Further Outpatient Care

Patient should have a follow-up visit with OB/GYN (female) or with urology (male) within 1 week. Treat patient using medications and, if ineffective, with cryotherapy, curettage, electrodesiccation, surgical excision, carbon dioxide laser treatment, or combination therapy. Evaluate and treat sexual partner(s). Perform workup for human papillomavirus (HPV) and other sexually transmitted diseases (STDs).

Search for immunosuppression in patients with treatment failures and recurrences.

Look for biopsy recurrences and treatment failures.

Further Inpatient Care

Generally, no further inpatient care is necessary unless the patient has malignant transformation of lesions to carcinoma.

Inpatient & Outpatient Medications

Podofilox (purified podophyllotoxin) is available for home use by the patient.

Deterrence/Prevention

No medications or vaccines are 100% effective. One human papillomavirus vaccine (9-valent, Gardasil 9) is available in the United States for the prevention of HPV-associated neoplasias and dysplasias, including genital warts (condylomata acuminata). The FDA has expanded the age to receive the vaccine through age 45 years.^[7]

Sexual abstinence and monogamy are protective.

Condoms may discourage transmission.

Complications

See the list below:

Local disfigurement
Transformation to genitourinary malignancies in both males and females^[8]
Transmission to neonate or partners
Recurrence of condyloma acuminatum

Prognosis

Many patients either fail to respond to treatment, or condyloma acuminatum recurs after adequate response.

Recurrence rate of cervical dysplasia in women is not altered by treatment of sexual partners.

Recurrence rates exceed 50% after 1 year and have been attributed to the following:

Repeat infection from sexual contact
Long incubation period of HPV
Location of virus in superficial skin layers away from lymphatics
Persistence of virus in surrounding skin, hair follicles, or sites not adequately reached by intervention used
Missed or deep lesions
Subclinical lesions
An underlying immunosuppression

Patient Education

Identify and educate individuals at risk for condyloma acuminatum.

For excellent patient education resources, visit eMedicineHealth's Sexual Health Center. Also, see eMedicineHealth's patient education article Genital Warts (HPV Infection).

Questions

Samuel Alizon 1 , Carmen Lía Murall 2 , Ignacio G Bravo. Why Human Papillomavirus Acute Infections Matter. Viruses. 2017 Oct 10. 9(10):293. [QxMD MEDLINE Link].
Sinal SH, Woods CR. Human papillomavirus infections of the genital and respiratory tracts in young children. Semin Pediatr Infect Dis. 2005 Oct. 16(4):306-16. [QxMD MEDLINE Link].
[Guideline] Centers for Disease Control and Prevention, Workowski KA, Berman SM. HPV infection and genital warts. Sexually transmitted diseases treatment guidelines 2006. MMWR Morb Mortal Wkly Rep. 2006. 55(RR-11):62. [Full Text].
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Safi F, Bekdache O, Al-Salam S, Alashari M, Mazen T, El-Salhat H. Management of peri-anal giant condyloma acuminatum--a case report and literature review. Asian J Surg. 2013 Jan. 36(1):43-52. [QxMD MEDLINE Link].
Zhu X, Chen H, Cai L, Yu Z, Cai L. Decrease recurrence rate of condylomata acuminata by photodynamic therapy combined with CO2 laser in mainland China: a meta-analysis. Dermatology. 2012. 225(4):364-70. [QxMD MEDLINE Link].
U.S. Food and Drug Administration. FDA approves expanded use of Gardasil 9 to include individuals 27 through 45 years old. FDA News Release. 2018 Oct 05. Available at https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm622715.htm.
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VanDamme P, et al. Immunogenicity and safety of a novel 9-valent HPV L1 virus-like particle vaccine in boys and girls 9-15 years old; comparison to women 16-26 years old. Abstract (SS 8-5) presented at EUROGIN 2014 November 5, 2013.
ACIP. FDA licensure of bivalent human papillomavirus vaccine (HPV2, Cervarix) for use in females and updated HPV vaccination recommendations from the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep. 2010 May 28. 59(20):626-9. [QxMD MEDLINE Link].
Juckett G, Hartman-Adams H. Human papillomavirus: clinical manifestations and prevention. Am Fam Physician. 2010 Nov 15. 82(10):1209-13. [QxMD MEDLINE Link].
Chan PD, Winkle PJ, Winkle CR. Condyloma acuminata. Current Clinical Strategies - Family Medicine. 2nd ed. Current Clinical Strategies Publishing Inc; 1995. 209-210.
Congilosi SM, Madoff RD. Current therapy for recurrent and extensive anal warts. Dis Colon Rectum. 1995 Oct. 38(10):1101-7. [QxMD MEDLINE Link].
Friedman M, Bayer I, Letko I, Duvdevani R, Zavaro-Levy O, Ron B, et al. Topical treatment for human papillomavirus-associated genital warts in humans with the novel tellurium immunomodulator AS101: assessment of its safety and efficacy. Br J Dermatol. 2008 Sep 19. [QxMD MEDLINE Link].
Garrido JL. Human papilloma virus--H.P.V. condyloma. Current studies in diagnosis, treatment and prognosis. Clin Exp Obstet Gynecol. 1996. 23(2):99-102. [QxMD MEDLINE Link].
Kodner CM, Nasraty S. Management of genital warts. Am Fam Physician. 2004 Dec 15. 70(12):2335-42. [QxMD MEDLINE Link].
Leung AK, Kellner JD, Davies HD. Genital infection with human papillomavirus in adolescents. Adv Ther. 2005 May-Jun. 22(3):187-97. [QxMD MEDLINE Link].
Mayeaux EJ, Harper MB, Barksdale W, Pope JB. Noncervical human papillomavirus genital infections. Am Fam Physician. 1995 Sep 15. 52(4):1137-46, 1149-50. [QxMD MEDLINE Link].
Prasad CJ. Pathobiology of human papillomavirus. Clin Lab Med. 1995 Sep. 15(3):685-704. [QxMD MEDLINE Link].
Sykes NL. Condyloma acuminatum. Int J Dermatol. 1995 May. 34(5):297-302. [QxMD MEDLINE Link].
Gardasil 9 (human papillomavirus 9-valent vaccine, recombinant) [package insert]. Whitehouse Station, NJ: Merck & Co, Inc. December, 2015. Available at [Full Text].