Condyloma Acuminatum -- United States, 1966-1981

From 1966 to 1981, the estimated number of consultations* for condyloma acuminata (genital and venereal warts) with office-based, private physicians in the United States increased 459%. CDC analysis of data on condylomata collected by the National Disease and Therapeutic Index (NDTI)** shows that the number of consultations rose from 169,000 in 1966 to 946,000 in 1981 (Figure 3). By comparison, in 1981, the number of consultations with private physicians for genital herpes was 295,000; thus, in that year genital and venerealwarts accounted for more than three times as many consultations with private physicians as genital herpes.

From 1966 to 1978, the number of consultations for condyloma acuminata increased 398% for males and 684% for females. Although the number of visits or calls declined slightly in 1978-1981, this may have been due in part to sampling error. For example, at the 95% confidence level, the associated relative sampling error in the NDTI survey for 900,000 consultations is 22% (range 703,000-1,096,000).

In 1978, the year when consultations for the disease peaked, 62% of all visits and calls were made by females. Except in 1980, more consultations were with females than males during all these years.

Females and males consulted different specialists. Over half the females (54.4%) visited or called obstetrician-gynecologists. For males, the largest percentage (24.4%) of consultations was with dermatologists; general practitioners, internists, and urologists also handled a sizeable percentage (Table 1).

As with other sexually transmitted diseases (STDs), young adults comprised the group most frequently consulting physicians for genital warts. In 1981, more than 65% of such consultations were with persons aged 15-29 years. The highest risk group was the 20- to 24-year age group (33% of total), followed by the 25- to-29-year group (23%). The mode was 23 years. Reported by Evaluation and Statistical Svcs Br, Operational Research Br, Div of Venereal Disease Control, Center for Prevention Svcs, CDC.

Editorial Note

Editorial Note: Condyloma acuminata are Papillomavirus-induced soft, pink growths that appear singly or in clusters in moist areas around the genitalia and rectum. This disease is one of the most common STDs in the United States. Morbidity and complications associated with it Reported by Evaluation and Statistical Svcs Br, Operational Research Br, Div of Venereal Disease Control, Center for Prevention Svcs, CDC. Editorial Note: Condyloma acuminata are Papillomavirus-induced soft, pink growths that appear singly or in clusters in moist areas around the genitalia and rectum. This disease is one of the most common STDs in the United States. Morbidity and complications associated with it can be severe. One study has shown a positive epidemiologic association between genital warts and cervical carcinoma (2).

Because the NDTI survey does not include visits to public health, hospital outpatient, or military medical facilities, it is impossible to estimate the total number of consultations in the United States for genital warts. The data collected do indicate, however, the relative importance of various STDs among persons visiting private practitioners.

A limited study by CDC of visits to public clinics for STDs supports the NDTI findings that visits for genital warts may surpass those for genital herpes in this country (1). For males attending public STD clinics, 4.3 cases of venereal warts were diagnosed for every 100 visits, compared with 3.4 cases of genital herpes and 24.0 cases of gonorrhea. For every 100 visits by females, 4.0 cases of venereal warts were diagnosed, compared with 2.1 cases of genital herpes and 23.5 cases of gonorrhea.

Unlike the more publicized STDs, such as gonorrhea, syphilis, genital herpes, and genital chlamydia infections, relatively little is known about the epidemiology, microbiology, and complications of genital warts. Although they tend to recur, no specific treatment is available to prevent further episodes. Small condyloma acuminata usually result in dyspareunia and rectal pain, while large condylomata can cause tenesmus and may result in transmission to neonates during childbirth. Such neonatal transmission is thought to cause childhood laryngeal papillomatosis (3). Additional studies are needed to better define the epidemiologic relationship between condyloma acuminata and genital malignancies.

The NDTI data show an increased number of consultations for condyloma acuminata during the 1970s. The rate of increase in consultations for genital warts is particularly notable because visits to physicians for all reasons did not increase after 1972, while visits for genital warts continued to rise until 1978. As with some other STDs, this overall increase may be partially due to changing social and demographic factors, including changes in marriage and family institutions, shift in the age pyramid as a result of the "baby-boom," increased urbanization of the American population, and changes in casual and non-marital sexual behavior (4).

Diagnostic and therapeutic practices have lowered the incidence of STDs for which laboratory tests can detect asymptomatic or incubating infection and which readily respond to therapy (e.g., syphilis and gonorrhea); however, they have had little influence on the incidence of genital warts. At present, no laboratory tests exist to detect incubating condyloma acuminata; moreover, therapy can be difficult, prolonged, and only marginally efficacious (5). These are areas in which research is needed.

References

1. CDC. Nonreported sexually transmitted diseases--United States. MMWR 1979:28;61-3.

2. Reid R, Stanhope CR, Herschman BR, Booth E, Phibbs GD, Smith JP. Genital warts and cervical cancer. Cancer 1982;50:377-87.

3. Cook TA, Cohn AM, Brunschwig JP, Butel JS, Rawls WE. Wart viruses and laryngeal papillomas. Lancet 1973;1:782.

4. Aral SO, Johnson RE, Zaidi AA, Fichtner RR, Reynolds GH. Demographic effects on sexually transmitted diseases in the 1970's: The problem could be worse. Sex Trans Dis (in press).

5. Margolis S. Therapy for condyloma acuminatum: a review. Rev Inf Dis 1982;4:S829-36.

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