Genital warts

Patients often report asymptomatic, painless lesions/ growths in the anogenital area but may sometimes experience itching, pain, or bleeding. Psychological distress from visible lesions is also common. Some patients might present with oral lesions or bring up the potential for sexual transmission, which is common for anogenital presentations.

Condyloma acuminata usually appear as multiple raised, skin-colored, or fleshy papules, about 1-5 mm in diameter, with possible coalescence into larger lesions. They might present as broad, flat, or cauliflower-like growths in the anogenital region or on the tongue and lips if oral. 

Topical Treatments

• Podophyllotoxin 0.5% solution or 0.15% cream is applied bi-daily for three days, with a four-day interval between cycles.

• Imiquimod 5% cream has lower recurrence rates and is used three times weekly, typically resolving lesions in 16 weeks.

• Sinecatechins 15% ointment offers an alternative topical therapy, applied three times daily for up to 16 weeks.

Clinical Procedures

• Cryotherapy: Safe in pregnancy, involves weekly applications of liquid nitrogen to the lesion for 6-10 weeks.

• Trichloroacetic Acid (TCA) 80-90%: Applied weekly to smaller lesions, forming a healing ulcer without scarring.

• Surgical Excision: Effective for refractory lesions, including methods like electrosurgery, curettage, scissors excision, and laser therapy.

Emerging Treatments

• Photodynamic Therapy (ALA): Combines 5-aminolevulinic acid with light exposure and has shown promise for lower recurrence rates compared to traditional CO₂ laser therapy.