OVERVIEW

What is oral condyloma acuminatum?

Oral condyloma acuminatum is a contagious disease caused by the occurrence of condyloma acuminatum on the oral mucosa. Its typical feature is the appearance of cauliflower-like or papillary lesions on the lips, tongue, palate, gums, and other areas. However, patients usually only experience mild foreign body sensation or bleeding and often discover it while looking in the mirror.

Oral sexual behaviors, such as oral sex, are the primary transmission route for oral condyloma acuminatum.

Treatment methods for oral condyloma acuminatum include physical therapy (laser, hot compress, electrocautery, microwave, etc.), drug therapy (as an adjunct), and surgical treatment. If a spouse is infected, the other partner should also undergo examination and treatment.

Is oral condyloma acuminatum common?

No, it is uncommon.

Condyloma acuminatum commonly occurs in areas such as the external genitalia and perianal region, as well as in moist, folded areas like the armpits, navel, breasts, and between the toes. It rarely occurs in the oral cavity^[1].

SYMPTOMS

What are the symptoms and manifestations of oral condyloma acuminatum?

Oral condyloma acuminatum can cause growths inside and outside the patient's mouth, often located at the junction of the skin and mucous membranes, such as around the oral cavity. Intraoral lesions may affect the tongue, cheeks, lips, palate, gums, etc.

The growths are mostly pale red or dark red, appearing papillomatous or cauliflower-like, often with white discharge on the surface that can be wiped away. At the junction of the skin and the growth, there is a root-like structure called a "pedicle," which is slightly hard, prone to erosion, and bleeds easily upon contact. Multiple growths are common, but single occurrences are also possible.

Patients usually experience only mild discomfort or bleeding, often discovered while looking in the mirror^[2].

CAUSES

What is the cause of oral condyloma acuminatum?

Most oral condyloma acuminatum cases are caused by low-risk human papillomavirus (HPV) types HPV-6 and 11^[3], while a minority are caused by high-risk HPV types such as HPV-16, 18, 31, or low-risk types like HPV-42 and 43^[4].

HPV is a DNA virus without an envelope, exhibiting high host specificity and tissue tropism (though widely distributed in humans and animals, only humans are susceptible to infection). It can cause squamous epithelial proliferation in human skin and mucous membranes, leading to superficial skin growths.

Is oral condyloma acuminatum contagious? What are the transmission routes?

Yes, it is contagious. Transmission routes include:

1. Sexual transmission: This is the primary route of transmission for condyloma acuminatum. Oral condyloma acuminatum often occurs due to oral-genital contact, such as oral sex. When a sexual partner is a carrier of low-risk HPV types HPV-6 or 11, the virus can invade damaged oral mucosa, leading to infection.

2. Direct or indirect contact: Direct or indirect contact with secretions from other condyloma acuminatum patients or contaminated items may lead to infection.

3. Mother-to-child transmission: When a mother is infected with HPV, the fetus or newborn can be infected via vertical transmission through the placenta, during delivery through the birth canal, or through close contact with the mother after birth. If contaminants enter the newborn's mouth or nose and invade the oral mucosa, infection may occur.

4. Self-transmission: HPV from other parts of the patient's body can spread to the mouth via hands, potentially causing oral condyloma acuminatum^[1,5].

What factors are associated with oral condyloma acuminatum?

1. Immune status: The use of immunosuppressants or conditions such as cancer and leukemia can weaken the immune system, making individuals more susceptible to infection by low-risk HPV types HPV-6 and 11.

2. Sexual behavior: Practices such as having multiple sexual partners or engaging in oral sex increase the risk of HPV invading the oral cavity, thereby raising the likelihood of developing oral condyloma acuminatum^[6].

Which groups are more prone to oral condyloma acuminatum?

1. Young and middle-aged men: The condition is significantly more common in men than women, with the peak age for seeking medical attention being 21–30 years^[7].

2. Individuals with risky sexual behaviors: Those with multiple sexual partners or who engage in oral sex are at higher risk. If low-risk HPV types HPV-6 or 11 invade the oral cavity, oral condyloma acuminatum may develop.

3. Immunocompromised individuals: People taking immunosuppressants or those with conditions like cancer or leukemia are less able to resist HPV infection, making them more susceptible to oral condyloma acuminatum.

DIAGNOSIS

What tests are needed to diagnose oral condyloma acuminatum?

In most cases, doctors familiar with the clinical manifestations of oral condyloma acuminatum can make a direct clinical diagnosis based on symptoms and signs under adequate lighting. If the skin lesions are atypical and difficult to judge with the naked eye, auxiliary or laboratory tests may be performed.

1. Common auxiliary tests include: acetic acid whitening test and dermoscopy. These auxiliary tools can magnify the wart-like growths, facilitating the doctor's differential diagnosis.

   Acetic acid whitening test: The doctor applies a low concentration of acetic acid to the rash and observes whether whitening occurs after 3–5 minutes. When the patient's symptoms are atypical, this method can effectively differentiate the condition from other skin diseases^[6]. However, the test may cause pain and requires high patient cooperation.

2. Common laboratory tests include: histopathological biopsy and nucleic acid amplification test^[6]. A biopsy typically involves scraping suspicious wart-like growths or sampling from larger suspicious lesions for examination. Histopathology can be used to confirm the diagnosis.

TREATMENT

What department should patients with oral condyloma acuminatum generally visit at the hospital?

If rashes appear around the mouth (such as the lips, palate, or tongue), it is generally recommended to visit the Department of Stomatology.

How is oral condyloma acuminatum treated?

The treatment methods for oral condyloma acuminatum mainly include: physical therapy, drug therapy, and surgical treatment.

1. Physical therapy: Methods such as laser, electrocautery, cryotherapy, and microwave are used to remove the warts and promote skin or mucosal repair^[7].

   • Laser therapy: For example, CO2 laser uses concentrated heat from the beam to burn off the warts, suitable for most cases of condyloma acuminatum. The advantage of laser therapy is its high wart clearance rate (close to 100%) and absence of bleeding. However, some patients may experience pain or pigmentation.

   • Electrocautery: The doctor uses the heat generated by the high-frequency electric knife's current to excise the warts. However, this method requires the doctor to carefully control the depth to avoid scarring.

   • Cryotherapy with liquid nitrogen: The affected tissue is rapidly frozen with liquid nitrogen, causing it to necrotize at low temperatures. This method is inexpensive, but patients may experience significant pain and a high recurrence rate.

   • Microwave therapy: Microwaves can coagulate and detach wart tissue, quickly clearing the warts with good hemostatic effects. However, the recurrence rate is high.

2. Drug therapy: Oral interferon can be used as adjuvant therapy to enhance the patient's immunity and reduce the risk of recurrence^[2]. Some patients may experience flu-like symptoms such as fever, and it should be used with caution in pregnant women^[6].

3. Surgical treatment: The warts are directly excised through surgery. This is suitable for larger oral condyloma acuminatum that cannot be completely eliminated by physical or drug therapy^[6].

Can oral condyloma acuminatum be cured?

Yes, it can be cured^[6].

Can oral condyloma acuminatum recur?

Yes. Factors contributing to the recurrence of oral condyloma acuminatum include:

1. Incomplete removal of the original lesion, such as insufficient laser ablation depth^[6];

2. Continued spread of the infection;

3. Latent infection with low-risk HPV-6 or 11;

4. Patients with compromised immune status are prone to recurrence.

DIET & LIFESTYLE

What should patients with oral condyloma acuminatum pay attention to in daily life?

1. Patients should get plenty of rest, avoid staying up late, and choose suitable physical exercises (e.g., jogging, table tennis) according to their physical condition to enhance immunity and reduce the risk of recurrence.

2. Avoid sharing personal items such as towels with others, and regularly disinfect personal belongings. For example, sterilize tableware daily using a high-temperature disinfection cabinet.

3. Honestly inform sexual partners about the condition and encourage them to actively cooperate with examinations and treatment.

4. Avoid sexual activity before the lesions disappear. If unavoidable, use condoms to reduce the risk of infecting sexual partners.

5. Change unhealthy sexual behaviors, such as having multiple sexual partners or engaging in oral sex (e.g., oral intercourse).

Do patients with oral condyloma acuminatum need follow-up visits?

Since oral condyloma acuminatum often recurs within 3 months after treatment, patients usually require follow-up visits every 2 weeks during the first 3 months of treatment. After 3 months, the frequency of follow-ups may be appropriately reduced until 6–9 months after the last treatment^[6].

The specific follow-up schedule should follow the doctor's instructions.

PREVENTION

How to Prevent Oral Genital Warts?

It can be prevented.

1. Avoid Unhealthy Sexual Behaviors:

   Oral sex is a major risk factor for oral genital warts, so avoiding it is crucial for prevention. Additionally, refrain from high-risk sexual behaviors such as having multiple partners or not using condoms.

2. Boost Immune System:

   A strong immune system acts as a barrier against viral infections. A weakened immune system increases susceptibility to symptoms or diseases. Therefore, adopting a healthy lifestyle is essential for immunity.

   For example: Maintain a regular sleep schedule, avoid staying up late, and prioritize early sleep and wake times; follow a balanced diet with diverse, nutritious foods; engage in suitable physical activities (e.g., jogging, table tennis); and manage underlying conditions (e.g., cancer, leukemia) with medical treatment to enhance immunity.

3. Vaccination:

   Oral genital warts are primarily caused by low-risk HPV types 6 and 11. Thus, HPV vaccination effectively prevents them. In China, HPV vaccination primarily targets females, but it also provides cross-protection and herd immunity benefits for males.

   Currently, three HPV vaccines are approved in China: bivalent, quadrivalent, and nonavalent. The quadrivalent or nonavalent vaccines can prevent 90%–95% of genital warts. However, they do not treat existing HPV infections or warts—vaccination must occur before infection to be effective^[6].

   The recommended age for HPV vaccination is 11–12 years, with eligibility starting as early as 9. Unvaccinated or incompletely vaccinated individuals aged 13–26 may receive catch-up doses. Immunocompromised individuals (including HIV patients) should be vaccinated before age 26 if previously unvaccinated. Vaccination is not recommended during pregnancy^[6].

4. If one partner is diagnosed with genital warts, avoid sexual activity until cured to prevent transmission. The other partner should also undergo testing.