The pathology of condyloma
BETTER UNDERSTANDING, BETTER HEALING!
What are condylomas and how do they appear?
Condylomas are lesions in the anal and genital areas. They take the following forms:
- raised lesions: cauliflower or rooster-crest shaped
- papular lesions (pimples), flat or pigmented
Condylomas are often multiple and asymmetrical, and come in different shapes. They are mainly located where the skin or mucous membrane is subject to friction. They sometimes cause itching and, more rarely, bleeding.
It is advisable to perform a self-assessment and consult a doctor in case of injury.
What causes condylomas? (Transmission)
More than 90% of condylomas are caused by low-risk human papillomavirus (HPV) (mainly HPV types 6 and 11).
HPV is transmitted through sexual contact with the genitals or anus, with or without penetration, including sexual contact between the mouth and genitals or anus. HPV is highly contagious.
The vast majority of people infected with HPV do not know they have it. It is often difficult to know for sure when transmission has occurred.
HPV infection does not protect against other types of infection.
HPV remains contagious for an unknown length of time after the lesions have disappeared, regardless of whether they are treated or not. Patients are advised to inform their sexual partners.
Visiting the clinic for condylomas
Preparing for the visit
It is advisable to take an analgesic (Tylenol or Advil, if there is no contraindication from your family doctor) one hour before your visit since you will likely be getting treatment.
What to expect during the visit
The treatment itself usually takes no longer than one minute. In most cases, your doctor will locally apply a medication (trichloroacetic acid, or TCA) on the condylomas. He/she may also use cryotherapy treatments (contact with a probe that has been cooled using liquid nitrogen).
On some visits, your doctor will suggest a rectoscopy to make sure you do not have any internal condylomas.
Your doctor may talk to you about getting the HPV vaccine.
What to expect after the visit
This treatment can generate pain of varying duration and intensity from one person to another (and from one time to the next). In general, this pain is moderate and relieved by analgesics (Tylenol or Advil) or by anti-inflammatory drugs (Aleve or Naproxen). Sitz baths (sitting with your buttocks in warm water) can also help.
Condylomas occur following an infection with the human papillomavirus (HPV) and treatment requires several sessions. The exact number is impossible to predict and depends on your immune system, among other things. In general, several visits with short intervals (every week or two) are necessary to eliminate all visible lesions.
It is advisable to keep the area clean through usual care (shower or bath) and to avoid applying any sort of cream.
The human papillomavirus (HPV) is highly contagious. It is essential to inform your partner(s) and avoid direct contact with the affected area.
How to treat condylomas (treatment)
How to treat it (Treatment)
Condylomas can disappear spontaneously. However, their disappearance does not protect against a recurrence or infection with another type of HPV. With or without treatment, condylomas often recur.
Although treatments can reduce symptoms and clear lesions, there is no treatment that will make HPV go away.
Your doctor will recommend the specific treatment that is right for you. Here are some of the possible treatments:
- application by the patient of a podofilox or podophyllotoxin solution, a 5% imiquimod or 10% sinecatechins ointment;
- cryotherapy (cold therapy) performed by a health professional using liquid nitrogen, carbon dioxide (dry ice) or nitrous oxide;
- application of bichloracetic or trichloroacetic acid performed by a health professional.
When patients are responsible for applying treatment themselves, at least one follow-up visit will be recommended two weeks after the end of the treatment cycle.
If there are internal lesions, numerous or large external lesions, or lesions that are resistant to initial treatment, the healthcare professional may refer the patient to a specialized colleague or ask that the patient be seen at a hospital.
How to prevent condylomas (Prevention)
Condom use is recommended during all vaginal, anal, oral and oral-anal sex to prevent sexually transmitted infections (STIs). At the same time, condoms may not provide as much protection against condylomas as they do against other STIs. This is because HPV can infect any areas that are not covered by condoms.
The best way to protect yourself against HPV is to get vaccinated. The vaccine is recommended even for people who have or have had condylomas. However, it is most effective when the person receiving the vaccine has never had HPV.
Note: HPV vaccines do not treat condylomas that are already present.
Human Papillomavirus (HPV) vaccine
Gardasil® 9 is a “nonavalent” vaccine that helps protect against HPV (types 6, 11, 16, 18, 31, 33, 45, 52 and 58). Among these are the types that cause the majority of condylomas. Cervarix®, for its part, is a bivalent vaccine that provides protection against HPV type 16 and 18. It is possible for a person to get the vaccine even if they have already had condylomas. HPV vaccines cannot, however, treat existing condylomas.
HPV is responsible for the majority of condylomas as well as cancers of the cervix, vagina, vulva, penis, anus and mouth/throat. Very often, infected people have no symptoms and do not know they have HPV.
The best way to protect yourself against HPV is to get vaccinated. The vaccine is recommended even to those who have had condylomas. At the same time, it is more effective when the person receiving the vaccine has never had HPV.
The HPV vaccines used for the Québec vaccination program are Gardasil® 9 and Cervarix®. These vaccines stimulate the immune system to prepare antibodies to fight the viruses. Because they are “inactivated” vaccines (made up of certain portions of the virus that cannot infect the person), they cannot transmit HPV.
These vaccines contain no preservatives, latex, antibiotics, thimerosal or mercury. They were approved by Health Canada after going through the regulatory process of research, manufacturing, licensing, efficacy and safety that surrounds vaccine production.
Those under 18 years of age receive one dose of Gardasil® 9 followed by one dose of Cervarix®. Those 18 years of age or older receive three doses of Gardasil® 9. This vaccination provides protection against HPV infections, precancerous lesions and condylomas for at least 14 years.
Keep in mind that the vaccine in no way replaces cervical cancer screening.
References :
INSTITUT NATIONAL D’EXCELLENCE EN SANTÉ ET SERVICES SOCIAUX, Traitement pharmacologique (ITSS) — Condylomes (verrues anogénitales), [En ligne], mars 2019. [https://www.inesss.qc.ca/fileadmin/doc/INESSS/Outils/Guides_ITSS/Guide_ITSS_Condylomes.pdf] (Téléchargé le 25 octobre 2020)
MINISTÈRE DE LA SANTÉ DU QUÉBEC, Vaccins contre les infections par les virus du papillome humain (VPH), [en ligne], mis à jour le 1er septembre 2020. [https://www.quebec.ca/sante/conseils-et-prevention/vaccination/vaccin-infections-par-vph/] (Consulté le 25 octobre 2020)
Practical advice
In order to help you, we have put at your disposal several useful tips.
