Snapshot A 43-year-old man presents to his primary care physician in a panic stating that his wife is going to kill him! The doctor calms him down and learns that during a recent trip to Las Vegas he had sexual relations with a prostitute. He now has raised groupings of lesions on the shaft of his penis. He asks if there is anything you can do. Introduction Condylomata acuminata, also known as genital warts, is a viral skin infection Caused by human papilloma virus (HPV) strains 6 and 11 Risk factors majority of cases are transmitted by sexual contact or intercourse Epidemiology Usually presents in adults If child presents with genital warts, must investigate possibility of child abuse highly prevalent in immunocompromised individuals Presentation Symptoms painless lesions on the genitalia often appearing in clusters or groups Physical exam raised, cauliflower-like lesions on the genitals may identify additional lesions in other areas including peroneum oral cavity/throat Evaluation Diagnosis is usually based on clinical observations Biopsy for definitive diagnosis Differential Condylomata lata, verruca vulgaris, and vurruca plana Treatment Non-operative chemical exposure is indicated for first-line therapy TCA podophyllin 5-FU podofilox immunologic agent imiquimod Operative indicated for large/recalcitrant lesions if chemical/immunologic therapy is ineffective several interventions available including laser removal local excision cryosurgery Prevention and Complications Prevention use barrier protection during sexual contact or intercourse vaccines for several strains of HPV are available for prevention of transmission Complications AIDS patients have higher risk of developing warts and more frequent occurrences AIDS patients are also at higher risk of developing cervical cancer from HPV strains 16 and 18, which often travel with strains 6 and 11 Prognosis There is no definitive treatment for HPV warts, so most cases recur and require multiple, repeat excision procedures