Telltale skin lesions of syphilis, gonorrhea, human papillomavirus infection, and Haemophilus ducreyi infection.
A solitary polypoid lesion had been present for 6 months on the urethral meatus of a 24-year-old man. The patient and his wife, who was symptom-free, denied contact with anyone who had similar lesions.
The patient was given a local anesthetic, and the lesion was excised in the office. Microscopic examination of the tissue confirmed the diagnosis of condyloma acuminatum.
Genital warts are caused by several strains of the human papillomavirus (HPV) that are transmitted by sexual contact. Unlike the presentation in this patient, genital warts usually erupt in multiples and may be numerous. HPV types 16, 18, 31, 33, and 45 cause at least 85% of cervical cancers; the primary culprits, HPV types 16 and 18, are associated with the most pernicious cancers of the cervix.l,2 A controlled trial of an HPV type 16 vaccine showed promising results; women who received the vaccine were protected from cervical cancer and persistent genital tract infections, thereby precluding transmission of the virus to sex partners.1,3
Treatment options for genital warts include local excision; electrocauterization; cryotherapy with liquid nitrogen; and applications of podophyllum resin, 10% to 25%, trichloroacetic acid or bichloracetic acid, 80% to 90%, and intralesional interferon. Podofilox 0.5% solution or gel and imiquimod 5% cream may be administered by the patient. Topical trichloroacetic acid is the preferred chemical treatment for pregnant patients. Genital warts often recur after treatment.
This patient has had no recurrence since the lesion was excised. His wife was advised to seek medical evaluation and to remain alert for signs and symptoms of HPV infection.
(Case and photograph courtesy of Robert P. Blereau, MD.)