Condylomata Acuminata: Causes, Symptoms & Treatment

Condylomata acuminata are considered a sexually transmitted disease caused by infection with papillomavirus and manifested by nodular skin growths. Across Europe, condylomata acuminata affects approximately 1 to 2 percent of the sexually active population, with a peak age between 20 and 24 years of age.

What is condylomata acuminata?

Condylomata acuminata (also genital warts, condylomas) are benign (benign) nodular growths of the skin the size of a pinhead, caused by infection with human papillomavirus (HPV), which usually affects the anogenital area. In most cases, the infection does not trigger any other symptoms besides the wrinkly-looking, reddish-brownish or grayish-white skin growths, which can lead to pruritus (itching), discharge or burning. On the other hand, the psychological burden as well as impairment of sexual life is to be considered much greater. Women are mostly affected in the area of the vaginal entrance, the cervix (neck of the uterus) and less frequently the urethral orifice, while men primarily have condylomata acuminata on the glans penis (glans), foreskin, anus, and urethral orifice and rectum.

Causes

Condylomata acuminata is caused by human papillomaviruses (HPV), particularly sero-types 6 and 11, and in rare cases also types 16 and/or 18, which are usually transmitted to the skin through unprotected sexual contact or via smear infection (including via contaminated sex toys). In this case, the viruses first colonize the upper layers of the skin, where they enter via small lesions in the skin or mucous membrane of the anus, rectum, vagina or penis. In the case of a weakened immune system as a result of HIV, immunosuppressive medication or drug abuse, they can multiply and cause tissue overgrowth with wart formation. Fungal infections, genital herpes or eczema also promote infection. In addition, an infected mother can infect her newborn child with papillomavirus during birth and cause condylomata acuminata.

Symptoms, complaints, and signs

Condylomate acuminate are benign skin growths. They can be recognized by their typical shape, which resembles normal warts. Genital warts reach the size of a pinhead, and occasionally they grow larger. They are reddish to brownish or grayish-white in color and usually appear in several groups that are close together. These wart beds typically cause severe itching, associated with tenderness and possibly bleeding. They usually occur in the intimate area or on the feet. In women, they usually grow on the labia, at the entrance to the vagina, in the cervix or in the mouth of the urethra. In men, they develop mainly on the foreskin, glans, anus, urethral entrance and rectum. If not treated, genital warts can spread to other parts of the body. If genital warts are opened, a purulent secretion flows off, which usually smells unpleasant. Condylomas can be accompanied by a feeling of illness. Some sufferers complain of fever, nausea and vomiting and other symptoms, which always depend on the causative disease. Most often, genital warts are accompanied by psychological discomfort. The skin growths are a cosmetic blemish. Those affected are often ashamed of them and withdraw from social life. In the course, serious psychological problems such as anxiety, inferiority complexes, feelings of guilt or depression can develop.

Diagnosis and course

In all cases, condylomata acuminata can be diagnosed on the basis of the skin condition or the characteristic wart formation in the anogenital area. Using the so-called acetic acid test, the affected areas can be localized as white discolored districts. An HPV DNA test and a PCR (polymerase chain reaction) allow the detection of the specific papilloma viruses present. The diagnosis is confirmed by a biopsy with subsequent histological analysis. An endoscopic examination can exclude intraanal or intrarectal infection. Differentially, the disease should be differentiated from fibromas and squamous cell carcinomas of the genital area as well as from precancerous lesions and certain forms of Hirsuties.Condylomata acuminata generally have a good course with a very good prognosis, although recurrences are not uncommon. The risk of cervical cancer is considered low for the HPV types that predominantly cause condylomata acuminata.

Complications

In most cases, condylomata acuminata causes the so-called genital warts. These are strong growths that are associated with relatively severe and burning pain, thus extremely reducing the patient’s quality of life. Likewise, a strong itching occurs at the genitals, which is connected with redness. Due to the discomfort, sexual desire decreases enormously, which can also lead to depressive moods and other psychological complaints. Since the symptoms are relatively characteristic, early diagnosis of the disease is possible, so that treatment can also be started early. The treatment itself is symptomatic and primarily alleviates the symptoms. Creams, ointments and medications are used, and there are no further complications. The growths can be removed with the help of surgical procedures. However, this does not prevent a recurrence of the disease. Complications can usually occur only if the disease is not treated and spreads to the neighboring regions. With early treatment, there is always a positive course of the disease.

When should you go to the doctor?

In the case of condylomate acuminata, it is not necessary to consult a doctor. In most cases, condylomata do not cause any discomfort and detach themselves after some time. However, if the growths bleed, ooze, itch badly or cause other discomfort, medical advice is needed. Warts that enlarge or multiply quickly are also best examined by a specialist and treated if necessary. Genital warts that appear for no apparent reason or keep coming back indicate a serious condition – in this case, be sure to talk to your family doctor. Children and elderly people should always see a doctor in case of condylomate acuminata to exclude serious diseases and complications. The same applies to patients with neurodermatitis or other skin diseases. Anyone who has already been infected once with HP viruses is best advised to consult a general practitioner in the event of a recurrence. Other contacts are the dermatologist, urologist or gynecologist. If the Condylomate acuminata strongly affect the well-being and represent an emotional burden, should be accompanied by talking to a therapist.

Treatment and therapy

Therapeutic measures for condylomata acuminata depend primarily on the extent of the infection as well as the localization. If the outer layers of the skin are affected, solutions or ointments or creams containing podophyllotoxin (cytostatic), silver nitrate, epigallocatechin gallate, which is found in green tea, or imiquimod, a virostatic agent that stimulates the body’s own defenses, are usually recommended for external topical application over several weeks. However, podophyllotoxin, which inhibits cell division, should not be used during pregnancy. If internal infections are present on the mucous membranes of the vagina, anal canal, or in the urethral orifice, treatment with trichloroacetic acid applied to the affected areas at weekly intervals may be indicated. In addition, the skin growths can be cryotherapeutically iced by liquid nitrogen. In both cases, a local anesthetic may be applied because of the accompanying pain. In the case of beet-like or pronounced growths as well as recurrences, surgical intervention may be considered. In this case, the genital warts are removed either with the help of a curette (e.g. sharp spoon) or in the course of an electrocaustic (heat-generating electric current) or laser therapy under local or general anesthesia. Photodynamic therapy (PDT) using 5-aminolevulinic acid may also be used if appropriate. In cases of recurrent recurrence, therapy with gels containing interferon-beta may be indicated to prevent recurrence of condylomata acuminata.

Outlook and Prognosis

The prospect of cure for condylomata acuminata depends on the time of diagnosis as well as the start of treatment. No spontaneous recovery occurs and alternative cures are ineffective. The prospect of recovery can only occur via medical treatment.With early medical care, a good prognosis is possible. The skin abnormalities are removed in a surgical procedure and subsequent treatment to rid the skin of the human papillomavirus (HPV) is initiated. If the course is favorable, the patient can be discharged as symptom-free within a few weeks. For a permanent cure, protection against re-infection of the HPV is necessary. If the growths have already spread, the risk of a malignant course of the disease increases. The genital warts can lead to the formation of metastases. There is a possibility that cancer cells detach and spread in the organism through the bloodstream. In severe cases, organs or other regions of the body are affected by cancer. For the patient, this situation represents a potential danger to life. Condylomata acuminata has a high recurrence rate. People who are affected by the HPV have a high risk of a recurrence of the condylomata. Sufferers who have had very severe condylomata acuminata also show a higher susceptibility of recurrence than other patients.

Prevention

Infection with HP viruses and, correspondingly, condylomata acuminata can be prevented by protected sexual intercourse or the use of condoms, as well as by prophylactic vaccination against HP viruses. In addition, direct contact with infected skin areas should be avoided. As a general rule, partners of affected individuals should also be examined for condylomata acuminata to rule out ping-pong infection (mutual reinfection).

Follow-up

When condylomata acuminata occurs, complete recovery is extremely rare or virtually never. On the contrary, degeneration of the condylomas is possible in the long term. In many cases the condylomas become malignant. This worsens the prognosis. For this reason, close and sufficiently frequent follow-up of affected patients is essential. After surgical procedures or ointment treatment, follow-up examinations are initially performed at intervals of three to four weeks. Later, the intervals between individual follow-up examinations can be increased. With proper treatment and sensible therapy, the chances of recovery are quite good. However, it is problematic that even surgical removal of the genital warts does not mean one hundred percent safety from recurrence. The reason for this lies in the viral causation of condylomata acuminata. Only their visible consequences can be removed. During postoperative follow-up, it is often discovered that a smaller infestation of genital warts has reappeared. Since it may not be appropriate to proceed surgically for every recurrence, therapy with antiviral ointments or solutions is useful in this case. However, immediate surgical intervention may also be required in cases of condylomata acuminata. The purpose of close follow-up is to prevent severe progression. The involvement of papilloma viruses involves the risk of degeneration and a high risk of infection.

What you can do yourself

Genital genital warts are extremely unpleasant and distressing, but as a rule they are not dangerous. Nevertheless, it is essential to refrain from purely self-treatment and to consult a doctor immediately. The human papillomaviruses (HPV) that cause the infection are highly contagious and are predominantly transmitted during sexual intercourse, even though other transmission routes cannot be ruled out. The best self-help measure is to avoid infection. The viruses enter the body through tiny skin lesions. Certain sexual practices that increasingly involve small injuries to the mucous membranes, as is particularly the case with anal intercourse, are therefore particularly risky. It is therefore essential to use condoms during sexual intercourse. These do not guarantee one hundred percent protection, since even touching infected areas of the body can be enough to contract the infection. Nevertheless, condoms considerably reduce the risk of infection. Anyone who is affected by an acute genital wart infection must not have sexual intercourse under any circumstances. In this situation, there must also be no hygiene deficits, otherwise there is a risk of smear infection. In particular, no towels should be shared and no items of clothing should be placed directly on the skin.Laundry and other clothing that has been in contact with infected areas of the body should definitely be washed at at least 60 degrees. Strengthening the immune system with a healthy diet rich in vitamins can also help to overcome an infection more quickly or prevent the disease from breaking out in the first place.