So this is usually a clinical diagnosis
and there’s rare confusion with other things,
such as condylomalata,
those elevated lesions of secondary syphilis.
Scabies, which are little itchy pustules.
Genital herpes, which is usually quite painful series of ulcers.
LGV, lymphogranuloma venereum,
with its inguinal lymphadenopathy and its groove sign.
And donovanosis with these festering ulcers that are characteristic.
And occasionally, Molluscum contagiosum,
which are papules that look umbilicated.
They’re sunk in the center.
This is classic Molluscum contagiosum virus infection.
So we make the diagnosis by generally biopsy.
Viral culture is not really available for a clinical diagnosis.
It can be done in research labs, but it’s not available for usual clinical diagnosis.
The treatment is not good.
Highly effective and safe treatments are not yet available for this.
So we don’t have good current therapy,
so we need to either decrease
or eliminate the clinical manifestations if we possibly can.
What’s tried, especially in small lesions, is podofilox,
which is a derivative of podophyllin.
This is a derivative of fungal organism.
We don’t know its mode of action.
It’s in the form of a cream or lotion applied directly to the wart once a week.
So one of the big problems is chemical burns develop in 1/3 to 1/2 of the patients
when podofilox is applied.
And obviously for that reason,
we want to stay away from areas greater than 10 square centimeters.
It’s also contraindicated in pregnancy.
Imiquimod is another agent, which is available as a cream.
And what this does is it increases the production of interferon alpha
and other cytokines, and that’s where its antiviral action comes from.
Polyphenon E is a green tea extract, which is available as an ointment.
But this, too, is contraindicated in pregnancy.
Cidofovir is an acyclic pyrimidine.
It’s a chain terminator and causes apoptosis of HPV infected cells.
As far as preventing genital warts,
there’s really no effective method that we know of,
except perhaps to avoid contact with infectious lesions.
Condoms do not provide perfect protection.
And unlike the HPV vaccine, we have to prevent cervical cancer,
we don’t have a vaccine yet for this particular HPV infection.
And that brings me to the conclusion of my discussion on genital warts.