Condyloma
Like other warts, subtypes of
human papilloma virus also cause these lesions. Like other warts, the
infection is a lifelong one. Sexually transmitted diseases such as
condylomata love company. Make sure that your patient does not have
other STDs. Evaluation for other STDs (e.g. syphilis, urethritis, and
HIV) should be considered on the initial visit.
Once a patient has had condylomata, the
skin always sheds virus to some degree. As such, barrier
contraception (e.g. condoms) is recommended unless a couple is
actually trying to conceive. The question of who gave the virus to
whom is not a useful one. The virus may have been shed
asymptomatically by either partner for quite some time before lesions
develop.
The goal is to make your patient
free of visible warts for as long as possible. Eradication of the
virus from the skin is impossible. Destructive modalities delivered
with precision such as liquid nitrogen, Trichloroacetic acid,
electrosurgery, and podophyllin are helpful.
Podophyllin resin in tincture of
benzoin has long been a mainstay of therapy. Apply it to external
lesions (do not apply to vaginal or cervical warts in women or use
during pregnancy) and wash off with soap and water after 4 - 6 hours.
Re-evaluate your patient 1 week after treatment to determine whether
additional therapy is necessary.
A new form of podophyllin (Condylox)
is commercially available and should only be considered for
emotionally mature, dexterous, and reliable patients. The active
ingredient is podofilox, a purified and standardized form of
podophyllin toxin suitable for self-application by a patient.
Podofilox is meant only for
external condylomata and should not be used on mucous membrane lesions
or during pregnancy in females. Follow the PDR recommendations
carefully because over treatment will result in considerable
irritation. This should be applied only to lesional skin. This
medication is also quite expensive. It is not meant for everyone.
Other pharmacologic means to
treat condylomata include biologic response modifiers such as topical
imiquimod cream (Aldara) and intralesional interferon. These
modalities are very costly and are only considered appropriate for
treatment when prescribed by Dermatologists.
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Written and revised by CAPT Dennis
A. Vidmar, MC, USN, Department of Military and Emergency
Medicine, and Department of Dermatology, Uniformed Services University
of the Health Sciences, Bethesda, MD (1999).
Additional images provided by CAPT Vidmar in
June, 2000, subsequent to the initial publication of this manual.
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Preface
· Administrative Section
· Clinical Section
The
General Medical Officer Manual , NAVMEDPUB 5134, January 1, 2000
Bureau
of Medicine and Surgery, Department of the Navy, 2300 E Street NW, Washington, D.C.,
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