Case Reflection:

Condyloma Acuminata
PRESENTED BY

WAQQAS HANAFI
KOAS OBSGYN
14829 // FK UGM
 Patient
S O
◦ Chief complaint: “kenceng2 sejak tadi malam” ◦ Compos mentis.
◦ 22-year-old woman: G1P0A0. ◦ BP: 110/80 mmHg. HR: 85/min.
◦ I: This pregnancy. ◦ T: 36.5*C RR: 20/min.
◦ Gestational age: 36+4 weeks (aterm). ◦ FHR: 120/min.
◦ HPHT: Forgot. HPL: Forgot. ◦ Abd. exam: Head entered 4/5, TFU 28 cm.
◦ HT Ө, DM Ө, Asthma Ө, Allergy Ө, Jamu Ө, ◦ VT: Ø 3 cm, soft, thin, 100% effacement.
Pijet (x1). ◦ Condyloma acuminata multiple solitary (3)
◦ ANC: Midwife x 2. Doctor x 1. ◦ EFW: 2915g. (USG, 36 weeks+6)
◦ Contractions Ꚛ 2/10min, ROM Ө blood Ө. ◦ BPD: 8.91 (USG, 36 weeks+4)
Condyloma Acuminata

1. Κόνδυλος “Kondulos” = knuckle.

2. Anogenital warts.
3. Vulva, penis, groin, perineum, perianal skin, suprapubic skin.
4. Sexual activity.
5. Manifestations of HPV infection.
 Human papillomavirus
1. Virus.
2. Most HPV infections are asymptomatic and resolve
themselves. (90% within 2 years)
3. Some can progress to cancer: mostly cervical cancer.
4. Cervical cancer is the fourth most frequent cancer in
women with 500 000+ new yearly cases.
5. High mortality rate (52%).
6. Nearly all cervical cancer is caused by HPV.
7. Early treatment prevents up to 80% of cervical
cancers in these countries.
Diagnosing C.A.
1. Can be made by physical exam alone, but keep DDx in mind.
2. Single or multiple soft, smooth or papillated papules or
plaques limited to the anogenital area.
3. Common DDx:
1. Umbilicated papules: molluscum contagiosum
2. Keratotic plugs and hyperpigmentation: seborrheic keratosis
3. Violaceous color: lichen planus
4. Moist surface: condylomata lata of syphilis
4. Gold standard: biopsy. Also helps to rule out malignancy.
“Doctor, is it cancer?”
Cervical Cancer
1. Persistent infection with type 16,18
of HPV may lead to precancerous
lesions.
2. It takes 15-20 years to develop.
3. Symptoms:
a. irregular, intermenstrual (between periods)
or abnormal vaginal bleeding after sexual
intercourse;
b. back, leg or pelvic pain;
c. fatigue, weight loss, loss of appetite;
d. vaginal discomfort or odourous discharge;
and
e. a single swollen leg.
Case Reflection
1. 22 years old: too young for cervical cancer manifestation.
2. Multiple tattoos: increased risk of HIV (immunosuppression).
3. Multi partner sex: risk factor for HPV infection. Risk of HIV.
4. Condyloma Acuminata is caused by low-risk types of HPV, but co-
infection with high-risk types is not impossible.
5. Pregnant: low risk of HPV infections for baby.

Diagnosis: Condyloma Acuminata = Most likely a low-risk HPV

infection.

Management by Obsgyn department: refer to Dermatology &

Venerology department because the lesions were external warts on the
anogenital area. The management will probably be surgical excision,
chemical ablation, and cryotherapy.
C.A. in Pregnancy: Importance in Obsgyn
During pregnancy, vaginal secretions contacting the skin and mucous membranes are more
abundant, meaning that the vulva will remain in a moist and immersed state, which would be
problematic for CA patients.
Several factors associated with pregnancy can promote the growth of HPV-induced lesions, for
example, pregnancy hormones and reduced immunoresponsiveness.
Cases of CA in pregnancy are normally characterized by fast-growing warts, and a reduced
tolerance and poor compliance to treatment.
Treatments: bi- and tri-chloroacetic acid (BCA/TCA), cryotherapy, electrocautery and surgical
excision, including laser treatment.
Thank you
Does HPV cause other types of cancer?
Screening for HPV
1. Because pre-cancerous lesions take many years to develop, screening is recommended for
every woman from aged 30 to 49.
2. There are 3 different types of screening tests are currently available:
1. conventional (Pap) test and liquid-based cytology (LBC)
2. visual inspection with Acetic Acid (VIA)
3. HPV testing for high-risk HPV types.
Vaccines
1. Gardasil, a quadrivalent HPV vaccine, targets HPV types 6, 11, 16, and 18.
2. Gardasil 9, a 9-valent vaccine, targets the same HPV types as the quadrivalent vaccine (6, 11,
16, and 18) as well as types 31, 33, 45, 52, and 58.
3. Cervarix, a bivalent vaccine, targets HPV types 16 and 18.

HPV vaccines are most effective among individuals who have not been infected with HPV
Treatment of the warts
In a nonpregnant patient, podofilox gel or solution is recommended. This antimitotic agent is
either chemically synthesized or purified from naturally occurring podophyllin resin. Podofilox is
used in the treatment of external genital warts or condyloma acuminatum. It is applied twice
daily for 3 consecutive days and repeated for up to 4 weeks. Application stimulates visible
necrosis of wart tissue. Side effects are minimal.
References
1. American Cancer Society
2. UpToDate
3. Medscape
4. WHO