See also: Vulvar lesions
Pathology
Caused by human papilloma virus (HPV) infection
Sx
Females may have internal and/or external vaginal lesions as well as anogenital lesions
Patients are most often asymptomatic
Pruritus, pain and bleeding are possible
PE
Clusters of pink or skin-colored lesions with a smooth, TEARDROP appearance
Small teardrop-shaped growths at the vestibule of the vulva
Application of TRICHLOROACETIC ACID results in complete resolution of the lesions
Dx
Can be made based solely on the characteristic appearance of the lesions, although application of acetic acid (condyloma lesions turn white) and/or biopsy may be used to support the diagnosis.
Tx
Depends on the size of the lesions.
Regardless of method treatment, rates of recurrence are high.
Tx (small lesions)
May be treated in the office with trichloroacetic acid or podophyllin
Tx (larger lesions)
Often treated with excision or fulguration (electric current).
NOT
Do not confuse condyloma acuminata with condyloma lata, which is caused by secondary syphilis and is characterized by flat, velvety lesions. They respond to penicillin.
Vulvar cancer typically presents as a singular, fleshy lesion on the labia majora. Vulvar cancer is commonly seen in elderly individuals and will not resolve with application of trichloroacetic acid.
Lichen sclerosus presents as white, thin, and wrinkled skin over the labia. It typically affects postmenopausal females, and causes pruritus.
Vulvar lichen planus typically affects middle-aged women. Lesions may be hyperkeratotis, erosive or papulosquamous in appearance. Pruritus, soreness, and vaginal discharge are common.
Dr. Kwinter is a Cayman Family Doctor. He runs a Family Medicine Clinic at Cayman Medical in George Town, Grand Cayman, Cayman Islands.