Venereal Warts

Overview

Condylomas are the most common sexually transmitted disease (STD). They are small lesions or "warts" which occur in the genital, oral and anal regions in sexually active individuals. They are caused by a virus called the human papilloma virus (HPV). They are much more common than gonorrhea, chlamydia or syphilis.

Evaluation

In men they may appear as small raised or flat regions on the penis, scrotum, groin or anal region. In women they may also appear on the visible external genital regions or on the cervix. The diagnosis may be obvious when a prominent "wart" is present, or the lesions may be small and obscured. A vinegar solution of acetic acid can be placed on the genitals and inspected with a magnifying lens to see if characteristic white lesions are seen.

It is very important to detect HPV in both men and women. In women, HPV has been associated with cancer of the cervix. The gynecologist must inspect and biopsy suspicious areas of the cervix to make the diagnosis. After the cervix has been found to be infected or show signs of dysplasia (a possible premalignant condition), then the male partner should be evaluated because of the "ping-pong" phenomenon involved with a sexually transmitted virus. A condom is recommended to prevent transmission of the virus.

Treatment

Treatment is determined by the site and size of the lesion. At times a "wart" is seen protruding out the tip of the penis. When this is seen, then we need to look inside the urine tube toward the bladder to see if other lesions are present. When small lesions are identified on the penis, we usually recommend medical application of a liquid (Condylox®) to eliminate the lesion. Larger lesions or those that do not respond to medical management will require either surgical excision or some form or destruction with either a laser, coagulation or freezing device. These usually can be treated with a local anesthetic although more extensive lesions will necessitate treatment under general anesthesia.