37 year old man came to ED c/o penile discharge for 2 days.

Dr. Madhav Mishra

General Surgery

37 year old man came to ED c/o penile discharge for 2 days. Patient confirmed multiple sexual partners and having unprotected sex. Medical history included HIV and Hep C. After antibiotics were administered , patient shared he also had some “bumps” on his rectal area. This is what his physical exam revealed.

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Dr. Sandip Debashis Mishra

Top Endocrinologist of March

Condyloma acuminatum (CA) or venereal/genital warts refer to benign proliferative epidermal or mucosal lesions attributed mostly to HPV type 6 or 11, but co-infections with high-risk HPV types are frequent. More than 100 types of HPV have been identified, of which 40 can infect the genital areas. HPV are highly specific viruses showing both species and regional specificity. They represent the most common sexually-transmitted disease (STD) and are highly contagious. The prevalence of CA peaks in the early sexually active years, with two-thirds of the respective sexual partners complaining of warts. The median time between infection and development of lesions is about 5-6 months among women. Up to 20% of people with genital warts will present other STDs. The following risk factors have been described, including smoking, hormonal contraceptives, multiple sexual partners, and early coital age. Patients who develop CA complain of painless bumps and, less frequently, of pruritus, discharge, or bleeding. Lesions are commonly multiple (multicentric) and multifocal, also affecting the perianal, vaginal, and cervical regions, but oral and laryngeal regions may also be involved. Latent illness may become active, particularly with pregnancy and immunosuppression. Lesions may regress spontaneously, remain stable, or progress in size and/or number. CA are soft, raised masses, with smooth, verrucous, or lobulated aspects that may appear as pearly, filiform, fungating, or plaque-like eruptions. The surface commonly shows finger-like projections, generally nonpigmented. They mainly occur in the moist areas of the labia minora and vaginal opening, but virtually, all genital regions may be affected (fourchette, labia minora/majora, pubis, clitoris, urethral meatus, perineum, perianal region, anal canal, introitus, vagina, and ectocervix). Therefore, minutious colposcopic examination, using acetic acid 2–5%, is of crucial importance to detect potentially multiple involved sites. CA are perceived as disfiguring, they impact sexual lifestyle, causing anxiety, guilt, and loss of self-esteem and creating concerns about cancer risk. The most common treatments are painful and nonspecific, addressing the clinically evident lesions rather than the viral cause. Various modalities include office-based treatment (cryotherapy, electrocautery, laser, and/or surgery) or home-based treatment (chemotoxic agents or immunomodulatory therapy). First episode patients should be STD screened. Management should include partner notification.