DR10.11 | Genital Wart Diagnosis Treatment and Education — Summary & Reflection

KEY TAKEAWAYS

Genital warts (condylomata acuminata) are soft, cauliflower-like anogenital growths caused chiefly by low-risk HPV types 6 and 11, which are non-oncogenic; the high-risk types 16 and 18 drive cervical and other anogenital cancers through their E6/E7 inactivation of p53 and Rb but do not usually cause visible warts. Diagnosis is clinical (acetowhitening can help), and the essential differentials are condylomata lata of secondary syphilis (flat, moist, broad-based, VDRL/RPR positive), molluscum contagiosum (umbilicated), and pearly penile papules (a normal variant — do not treat). Investigate with VDRL/RPR where morphology is atypical, offer HIV testing, and refer women for cervical screening. Treat with patient-applied podophyllotoxin (contraindicated in pregnancy) or imiquimod, or provider-applied TCA, cryotherapy, or excision (TCA and cryotherapy are pregnancy-safe) — always asking about pregnancy first. Complete the consultation with education: recurrence is common, condoms reduce transmission, HPV vaccination prevents oncogenic infection, and cervical screening and partner examination matter.

REFLECT

Reflect on how you would use a genital-wart consultation as a prevention opportunity without overwhelming or frightening the patient. How would you explain, in plain language, that the warts themselves are caused by low-risk HPV and are not cancer, while still motivating the patient (and, where relevant, their children) toward HPV vaccination and cervical screening against the high-risk types? Consider also how you would sensitively counsel a young woman about treatment recurrence so that a wart returning after treatment does not make her lose trust in you or in the care she has received.