The term condyloma acuminatum (pl. condylomata acuminata) is derived from the Greek phrase for a caruncle or node and the Latin phrase for sharply pointed. Condyloma acuminatum is a cutaneous benign neoplasm caused by the human papillomavirus (HPV), usually HPV type 6 or 11, which typically has a verrucous, papillary or sessile appearance and exhibits viral HPV cytopathologic effects characterized by epithelial thickening with acanthosis, including elongation and thickening of the rete ridges and koilocytosis in the superficial keratinocytes.

The frequency of vulvar condylomata acuminata (condylomata) in the adult population generally exceeds 1 in 100 individuals (1%) but varies with the population studied. These benign HPV-related lesions are typically multiple, and in women involve the vulvar vestibule, labia minora, labia majora, adjacent hair-bearing skin, and perianal areas. Condylomata can vary greatly in size; however, small lesions are common and often difficult to detect. The use of topically applied 3% to 5% acetic acid with examination under illuminated magnification is of value. Condylomata can involve the vulva as well as the vagina and cervix. Less commonly the urethra, perianal skin, or the anus may also be involved. Typical condylomata are benign, self-limited lesions; however, in some women there can be associated intraepithelial neoplasia, or squamous cell carcinoma of the vulva, cervix, or anus associated with these lesions. In these women, the premalignant or malignant neoplastic lesion is typically associated with an oncogenic HPV type, such as HPV 16 or 18, rather than the typically wart-related HPV type 6 or 11. A rare tumor, verrucous carcinoma (giant condyloma of
Buschke Lowenstein), can be identified associated with condylomata. These tumors are also HPV 6 or 11 related, but they can be locally invasive (see discussion of verrucous carcinoma).

Extremely specific and sensitive polymerase chain reaction (PCR) studies indicate that HPV has widespread prevalence in the general population. Although the incubation period for HPV is noted to be approximately 3 months, the inability to study the virus in an animal model has resulted in poorly understood epidemiology. It is possible that incubation periods may be vastly underestimated. Subclinical infection with HPV may be present for months to years before clinical evidence of the disease manifests.

Patients with clinical disease will present complaining of warty growths on the vulvar skin. They may have been present for variable periods of time, and occasionally a patient will wait months before presenting for evaluation. On examination the typical verrucous, papillary lesions will be noted on the vulvar skin. Most commonly, multiple lesions will be noted. The lesions may be observed at the vestibule and on the labia minora, labia majora, and perianal regions. Examination of the vagina will frequently demonstrate disease in the vagina and on the cervix. Approximately 30% of women with vulvar condylomata have associated cervical or vaginal condylomata or intraepithelial neoplasia. Disease is especially widespread in immunosuppressed individuals, patients who have had organ transplants, and patients with diabetes, autoimmune disease, or acquired immunodeficiency syndrome (AIDS). Frequently, in immunosuppressed patients, evidence of viral disease will be noted elsewhere, such as on the extremities, where common warts may be noted. Excessive growth of the verrucous lesions may impair the patient’s ability to have vaginal intercourse. Maintenance of proper hygiene after defecation may become impossible.

The diagnosis of condyloma acuminatum is most frequently made by visual inspection. The classical warty growths are well known to clinicians. Rarely is it necessary to biopsy such lesions. Small, unifocal lesions may be confused with skin tags or intradermal (or dermal) nevi. More diffuse lesions may rarely be confused with condylomata lata, vulvar intraepithelial neoplasia (VIN), and verrucous carcinoma. When uncertainty exists, or when therapeutic intervention fails to ameliorate the condition, biopsy should be performed for a confirmation of diagnosis. The clinical usefulness of HPV serotyping has not been documented and is currently not cost-effective. Regardless of the HPV serotype involved, patients should be observed closely for evidence of dysplastic or neoplastic growth on a long-term basis.