condylomas

Condylomas, or genital warts, are mucosal lesions caused primarily by human papillomavirus (HPV), most often types 6 and 11. They can appear on the penis, scrotum, vulva, vagina, perianal area, and anus, and less commonly in the oral cavity. Lesions are typically soft, flesh-colored, and may be raised or cauliflower-like. Many HPV infections, including those that produce condylomas, can be asymptomatic.

HPV is transmitted through sexual contact. Risk factors include multiple sexual partners, a history of other sexually transmitted infections, and immunosuppression. Although condylomas are usually caused by low-risk HPV types, infection with high-risk types such as 16 and 18 is associated with an increased risk of cancers of the cervix, anus, and oropharynx, which may coexist with or be unrelated to visible warts.

Diagnosis is usually clinical. An acetic acid test can cause warts to turn white, aiding visualization. Biopsy may be used to distinguish condylomas from other lesions or to assess dysplasia or cancer in uncertain or unusual cases.

Treatment aims to remove visible warts and reduce transmission. Options include patient-applied therapies such as imiquimod cream, podophyllotoxin preparations, and sinecatechin, and provider-administered therapies such as cryotherapy with liquid nitrogen, trichloroacetic acid, surgical excision, curettage, or laser therapy. Recurrence is common, and therapy does not eradicate HPV infection.

Prevention relies on vaccination against HPV (e.g., Gardasil 9), which reduces the risk of wart-causing types and certain high-risk types. Safe sex practices and regular screening where indicated are also important. Some treatments may be avoided or modified during pregnancy, with management guided by clinical judgment.