Symptoms
Condylomata acuminata is a benign infectious disease of the skin and mucous membranes caused by human papillomavirus. It manifests itself in benign warts, called genital warts, which appear in the genital and/or anal areas. However, such warts appear in less than 1% of people infected with HPV. In men, the tip of the penis (glans) is mainly affected, while in women the vagina, vulva and sometimes the cervix are affected. In both sexes, the urethra can also become infected. The main symptoms are burning, itching and, in rare cases, pain may occur. In immunosuppressed individuals, the course is more severe and the skin growths more pronounced.
Causes and triggers
Triggers are human papillomaviruses (HPV) types 6 and 11, which belong to the group of DNA viruses. Rarely, types 16 and 18 are also associated with genital warts. To date, more than 100 subtypes of this virus are known.
Transmission
The spiky condylomas are highly infectious. The transmission rate between sexual partners is about 65%. Infection occurs through direct contact with the infected skin and mucous membranes. Primarily, this occurs through unprotected sexual intercourse, oral or anal sex. In rare cases, the virus can also be transmitted through smear infection (e.g., on the toilet), physical contact during bathing, and possibly through contaminated objects. Condylomata acuminata is one of the most common sexually transmitted diseases. The incubation period ranges from 4 weeks to several months.
Complications
Genital warts can promote the development of genital carcinomas. Thus, in rare cases, genital warts can continue to grow, degenerate, and develop into a giant condyloma, a so-called Buschke-Löwenstein tumor. In the anal region, condylomas can develop into anal carcinoma. Types 16 and 18 of the human papilloma virus are often associated with the development of cervical cancer in women. However, genetic, hormonal, and immunologic influences also play a role.
Risk factors
Women with frequently changing sexual partners, immunocompromised patients, and patients with other STDs such as HIV are often affected. Other risk factors include sharing towels, bathing together, close physical contact, sexual abuse, and immunosuppressants. Excessive drug, alcohol, and nicotine use also increase the risk of HPV infection.
Diagnosis
Diagnosis is made by medical treatment on the basis of the typical clinical picture. To rule out other diseases such as condylomata lata, molluscum contagiosum, or benign and malignant tumors of the genital area, a tissue sample is taken, which is then examined histologically. Viral detection is also possible.
Prevention
Because human papillomavirus is transmitted in most cases through unprotected sexual intercourse, the risk of infection can be significantly reduced by safer sex (e.g., use of condoms). Other protective measures include using separate towels and avoiding close physical contact. HPV vaccination (Gardasil, Cervarix@), which protects against infection with human papillomavirus types 6, 11, 16 and 18, has also been available since 2006. Vaccination is recommended for girls aged 11 to 14 years.
Nonpharmacologic treatment
The warts can be removed by physical methods such as surgically by scraping them out with a curette. Other treatment options include cryotherapy, laser therapy, and electrotherapy. Recurrences are possible with all therapeutic methods and scarring occurs with overly invasive procedures.
Drug treatment
Drug therapy involves locally applied ointments and solutions that destroy the wart tissue. Topical self-treatments include therapy with antiproliferative agents such as podophyllotoxin (controversial), 5-fluorouracil, cidofovir, and with immunomodulators such as imiquimod. Treatment with imiquimod may cause local irritation, but it has a much lower recurrence rate compared to other therapies. Also approved is an extract of green tea for local treatment in the form of an ointment (see under green tea for genital warts). Caution: Even if the warts disappear, this does not mean that the infection with HPV is cured.
