
- Partner counseling; warts can come back after treatment
Red flags
- Pigmented, ulcerated, bleeding or hard lesions (consider cancer)
- Very large or fast-growing warts, especially with HIV or other immunosuppression
- Genital warts in a young child (consider sexual abuse)
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.