Anogenital warts

Question 1

What is another name for anogenital warts?

Answer 1

Condylomata acuminata

Question 2

What is the most common cause of anogenital warts?

Answer 2

HPV 6 or 11

Question 3

What might a patient with anogenital warts present with?

Answer 3

• Asymptomatic
• Single or multiple lumps
• Irritation/discomfort
• Bleeding
• Rare: secondary infection or maceration

Question 4

Describe the typical appearance of anogenital warts.

Answer 4

• Often present a soft cauliflower-like growths of varying sizes
• Can be flat, plaque-like, or pigmented
• Lesions on most, non-hair bearing skin tend to be soft and non-keratinised
• Lesions on dry and hairy skin tend to be firm and keratinised
• Lesions may be broad-based or pedunculated

Question 5

Where are common sites for extragenital lesions?

Answer 5

• Oral cavity
• Larynx
• Conjunctivae
• Nasal cavity

Question 6

How are anogenital warts diagnosed?

Answer 6

• Mainly a clinical diagnosis
• Speculum - look for internal warts
• Proctoscopy - only if warts are at anal margin, or if anal canal symptoms such as discharge and bleeding
• Meatoscopy - if difficulties in visualising full extent of intra-meatal warts

+/- biopsy

Question 7

When might a biopsy of an anogenital wart be indicated?

Answer 7

Features of wart:

• pigmentation
• depigmentation
• pruritis

PMH:

• immunosuppressed
• prior history of intraepithelial neoplasia

Question 8

What proportion of patients clear anogenital warts spontaneously?

Answer 8

1/3

Question 9

What management is suitable for soft non-keratinised lesions only?

Answer 9

Podophyllotoxin (BD for 3 days, 4 days rest, repeat for 4-5 cycles)

Question 10

What management is suitable for keratinised lesions only?

Answer 10

Physical ablative therapy - cryotherapy, excision, or electrocautery

Question 11

What management is suitable for both soft, non-keratinised and keratinised lesions?

Answer 11

• Imiquimod 5% cream

- Trichloroacetic acid 80-90% (weekly application in specialist clinic only)