Genital Growth (Condylomata Acuminata)

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This is a fleshy growth found around the anogenital region caused by Human papillomavirus infection HPV6 and 11 but HPV 16 and 18 are associated with cancer of the cervix.

Clinical Features Lesions can be subclinical (not visible to the naked eye) or overt anogenital warts.

Visual inspection of overt disease (fleshy growth of the lower genital tract) detects obvious lesions, which are often multifocal in distribution. However, the appearance and size depending on their location, the trauma to which they are subjected and the degree of irritation.

 

Genital growths

Genital warts (Condylomata Acuminata)

Benzathine Penicillin 2.4 MU IM weekly for 3 doses

Condylomata lata

 Podophyllin 25% topically by physician weekly till resolved

Cauterisation 
(i) 0 5 – fluorouracil cream
(ii)Trichloroacetic acid
(iii)Cryosurgery
(iv) Electro cauterisation
(v) Laser vapourisation
(vi) Surgical removal

Benzathine Penicillin 50000iu/kg IM weekly for 3 doses

For Cervical Warts DO NOT CAUTERISE

DiagnosisThis is based on direct inspection. If uncertain, confirmation can be done by biopsy. May predispose to cancer of the cervix.

TreatmentPodophyllin paint compound (Podophyllin resin 15% in compound Benzoin tincture) – applied every week until lesions disappear. The application should not be left on for more than 4 hours. Where possible, the application should be done in the clinic.

OR

Silver nitrate crystals 5% daily until lesions disappear. Recurrence is common.

Prevention Avoid multiple sexual partners.
Condom use is advised.

Special consideration pertaining to syndromic management

Pregnant women

  • Vaginal discharge syndrome: for Neisseria gonorrhoeae give Spectinomycin 2g IM stat; for Chlamydia give Erythromycin 500mg QID for 5-7 days
  • Genital Ulcer Disease: for Chancroid give Erythromycin 500mg QID X 7 days; for LGV give Erythromycin 500mg QID for 7 days; for Herpes Genitalis give Acyclovir as in the non-pregnant. In the event of an outbreak during labour, consult a gynaecologist to consider an emergency Caesarian Section; for Donovanosis give Erythromycin 500mg QID for 3 weeks until all lesions have completely healed.
  • Genital Growths: Genital warts, LEAVE ALONE, wait until delivery, then decide on surgical management. During labour, if the pelvic outlet is obstructed, or vaginal delivery would result in excessive bleeding, Caesarian Section is indicated. For cervical warts, refer to a gynaecologist for a pap smear to rule out CIN, because cauterization can lead to vaginal fistulas or perforation. For anal warts, refer to a surgeon because cauterization could lead to fistula formation. For urethral-meatal warts, refer to a surgeon
  • HIV Infected
  • Genital Ulcer Disease: in Chancroid, since the ulcers heal slower, it is recommended that the courses of treatment take longer, give Erythromycin 500mg QID for 5 - 7 days.

Children
For children treated with Erythromycin, follow up for symptoms of pyloric stenosis which present with vomiting and abdominal discomfort/distention.