Condyloma Acuminatum: A Patient's Journey Through Misdiagnosis

Cauliflower slices

Hello, Doctor.
Three weeks before my delivery, my obstetrician informed me that I had condyloma acuminatum, which shocked my husband and me as we had been living a completely monogamous life.
Subsequently, we visited a dermatologist, a urologist, and another obstetrician, all of whom performed internal examinations and concluded that it was not condyloma but rather a fungal infection.
Nevertheless, we ultimately followed the doctor's recommendation for a cesarean section.
Two weeks postpartum, the doctor performed a pathological examination and finally informed me that it was indeed condyloma acuminatum.
I still find it hard to understand.
The report is as follows, and I would like to ask the doctor if the contents of this report are correct and if there is a possibility of it being a false positive for condyloma.

Diagnosis: Vulva, excision...
condyloma acuminatum
Description: Gross: The specimen consists of 3 pieces of grayish skin with papillary growth measuring up to 0.4 x 0.2 x 0.1 cm.
All for section.

Microscopy: The sections show squamous epithelial tissue with acanthosis, papillomatosis, hyperkeratosis, and interspersed areas of parakeratosis.
Koilocytic changes are present.

Ellen, 20~29 year old female. Ask Date: 2016/01/28

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, according to the pathology report, the most accurate diagnosis is condyloma acuminatum, with a very low chance of error.
Wishing you good health.

Reply Date: 2016/01/28

More Info

Condyloma acuminatum, commonly known as genital warts, is a sexually transmitted infection caused by certain strains of the human papillomavirus (HPV). The journey of a patient experiencing misdiagnosis regarding condyloma acuminatum can be both confusing and distressing, as illustrated in your case.
From your description, it appears that you were initially informed by your obstetrician that you had condyloma acuminatum just weeks before giving birth. This diagnosis understandably caused shock, especially since you and your husband had been living a seemingly uncomplicated life. Following this, you sought second opinions from multiple specialists, including dermatologists and urologists, who suggested that the lesions were not condyloma but rather a fungal infection. This discrepancy in diagnosis highlights a common challenge in the medical field: the interpretation of symptoms and the need for accurate diagnosis.

The final diagnosis of condyloma acuminatum was confirmed through a pathological examination after your delivery. The pathology report you provided indicates the presence of squamous epithelial tissue with characteristics typical of condyloma acuminatum, including acanthosis (thickening of the skin), papillomatosis (nipple-like projections), hyperkeratosis (thickening of the outer layer of skin), and koilocytic changes, which are indicative of HPV infection.
It is important to understand that condyloma acuminatum can sometimes be mistaken for other skin conditions, including fungal infections, due to overlapping symptoms such as irritation or abnormal growths. The presence of koilocytic changes in your biopsy is a definitive indicator of HPV infection, confirming that the diagnosis of condyloma acuminatum is indeed correct.
Regarding your question about the possibility of "pseudo-condyloma," it is essential to clarify that while there are other conditions that can mimic the appearance of condyloma acuminatum, the histological features observed in your biopsy are characteristic of true condyloma. Pseudo-condyloma might refer to lesions that appear similar but do not have the same underlying viral etiology.
In terms of treatment and management, condyloma acuminatum can be approached in several ways, including topical treatments, cryotherapy, laser therapy, or surgical excision, depending on the size, number, and location of the warts. Since you have already undergone excision, it is crucial to follow up with your healthcare provider for ongoing monitoring and management, as HPV can remain dormant in the body and may lead to recurrences.

Additionally, it is advisable to discuss HPV vaccination with your healthcare provider. The HPV vaccine can help prevent future infections with the most common strains of the virus that cause genital warts and certain types of cancers.
In conclusion, your experience underscores the importance of seeking multiple opinions in the face of conflicting diagnoses. It also highlights the need for clear communication between patients and healthcare providers regarding the nature of their conditions. If you have further questions or concerns about your diagnosis or treatment options, it is essential to continue the dialogue with your healthcare team. They can provide personalized advice based on your medical history and current health status.

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