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 initial management option for this patient?

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 initial management option for this patient?

Quizplus · Accepted Answer

Explanation: The three major treatment modalities employed in patients with condylomata acuminata are chemical or physical destruction, immunotherapy, and surgical excision. Chemical destruction is preferred as the initial approach by many physicians. Trichloroacetic acid application destroys the lesion by protein coagulation. The clearance rate is not very high; therefore, repeated applications are usually necessary. Systemic or topical interferon is a form of immunotherapy that has been proven to be effective in patients with anogenital warts. A newer approach involves topical application of antimicrobials (e.g., cidofovir), but this requires further study. (Choice C)Podophyllin has a similar effect as trichloroacetic acid, but is not indicated for internal use (i.e., it should not be applied to the mucosal surface). Podophyllin is also contraindicated during pregnancy. (Choices A and B)Ablative or surgical procedures are considered in patients in whom medical therapy is not effective. (Choice D)Spontaneous regression can occur, but is not common. Educational Objective: Unlike trichloroacetic acid, podophyllin is not indicated for internal use in patients with condyloma acuminata and should not be used during pregnancy.

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