Infectious Disease Compendium

Warts

Diagnosis

A warty growth in the extremities or genitals (condyloma acuminatum).

Epidemiologic Risks

Touching other humans with warts. Handling frogs and toads are not a risk factor.

Microbiology

Human papillomavirus.

Empiric Therapy

- Warts on the hand and feet can be 'burned off' with liquid nitrogen (hold on the wart for 10 seconds, repeat 2 weeks later if needed) or various preparations containing salicylic acid (Compound W®).

- Condyloma acuminatum: Podofilox (podophyllotoxin) 0.5% podofilox solution or gel applied twice daily for three consecutive days every week for up to 4 weeks OR Imiquimod 5% cream three times a week (wash site with soap and water 6-10 hrs after applying.), on alternate days, for up to 8 weeks OR Trichloracetic acid 10% to 90% solution is used topically at weekly intervals in pregnancy. It isn’t fun OR Liquid nitrogen freeze every 1 or 2 weeks. I shall leave the treatment of cervical papilloma virus to ob/gyn.

Interferon injection into the wart is also effective (Meta analysis).

There is a vaccine.

Pearls

In a meta analysis "Imiquimod and podophyllotoxin possess similar curative effects on condylomata acuminata but podophyllotoxin has more serious adverse effects (PubMed)."

Rants

ICD9 Codes (Soon to be supplanted by ICD10)

Wart (common)(infectious) (viral) 078.10; external genital organs (venereal) 078.19; plantar 078.19; prosector 017.0; seborrheic 702.19; inflamed 702.11; senile 702.0; specified NEC 078.19; syphilitic 091.3; tuberculous 017.0; venereal 078.19