CASE REPORT

CONDYLOMA ACUMINATA ACCOMPANYING CANDIDIASIS

VULVOVAGINALIS
Henky Yoga Prasetya, Wiwiek Dewiyanti, Alwi Mappiasse
Department of Dermatovenereology Medical Faculty of Hasanuddin University / Wahidin
Sudirohusodo Hospital Makassar

ABSTRACT
Condyloma acuminata (CA) is a macular lesions, papules, and
stemmed the genital or anal mucosa, caused by infection with Human
papillomavirus (HPV). Condyloma acuminata often simultaneously with
sexually transmitted infections (STI).
Reported one case, a woman 16 years, with clinical
manifestations of papules verrucous with uneven surface of the vagina,
accompanied by watery white vaginal discharge, odorless, and itching,
also appeared erythematous around the vaginal area. Examination
acetowhite gave positive results in accordance with condyloma
acuminata. Examination by Amsel criteria negative, KOH examination
gave positive results when fungal spores are found on microscopic
examination, this is in accordance with vulvovaginal candidiasis.
Treatment with electrocauterizaation, and fluconazole 50 mg 1x1 for 7
days.
Keywords: condyloma acuminata, vulvovaginal candidiasis, a woman
16 years

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Condyloma Acuminata Accompanying Candidiasis Vulvovaginalis

INTRODUCTION

based on the clinical picture, acetic acid

test examination (acetowhite) positive and
histopathologic. Diagnosis of candidiasis
vulvovaginalis with the discovery of spores
on KOH 10 - 20% examination . (9, 14-16)

Condyloma acuminata (anogenital

warts / genital warts) is a sexually transmitted disease such as benign proliferation
of the skin and mucosa caused by
infection with Human Papilloma Virus
(HPV) of various subtypes, frequent HPV
types 6 and HPV type 11. (1-5)

The main goal of treatment is to

eliminate CA lesions. (1) Many treatment
options for CA, among others, can use
topical therapy (podophyllin, podophyllotoxin, trichloroacetic acid, imiquimod, 5fluorouracil), surgery (power surgery, scalpel surgery, frozen surgery, laser surgery)
and systemic therapy (interferon, isoprinosine). (7, 9, 13, 17, 18) Reported one case of a
woman of 16 years with CA accompanied
by vulvovaginalis candidiasis.

Condyloma acuminata can strike

all the nations where the frequencies
between men and women are equal. (2, 3) It
is estimated that 30% to 50% of sexually
active adults are infected by HPV. (6) Most
commonly occurs at the age of 16-25
years. (7, 8) Several epidemiological factors
associated with increased HPV infection,
among others: the young woman who did
especially aktivas first sex at an early age,
smokers, women who are pregnant or
taking oral contraceptives. (9-12)

CASE REPORT
A woman, aged 16 years came to
Dermatovenereology clinic Dr. Wahidin
Sudirohusodo hospital with complaint appears bumps in pubic since 2 months ago.
Initially small bump, then gradually getting
bigger. The complaint was accompanied
by vaginal discharge, itching, odorless
since 1 month ago after patients frequently
wash her genital with vaginal douching. No
complaints of dispareunia, dysuria. History
of sexual intercourse with her boyfriend
5 months ago. No prior treatment history.

Patients with condyloma acuminata

often have other genital infections include
candidiasis, and non-specific genital infection. (9) Though the condyloma accuminata
may result from exposure to the virus
during sexual activity, but HPV can also be
transmitted through autoinoculation of
finger warts, may also indirectly through
contaminated objects. (13) Transmission of
HPV can also go through perinatal transmission in neonates. (2, 10) Clinical picture
was originally a very small papules form of
a pin and a papilomatosa typically
increase in size and grow cauliflower
structure which can eventually cover the
entire external genitalia. (3, 9) Predilection
for female vulva and surrounding area,
vaginal introitus, sometimes on porsio
uteri. (2)

On physical examination found a good

general condition, composmentis, sufficient nutrition. Vital signs within normal
limits. On physical examination, dermatovenerology status: location labium major
regio inferior and superior dextra with
effloresense verrucous papules, diameter
papules 1.5 cm and 0.5 cm, painful,
no enlarged inguinal lymph, erythematous
vaginal mucous and white watery vaginal
discharge. (Figure 1)

Investigations CA include acetic

acid test and histopathological examination. (1, 7) Vulvovaginal candidiasis
investigation is the examination of KOH. (9,
14)
Diagnosis CA disease is established
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Other investigations such as acetowhite test positive, KOH examination showed

fungal spores (Figure 2). Complete blood routine and urine routine in normal limit, nonreactive VDRL, and histopathological examination was also performed.

Based on history, clinical manifestation and laboratorium investigations the diagnosis is CA and candidiasis vulvovaginalis.
Treatment given to patient include electrocauterization, amoxicillin 3 x 500mg,
fluconazole 150 mg single dose. One week later, CA lesions have dried up, no new lesions,
itching reduced, white watery discharge (figure 3). Histopathological result supports
condyloma acuminata (figure 4) . Then treatment was continued fluconazole 50 mg once a
day for 7 days, mupirocin cream, and sefadroxil 2 x 500 mg.

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Condyloma Acuminata Accompanying Candidiasis Vulvovaginalis

DISCUSSION

mination seemed spores. (9, 14, 15) Condyloma acuminata frequent co-infections with
candida and other anaero-bic bacteria.
Results of research conduc-ted in the
division of sexually transmitted diseases
outpatient unit RSU Soetomo obtained
was 21.7% in patients with CA and
candidiasis vulvovaginalis. (9)

Diagnosis in this case is established based on history, clinical examination and laboratorium investigation showed
condyloma acuminata and candidiasis
vulvovaginalis. From history was obtained
a lump in genital growing since two
months with white vaginal discharge, and
growing bump. This is consistent with
literature that CA lesions appeared after
incubation periode 1-8 months with an
average 3 months, the lesions can be
solitary or multiple lesions develop into 110 mm diameter with a typical clinical
picture of the lesion in the form of
papilliferus mass and irregular surfaces. (7,
9, 13)
In women with vaginal discharge
growing disease faster. (2) Venereology
status showed white watery fluor albus ,
erythematous vaginal mucous. In accordance with literature described that candidiasis vulvovaginalis provide symptoms
such as watery discharge, mild itching,
odorless. Vaginal discharge often seen in
vaginal mucous. (9, 14) Patients history was
obtained itching in vagianl area, white homogenous vaginal discharge, erythematous vaginal mucous, and 10% KOH examination showed spores . In accordance
with literature that candidiasis vulvovaginalis provide pruritus symptoms and vaginal mucous appeared red, white fluor
albus, no smell and vaginal wall usually
erythematous, and in 10-20% KOH exa-

Investigations conducted
acetic
acid test positive. Corresponding acetate
literature that tests performed by applying
3-5% acetic acid in distilled water, there
will be changes in lesions suspected
condyloma and provide color changes to
white (acetowhite). (3, 9) Histopathological
examination showed hyperplasia epidermal, hyperkeratosis, acanthosis, slight coilositosis, papilomatous, upper dermis contained a mild mononuclear inflammation
infiltrat, where appropriate literature of CA
histopathology seen as hyperkeratosis,
hypergranulosis, and coilositosis in stratum spinosum and irregular acanthosis
that extends to the middle. Mononuclear
infiltrates were slightly visible on dermis.
Dominant picture CA histopathology form
acanthosis and papillomatosis, parakeratosis horny layer also experienced but not
too thick. (1, 3) In the investigation found
10% KOH examination and obtained
spores on a microscope, showing the vulvovaginalis candidiasis. Appropriate literature that predisposing factor vulvovaginalis candidiasis among which endogenous
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and exogenous factors include among

others: sexual contact frequently and do
vaginal douche. This patient do vaginal
douching frequently and sexual intercourse with her partner. Presumably the
mechanism through an allergic reaction
resulting in increased susceptibility to
candida. Mechanisms of sexual contact
can cause candidiasis vulvovaginalis
allegedly caused by abrasion vagina and
allergic to semen. (9, 14) Every CA patient is
necessary to check possibility of sexually
transmitted diseases such as gonorrhea,
syphilis and others. (9) VDRL non-reactive
in this case.

avoid predisposing factors to prevent

recurrence. (9, 14)
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Management CA should consider

patient preference, availability of facilities,
and the experience of health workers. (17)
There is no single treatment is ideal for all
patients with condyloma acuminata. Factors that influence the choice of treatment
include: size, number, anatomic location
and morphology of the lesion, the patient
desires, the cost of treatment, convenience, adverse effects, and the experience of
health workers. (17) Therapeutic modalities
is used electrocauterization. The main
goal of treatment using electrocauterization surgical due to lesions more than 1
cm and because so far it is still considered
to be an effective methode for CA treatment . (2, 7)

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Treatment for candidiasis vulvovaginalis fluconazole 150 mg single dose,

then 50 mg once a day for 7 days.
Literature mentioned that vulvovaginalis
candidiasis therapy using azole class
more effective than nystatin. (9, 14) Patients
were educated to control during therapy
and CA in women have a higher incidence
of developing into dysplasia of vulva,
vagina or cervix. ( 7, 9, 13) For candidiasis
vulvovaginalis when giving the right
treatment it gives a good prognosis and do
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Hagjivassiliou M, Nicolaidou E, Panagiotopoulos A, et al. Comparison of cryotherapy
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