 Figure 1. Male 25 years-old, HIV positive with these cauliflower-like lesions on the maxillary interdental papillae between teeth 4 & 5, 5 & 6, 6 & 7 and 7 & 8. These papillary exophitic lesions are condyloma acuminatum. |
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Figure 1. Male 25 years-old, HIV positive with these cauliflower-like lesions on the maxillary interdental papillae between teeth 4 & 5, 5 & 6, 6 & 7 and 7 & 8. These papillary exophitic lesions are condyloma acuminatum. |
Condyloma acuminatum (CA) is an infectious transmissible lesion generally known as venereal or genital warts. Usually CA is produced by the human papilloma virus (HPV) 6 and HPV 11 occasional reports have implicated HPV 16, HPV 18 and some other HPV as the causative agents.
The lesions are generally transmitted through sexual contact and become clinically evident after a period of incubation of around one month. Lesions develop generally perianally or on the genitals. The oral mucosas may be involved as well, preferentially the nonkeratinizing mucosas such as lip, soft palate, floor of the mouth and lateral borders of the tongue. The gingiva is seldom affected. Some of the oral lesions are the result of autoinoculation from the genital lesions.
Intraorally these lesions can be single or multiple, generally starting as smooth slightly elevated papules with a color similar to that of normal mucosa. The papules tend to coalesce to form larger lesions. Verrucoid forms are also frequent especially on the border of the tongue and they are similar in appearance to the common wart or papillomas, that is, a rough surface with finger-like projections. The papillary forms are generally white in color. Condyloma acuminatum is a frequent intraoral infection in HIV positive patients. The distribution of the lesions is similar to that seen in HIV negative patients but the number of lesions are greater in HIV positive patients. Large lesions tend to interfere with mastication and occasional biting of these lesions induces bleeding.
 Figure 2. Another example of multiple condyloma acuminatum of the upper lip in an HIV positive male (Courtesy of Dr. Frank Lucatorto). |
 Figure 3. A wart-like condyloma acuminatum at the level of the lip commissure in a 28 year-old HIV positive woman. |
The genital lesions are generally treated with topical applications of podophyllin but this approach is contraindicated for the oral lesions because of the potential intoxication with this medication. Small lesions are surgically ablated. Multiple and large lesions are best treated with laser surgery.
Either conventional or laser surgery treatment for condyloma should be used only when the lesions interfere with mastication or for aesthetic reasons.