Also known as venereal warts, these are caused by the human papilloma virus [HPV] which is a small DNA virus.

These warts spread diffusely over the whole of the vulval area. The verrucos growths may appear discrete or coalesce to form large cauliflower –like growths. They affect the skin of the labia majora, perineum, and perianal region.

They are seen in women of the child bearing age, and are mainly sexually transmitted. Vaginal discharge, oral contraceptives and pregnancy favor their growth. They are several varieties of the HPV of which HPV 6, 11, 16 and 18 as well as 31, 32, 33 are of significance to the gynaecologist. HPV 6, 16 and 18 are implicated in the development of Condyloma acuminata, cancer of the cervix and vulva. The typing of the virus is based on DNA, DNA hybridization as well as by polymerase chain reaction [PCR].

Treatment
Young women with flat Condyloma may be observed for 6 months, especially when it develops during pregnancy, because the lesions often disappear spontaneously. 25% podophyllin in alcohol or 20% podophyllin in tincture benzoin locally or 25% tricholoacetic acid causes sloughing off of small warts in 3-4 days.

The treatment may need to be repeated weekly as the warts recur at 3-6 weeks interval. This treatment is however contraindicated in the first trimester of pregnancy, because the drug is absorbed into the circulation and is cytotoxic causing abortion and peripheral neuropathy. This treatment is also contraindicated in vaginal and cervical lesions, because of severe inflammatory reaction provoked at these sites.

The larger lesions are best removed by diathermy loop or laser ablation. The surgical excision of a localized growth is another alternative. Associated syphilis and malignancy need to be excluded.

The husband should be treated simultaneously or protected from infection by advising the use of condoms. Vulval and vaginal warts during pregnancy mandate caesarean section to avoid papilloma laryngitis in the neonate.
Lately interferon eye ointment has been advocated. It is applied 4-5 times daily 1 g each time; total daily dose of 6g for 8 weeks. 90% lesions regress by then. Intramuscular injections of interferon daily for 10 days yields 90% success. Side effects are fever, myalgia and headache. Cream is preferred to injection as the latte is painful. Interferons inhibit the viral and cellular growth.

Apart from surgery, the warts can be removed by cryosurgery, diathermy or by laser. Needless to say that biopsy is mandatory to rule out malignancy. Pap smear of the cervix is also required to rule out cervical malignancy.