From the Guidelines
The diagnosis for a benign growth caused by human papillomavirus (HPV) in the penile and pubic area is genital warts, also known as condylomata acuminata. Treatment options include patient-applied medications such as imiquimod 5% cream (applied three times weekly for up to 16 weeks), podofilox 0.5% solution or gel (applied twice daily for 3 days, followed by 4 days of no treatment, for up to 4 cycles), or provider-administered treatments like cryotherapy (freezing the warts with liquid nitrogen every 1-2 weeks), trichloroacetic acid (80-90% solution applied weekly), surgical excision, or laser therapy 1. No single treatment works for all patients, and recurrence is common as the virus may remain in surrounding tissue. Some warts may resolve without treatment, but therapy is recommended to reduce symptoms and possibly decrease transmission. The choice of treatment depends on the number, size, and location of warts, as well as patient preference, cost, and provider experience. It's essential to note that while treatment removes visible warts, it may not eliminate the underlying HPV infection completely. Sexual partners should be informed, and condom use is recommended to reduce transmission risk, though it doesn't provide complete protection since HPV can infect areas not covered by condoms 1. Genital HPV types are categorized according to their epidemiologic association with cervical cancer, with low-risk types (e.g., types 6 and 11) causing benign or low-grade cervical cell changes, genital warts, and recurrent respiratory papillomatosis, while high-risk HPV types can cause low-grade cervical cell abnormalities, high-grade cervical cell abnormalities that are precursors to cancer, and anogenital cancers 1. Approximately 100 HPV types have been identified, over 40 of which infect the genital area, with genital HPV infection being the most common sexually transmitted infection in the United States, and an estimated 6.2 million persons are newly infected every year 1.
Key Considerations
- The most common types of HPV that cause genital warts are types 6 and 11 1
- HPV infection is usually impossible to know from whom or when one acquired it because most people don’t know they have it 1
- A healthy immune system suppresses the virus, but it is difficult to predict when HPV is no longer contagious 1
- Lifetime mutual monogamy and abstinence are the best possibilities for prevention, and condoms prevent many bacterial and viral infections, but if HPV is present on uncovered skin, transmission is possible 1
Treatment Options
- Patient-applied medications: imiquimod 5% cream, podofilox 0.5% solution or gel 1
- Provider-administered treatments: cryotherapy, trichloroacetic acid, surgical excision, or laser therapy 1
- The choice of treatment depends on the number, size, and location of warts, as well as patient preference, cost, and provider experience 1
From the FDA Drug Label
External Genital Warts Imiquimod has no direct antiviral activity in cell culture A study in 22 subjects with genital/perianal warts comparing imiquimod cream and vehicle shows that imiquimod cream induces mRNA encoding cytokines including interferon-ɑ at the treatment site. In addition HPVL1 mRNA and HPV DNA are significantly decreased following treatment.
The diagnosis of a papilloma in the penile and pubic area is likely to be External Genital Warts caused by Human Papillomavirus (HPV). The treatment for this condition can be Imiquimod Cream, which induces mRNA encoding cytokines and decreases HPVL1 mRNA and HPV DNA at the treatment site 2. Key points:
- Imiquimod has no direct antiviral activity
- Imiquimod cream can decrease HPV DNA and induce cytokines
- Treatment with imiquimod cream may be effective for external genital warts.
From the Research
Description of Papilloma in the Penile and Pubic Area
- A papilloma in the penile and pubic area is a benign growth caused by the human papillomavirus (HPV) 3, 4.
- HPV infection is the most common sexually transmitted infection in the United States, and it can lead to clinical manifestations ranging from benign papillomas or warts to intraepithelial lesions 3.
- The growths are typically small, cauliflower-like bumps on the genital and anal areas, and can cause discomfort and psychological distress 4.
Diagnosis of Papilloma in the Penile and Pubic Area
- Diagnosis of HPV infection can be challenging because the infection is often asymptomatic, especially in men 4.
- In women, HPV testing can be done through cervical screening programs, which involve the collection of cervical cells for analysis 4.
- Abnormal results may lead to further diagnostic procedures, such as colposcopy or biopsy, to detect precancerous or cancerous changes 4.
Treatment of Papilloma in the Penile and Pubic Area
- The goal of treatment is clearance of visible warts, and some evidence exists that treatment reduces infectivity 5.
- Patient-applied therapy such as imiquimod cream or podofilox is increasingly recommended 5, 6.
- Other treatment options include surgical excision, cryotherapy, and fluorouracil cream 5, 6.
- The choice of therapy is based on the number, size, site, and morphology of lesions, as well as patient preferences, cost, convenience, adverse effects, and clinician experience 5.
Prevention of Papilloma in the Penile and Pubic Area
- Prevention of HPV infection includes vaccination and safe sexual practices 3, 4.
- HPV vaccines, such as Gardasil and Cervarix, are highly effective in preventing infection with the most common high-risk HPV types 3, 4.
- Safe sexual practices, such as consistent and correct condom use and limiting the number of sexual partners, can also reduce the risk of HPV transmission 3, 4.