Condyloma Acuminatum: A Patient's Journey Through Diagnosis and Treatment

Q: Condyloma Acuminatum: A Patient's Journey Through Diagnosis and Treatment

Hello： The pathology report from the biopsy suggests it is a cauliflower-like lesion, but the method of infection is unclear. <br>It is recommended to proceed with frozen embryo transfer after treatment. <br>Wishing you good health.

Cauliflower problem

Hello Dr.
Tsao,
I am married, and my husband and I have a very simple sexual relationship.
However, I have a constitution that is prone to recurrent vaginitis.
Over the past two years, in pursuit of pregnancy, I have undergone three artificial inseminations and one IVF (which failed in March of this year).
Due to the desire to conceive and the vaginitis, I have been visiting the obstetrics and gynecology department almost every month for treatment.
Two weeks ago, I initially intended to treat my vaginitis, but Dr.
A informed me that I have condyloma.
He pointed out that there were protrusions in my vulvar area and performed a biopsy (collecting a specimen from the vulva).
The report diagnosed it as Vulva, biopsy, condyloma acuminatum.
The pathology report states: "The specimen submitted consists of four tissue fragments, measuring less than 0.1 x 0.1 x 0.1 cm in size, fixed in formalin.
Grossly, they are pieces of gray and papillary skin papules.
All for section.
Microscopically, the sections show a picture of condyloma acuminatum with papillomatosis and acanthosis (based on visual and microscopic assessment)." Dr.
A referred me to Dr.
B for electrocautery.
During an internal examination, Dr.
B said it was not condyloma and, after reviewing the biopsy report, stated it was a vestibular gland adenoma that did not require treatment (though he did not perform an internal vaginal examination).
Unsatisfied, I consulted Dr.
C at the STD prevention clinic.
Dr.
C confirmed that the protrusions on the vulva were indeed normal tissue, but due to my trust in the biopsy results, he conducted a more detailed examination and visually identified symptoms of condyloma in the vagina.
He immediately applied medication and instructed me to return weekly for treatment.
I would like to ask the following questions:
1.
The biopsy report indicates that the specimen was taken from the vulvar area (which both doctors said was normal).
If it is normal tissue, why does the report indicate there is a problem?
2.
Now that Dr.
C has observed condyloma symptoms in the vagina, should I undergo another biopsy for confirmation, or will a Pap smear suffice (which I just had done yesterday)?
3.
Currently, Dr.
C has not prescribed any medication for me (as he said I wouldn't be able to apply it myself), only instructing me to return weekly for medication application.
Will this treatment duration be prolonged?
4.
My husband and I are monogamous partners, and due to my susceptibility to infections, I do not use hot springs, swim, or visit saunas.
I truly cannot understand the source of the infection.
5.
I plan to implant a frozen embryo in early August.
Will the vaginal procedure affect this, or should I wait until the condyloma is treated before proceeding with the embryo transfer?
I apologize for the numerous questions, and I appreciate your understanding! Thank you for your response!

daomai gui, 30~39 year old female. Ask Date: 2015/07/03

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello: The pathology report from the biopsy suggests it is a cauliflower-like lesion, but the method of infection is unclear.
It is recommended to proceed with frozen embryo transfer after treatment.
Wishing you good health.

Reply Date: 2015/07/03

More Info

Condyloma acuminatum, commonly known as genital warts, is a sexually transmitted infection caused by certain strains of the human papillomavirus (HPV). Your journey through diagnosis and treatment reflects the complexities often associated with this condition, especially in the context of fertility treatments and recurrent vaginal infections. Let's address your questions one by one.

1. Understanding the Biopsy Report: The biopsy report indicating condyloma acuminatum suggests that the tissue sampled from your vulva showed changes consistent with HPV infection. It's important to note that the presence of condyloma does not necessarily mean that all areas of your external genitalia are affected. The areas that were examined may have shown signs of HPV, while other areas may appear normal. This discrepancy can occur because the virus can be localized, and not all tissues may exhibit visible lesions.

2. Need for Further Testing: Since Dr. C observed signs of condyloma in the vaginal area, it may be prudent to consider further evaluation. A repeat biopsy could provide clarity, especially if there are visible lesions. Additionally, a Pap smear (cervical cytology) can help detect any changes in the cervical cells that may be associated with HPV. It's essential to discuss with your healthcare provider whether a repeat biopsy or further testing is necessary based on your symptoms and the findings.

3. Treatment Duration: The treatment for condyloma acuminatum can vary in duration depending on the extent of the lesions and the treatment method used. Topical treatments, such as those applied weekly, can take several weeks to months to fully resolve the warts. It's crucial to follow your doctor's instructions and attend follow-up appointments to monitor the progress of your treatment.

4. Understanding Infection Pathways: Condyloma acuminatum is primarily transmitted through skin-to-skin contact during sexual activity. Even with a single partner, it is possible to contract HPV if your partner has been exposed to the virus, even if they do not have visible warts. Additionally, HPV can remain dormant in the body for years before symptoms appear, making it challenging to pinpoint the exact source of infection. It's also worth noting that HPV can be transmitted through non-penetrative sexual activities.

5. Impact on Fertility Treatments: Regarding your upcoming embryo transfer, it is generally advisable to address any active infections before proceeding with fertility treatments. While HPV itself does not directly affect implantation, the presence of condyloma may complicate the situation. It is best to consult with your fertility specialist about the timing of the embryo transfer in relation to your treatment for condyloma. They can provide personalized advice based on your specific circumstances and health status.

In summary, navigating the diagnosis and treatment of condyloma acuminatum can be challenging, especially when considering fertility treatments. Open communication with your healthcare providers is essential to ensure that you receive the most appropriate care and guidance. If you have further concerns or questions, do not hesitate to reach out to your doctors for clarification and support.

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