A 30-year-old Caucasian female presents to your office for a routine check-up. Her past medical history is insignificant. She does not smoke, and consumes 1-2 bottles of beer on weekends. She is sexually active with her boyfriend and takes oral contraceptives. She also takes one multivitamin tablet daily. The physical examination reveals several 3-4 mm warty projections on the posterior wall of her vagina that turn white on acetic acid application. The patient denies ever having any sexually transmitted disease, but she describes having scant vaginal discharge, which she did not pay much attention to. She wants to know what the most probable cause of her problem is.
Which of the following is the best response to this patient's concern?

Question

A 30-year-old Caucasian female presents to your office for a routine check-up.  Her past medical history is insignificant.  She does not smoke, and consumes 1-2 bottles of beer on weekends.  She is sexually active with her boyfriend and takes oral contraceptives.  She also takes one multivitamin tablet daily.  The physical examination reveals several 3-4 mm warty projections on the posterior wall of her vagina that turn white on acetic acid application.  The patient denies ever having any sexually transmitted disease, but she describes having scant vaginal discharge, which she did not pay much attention to.  She wants to know what the most probable cause of her problem is.
Which of the following is the best response to this patient's concern?

Quizplus · Accepted Answer

Explanation: The clinical scenario described is suggestive of condylomata acuminata (anogenital warts). These can manifest with pruritus, bleeding, burning, tenderness, vaginal discharge and pain, depending on the location. Large lesions can interfere with defecation, vaginal intercourse and delivery. Small lesions are frequently accidental findings on physical examination or can be minimally symptomatic (such as in this patient). Visual inspection with application of acetic acid (lesions should turn white) is usually sufficient for making the correct diagnosis. (Choice B)Condylomata acuminata are caused by human papilloma virus (HPV) and represent the most common viral sexually transmitted disease in the US. (Choice C)A close association exists between oncogenic HPV infection and squamous intraepithelial lesions of the cervix, anus, vulva, penis, and vagina. (Choice D)Patients with HIV infection have a higher incidence of anogenital warts, and their lesions tend to be larger; however, having condyloma acuminata is not a marker of HIV infection. Educational Objective: Condylomata acuminata are caused by human papilloma virus (HPV) and represent the most common viral sexually transmitted disease in the US.

A 30-Year-Old Caucasian Female Presents to Your Office for a Routine