Genital Warts (Condyloma Acuminatum): Diagnosis and Management

00:01 So this is usually a clinical diagnosis and there’s rare confusion with other things, such as condylomalata, those elevated lesions of secondary syphilis.

00:19 Scabies, which are little itchy pustules.

00:24 Genital herpes, which is usually quite painful series of ulcers.

00:29 LGV, lymphogranuloma venereum, with its inguinal lymphadenopathy and its groove sign.

00:38 And donovanosis with these festering ulcers that are characteristic.

00:44 And occasionally, Molluscum contagiosum, which are papules that look umbilicated.

00:51 They’re sunk in the center.

00:53 This is classic Molluscum contagiosum virus infection.

00:58 So we make the diagnosis by generally biopsy.

01:03 Viral culture is not really available for a clinical diagnosis.

01:09 It can be done in research labs, but it’s not available for usual clinical diagnosis.

01:18 The treatment is not good.

01:22 Highly effective and safe treatments are not yet available for this.

01:28 So we don’t have good current therapy, so we need to either decrease or eliminate the clinical manifestations if we possibly can.

01:39 What’s tried, especially in small lesions, is podofilox, which is a derivative of podophyllin.

01:47 This is a derivative of fungal organism.

01:53 We don’t know its mode of action.

01:55 It’s in the form of a cream or lotion applied directly to the wart once a week.

02:03 So one of the big problems is chemical burns develop in 1/3 to 1/2 of the patients when podofilox is applied.

02:12 And obviously for that reason, we want to stay away from areas greater than 10 square centimeters.

02:19 It’s also contraindicated in pregnancy.

02:22 Imiquimod is another agent, which is available as a cream.

02:28 And what this does is it increases the production of interferon alpha and other cytokines, and that’s where its antiviral action comes from.

02:38 Polyphenon E is a green tea extract, which is available as an ointment.

02:44 But this, too, is contraindicated in pregnancy.

02:48 Cidofovir is an acyclic pyrimidine.

02:52 It’s a chain terminator and causes apoptosis of HPV infected cells.

02:59 Cell, as a summary of what we've discussed about the treatment there are patient applied treatments, such as topical imiquimod and podofilox.

03:08 And there is also clinician applied treatments, such as podophyllin, bichloroacetic acid, and trichloroacetitic acid.

03:17 As far as preventing genital warts, there’s really no effective method that we know of, except perhaps to avoid contact with infectious lesions.

03:26 Condoms do not provide perfect protection.

03:31 And unlike the HPV vaccine, we have to prevent cervical cancer, we don’t have a vaccine yet for this particular HPV infection.

03:43 And that brings me to the conclusion of my discussion on genital warts.