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con·dy·lo·ma a·cu·mi·na·tum(kon-di-lō'mă ă-kū-mi-nā'tŭm)
Synonym(s): genital wart, venereal wart.
common wartVerruca vulgaris.illustration
A variety of therapies, including topically applied chemicals such as podophyllin (10% to 25% in compound tincture of benzoine), trichloroacetic acid, or dichloroacetic acid usually remove small warts; other treatments include CO2 laser therapy, cryosurgery, electrocautery, 5-fluorouracil, imiquimod, and recombinant interferon alfa-2a. Nevertheless, there is no completely safe and effective therapy available for genital warts.
A history is obtained for unprotected sexual contact with a partner with known infection, a new partner, or multiple partners. Standard precautions are used to examine the patient, to collect a specimen, or to perform associated procedures. The health care professional inspects the genitalia for warts growing on the moist genital surfaces, such as the subpreputial sac, the urethral meatus, and less commonly, the penile shaft or scrotum in male patients and the vulva and vaginal and cervical wall in female patients. Multiple warts have a cauliflower-like appearance. The patient usually reports no other symptoms, as the warts are generally painless, but a few complain of itching and pain. Diagnosis usually is made by visual inspection, but darkfield examination of wart cell scrapings may be used to differentiate HPV warts from those associated with second-stage syphilis. Biopsy is indicated if cancer is suspected. A nonthreatening, nonjudgmental atmosphere is provided to encourage the patient to verbalize feelings about perceived changes in sexual behavior and body image. Sexual abstinence or condom use during intercourse is recommended until healing is complete. The patient must inform sexual partners about the risk for genital warts and the need for evaluation. The patient should be tested for human immunodeficiency virus and for other sexually transmitted diseases. Genital warts can recur and the virus can mutate, causing warts of a different strain. The patient should report for weekly treatment until all warts are removed and then schedule a checkup for 3 months after all warts have disappeared. If podophyllin is applied, the patient is taught to remove it with soap and water 4 to 6 hrs after the application. Female patients should have a Papanicolaou test on a schedule recommended by their health care providers.