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Patient Case: Anogenital Warts (Condylomata Acuminata)

Patient Case: Anogenital Warts (Condylomata Acuminata)

Discussion

A 27-year-old male presents to the dermatology clinic with multiple painless growths around his anus and genital area. He first noticed a few small bumps four months ago, but they have since increased in number and size. He denies pain, itching, bleeding, or discharge. He has had multiple sexual partners in the past year and reports inconsistent condom use.

On physical examination, numerous soft, flesh-colored, verrucous papules with a cauliflower-like appearance are observed on the perianal skin and extending to the penile base. There are no signs of ulceration, secondary infection, or systemic symptoms. A digital rectal exam reveals no internal lesions.

Given the characteristic appearance, the patient is diagnosed with anogenital warts (condylomata acuminata) caused by human papillomavirus (HPV). He is counseled on treatment options, including topical imiquimod and podophyllotoxin, as well as procedural options such as cryotherapy or electrocautery. He is also advised about HPV vaccination and safe sexual practices to prevent recurrence and transmission.

Questions
  1. What is the most likely causative agent of the patient’s condition?
    a) Treponema pallidum
    b) Human papillomavirus (HPV)
    c) Herpes simplex virus (HSV)
    d) Neisseria gonorrhoeae
  2. Which clinical feature is most characteristic of anogenital warts (condylomata acuminata)?
    a) Painful vesicular lesions with ulceration
    b) Soft, flesh-colored, verrucous papules with a cauliflower-like appearance
    c) Single, firm, painless ulcer with clean edges
    d) Thick, adherent white plaques with a foul odor
  3. Which HPV types are most commonly associated with anogenital warts?
    a) HPV 6 and 11
    b) HPV 16 and 18
    c) HPV 1 and 4
    d) HPV 31 and 45
  4. What is the most appropriate first-line treatment for anogenital warts?
    a) Oral antiviral therapy
    b) Topical imiquimod or podophyllotoxin
    c) High-dose systemic antibiotics
    d) Immediate surgical excision in all cases
Reveal answers

Answers

  1. (b) Human papillomavirus (HPV)
    • Anogenital warts are caused by HPV, with types 6 and 11 responsible for the majority of cases. These types are considered low-risk for malignancy.
  2. (b) Soft, flesh-colored, verrucous papules with a cauliflower-like appearance
    • Genital warts typically appear as painless, soft growths with a verrucous surface. They can vary in size and number and are commonly found in the anogenital region.
  3. (a) HPV 6 and 11
    • These low-risk HPV types cause benign warts but are not strongly linked to cervical or anal cancer, unlike high-risk types 16 and 18, which are associated with malignancy.
  4. (b) Topical imiquimod or podophyllotoxin
    • First-line treatments include topical agents like imiquimod (immune modulator) and podophyllotoxin (cytotoxic agent). Cryotherapy and electrocautery are alternative treatment options for persistent or extensive lesions.