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Condylomata
acuminata
Khairunnisa Nurul Huda/ G99152007
Adviser:
Nugrohoaji Darmawan, dr., Sp.KK, M.Kes

Genital warts
Clinical anogenital HPV infection
because they manifest as single or
multiple papules on the vulva,
perineum, perianal area, vagina,
cervix, penis, anus, scrotum and
urethra (Patel, 2013)

Epidemiology
the most frequent sexually transmitted
diseases (STD)

2,3, 4 gender
2 age
4-56 risk factor
Although AGWs rank among the most
frequent sexually
transmitted diseases (STD) [21,22]

Etiology
2
7
8

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Epidemiology
.

- This is an STD
- Half to one million new
cases are
diagnosed each year in the
United
States
- Half of these new infections

will
occur in young adults ages 15
(Valerie,
to 24 years
2012).

Etiology.

LOGO

Most
caused
by HPV6 or
HPV-11

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LOW RISK:
HIGH RISK:
HUMAN PAPILLOMAVIRUS HUMAN PAPILLOMAVIRUS
SUBTYPES 6 AND 11
SUBTYPES 16 AND 18
7590% cases of genital warts

70% cases of all invasive cervix

cancer

Remain separate from host cell

DNA,
undergo independent replication

Integrate viral DNA with hosts

genome promoting
transcription of oncoproteins that
inactivate tumor
suppressor genes

HPV4

HPV2
HPV4

(Valerie,
2012).

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Pathogenesis.

Transmission of HPV occurs

primarily by skin-to-skin contact
HPV replication cycle begins with entry of
the virus into the cells of the basal layer of
the epithelium
In the basal layer, viral replication is
considered to be non-productive
In the differenciated keratinocytes of the
suprabasal layer, the virus switches to a
rolling-circle mode of DNA replication

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Clinical
Features.

Virus requires an incubation period

ranging anywhere from 3 weeks to 8
months prior to clinical manifestation.

may increase in number and size or,

alternatively, undergo a spontaneous
regression. approximately 30 percent of all
warts will regress within the first four months
of
infection
majority
of genital warts will recur within
three months of infection, even after
undergoing the appropriate treatments

Clinical
Features.
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- Usually asymptomatic,

except for cosmetic

appearance
- Itching, burning, bleeding,
vaginal or urethral
discharge, dyspareunia

4
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Clinical types of
genital warts
occur:

- Small papular
Cauliflower-floret
(acuminate
or
pointed)
lesions
- Keratotic warts
Flat-topped
papules/plaques
(most

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Clinical
Features.

Color : skin-colored, pink,

red, tan, brown.
Solitary, scattered, and
isolated, or form voluminous
confluent masses

Sites of
Predilection.

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MAL
EFrenulu
m,
corona,
glans
penis,
prepuce,
shaft.

FEMAL
Labia
E

clitoris,
periurethral
area,
perineum,
vagina,
cervix (flat
lesions)

BOTH
Perineal,
SEXES

anal
canal,
rectal;
urethral
meatus,
urethra,
bladder;
orophary

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Multiple skin-colored papules on the penis and

scrotum.

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Multiple cauliflower floret-like papules on penile shaft

and foreskin

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Sharply
demarcate
d, whitish,
flat
plaques
becoming
confluent
around the
cervix.

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The vast

majority of can be accurately

diagnosed with a careful clinical history
and physical examination
extremely mild or subclinical cases, the
use of a 3 to 5% acetic acid solution
(the acetowhite test)
)

Treatment

modalities
for genital warts.

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TREATMENT
TYPE

Mechanisms of
Action

Podophyllotoxin Anti wart lignans

Administ
Comments
red by
Patient

Induces secretion
Imiquimod 5% of cytokines that
Patient
cream
reduce HPV DNA
viral load
Sinecathechin
TCA

Cryotherapy

Antitumor, antiviral,
Patient
antioxidant effects
Chemically
destructive acids
Dermal damage
induced by cold
temps initiate

Physician

Physician

Cost-effective home
treatment
Lengthy duration and
sporadic dosing
frequency can affect
compliance
Can often take 16
weeks to elicit
positive response

Podophyllotoxin
Podofilox solution (using a
cotton swab)
or podofilox gel (using a finger)
Applied to anogenital warts
twice
a day for 3 days, followed by
4 days of no therapy. This
cycle can be repeated, as
necessary, for up to four
Mild to moderate pain or
cycles
local irritation
Contraindicated in pregnancy

Imiquimod 5% cream

applied once at bedtime, three times a

week for up to 16 weeks
Local inflammatory
reactions,
including redness,
irritation,
induration,
ulceration/erosions
, and vesicles
might occur

Trichloroacetic acid
Caustic agents
Damage adjacent
tissues if applied
excessively

Treatment can be repeated

weekly if necessary

Cryotherapy
over- and undertreatment can result
in complications or
low efficacy
Followed by necrosis
and sometimes
blistering

Patogenesis
97

Clinical manifes
2, 6, 9,10

lab
9 acetowhite, biopsi

Dif diagnosis
2

prevention
2

treatment
2

prognosis
2

LOGO
Case Report

A 22 Year Old Female

with Condylomata
acuminata

Patient Identity
IDENTITY
Name: Ms. N
Age

: 22 y.o.

Address : Wonogiri
Occupation : Employee
Marital status : Not yet married
MR number : 013xxxxx
Date of examination : Dec 15th, 2016

Chief complaint: There were warts on the vulva

History of present illness:

2 months ago

3 weeks ago

Past Medical History

History ofmellitus
Diabetes
Hypertension
Allergy
HIV
similar disease

Familial Medical History

History ofmellitus
Diabetes
Hypertension
Allergy
HIV
similar disease

Sexual History
Pregnancy
Coitus
Sexual
Birth
control:
orientation
contact
: condom
: genital-genital,
: heterosexual
(+),

PHYSICAL EXAMINATION
General State : CM
VITAL SIGN
BP : 120/80 mmHg
RR : 18x/minutes
HR: 72x/minutes
T : 36,7oC
General status

Head

: normal

Face

: normal

Neck

: normal

Eye : normal

Ear : normal

Axilla

: normal

General status

Trun Anterior

: normal

Abdomen

:normal

Trunc post : normal

Inguinal

Genital
: see
dermatological status

Upper extremity

: normal

Lower extremity

: normal

: normal

PHYSICAL EXAMINATION
Dermatological Status :
Genital :
Multiple verrucous
papules, 1x0.5 cm, skincolored, scattered, sharpbordered,irreguler

Differential Diagnosis

Condylomata Acuminata

Condyloma Lata

Verruca Vulgaris

Laboratory Diagnosis

Acetowhite (+)

Condylomata Acuminata

Treatments
Non

pharmacological

Explain about the disease,

treatment, planning, and
prognosis to the patient
Educate patient about
personal hygiene (esp. genital
hygiene)

Educate patient about safe sex

(contraception) or abstinence
for a while, monogamy

Prevent patient to scratch the

lesion if it feels itchy

VCT

Pharmacologica

TCA

Surgical

Criotheraphy

Prognosis

Ad vitam

: bonam

Ad sanam

: dubia

Ad fungtionam

: bonam

Ad kosmetikum

: dubia

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