A 27-year-old man sought medical attention because of a malodorous discharge from the groin area and a “few bumps” in the same location.
Key point: There is a rather large area composed of many exophytic, verrucous nodules present on the upper, inner thighs and inferior portion of the scrotum. Just to make sure that this was not a verrucous carcinoma, a biopsy was performed. The latter confirmed the clinical diagnosis of severe external genital warts.
Treatment: Condylomata acuminata this extensive are beyond the capacity of all topical therapies. The area was initially treated by carbon dioxide laser ablation, and residual small foci of infection were subsequently treated with topical 5% imiquimod cream (applied 3 times weekly until cleared).
Note: The verrucous lesions became secondarily infected with yeast, resulting in the visible erythema and odor. Once these nodules were removed and the area could "dry out," the secondary infection resolved without additional treatment.