Condylomata lata

What is it, Cause, Presentation, and More

Author:Nikol Natalia Armata

Editors:Alyssa Haag,Emily Miao, PharmD

Illustrator:Jillian Dunbar

Copyeditor:David Walker

What is condylomata lata?

Condylomata lata, also known as condyloma latum, refers to a benign and painless cutaneous manifestation of secondary syphilis. They are skin-colored or hypopigmented growths characterized by gray to white lesions, typically located in the genital area or around the mouth. Condylomata lata are reported in about 9% to 44% of individuals who have syphilis.  

Syphilis is one of the most common sexually transmitted infections caused by the spirochete bacteria, Treponema pallidum. It may cause multiple skin lesions, including both flat and raised lesions (i.e., macular and papular eruptions, respectively) on the trunk, palms, or mouth. During primary syphilis, which typically occurs within three weeks of exposure to Treponema pallidum, the first skin lesions will present mostly as painless papules (i.e., raised bumps that are up to 1 cm in diameter). They usually appear at the site where the bacteria initially entered the body and, later on, produce a classic chancre (i.e., 1-2 cm painless ulcer). Secondary syphilis, which usually begins two to eight weeks after the first lesion, is characterized by the appearance of a rash. Another common symptom of secondary syphilis, other than condylomata lata, is the absence of hair from areas of the body (i.e., alopecia). It may occur in patches, widespread, or a combination in many parts of the body, including the eyebrows, beard, and scalp. Most commonly, however, individuals with secondary syphilis present with only hair loss and no sign of condylomata lata.

Condylomata lata mimicking conditions include genital warts from human papillomavirus (HPV) infection as well as squamous cell carcinoma. Their clinical presentations may resemble the cutaneous manifestation of secondary syphilis.

What does condylomata lata look like?

Condylomata lata are typically smooth, soft, and flat skin growths that may vary in shapes and sizes. They may range from pink to gray in color. They typically develop in warm, moist regions, such as the genitals (e.g., penis, labia), anus, or mouth. Usually, they are found in areas proximate to the primary chancre, such as clusters around the anus, especially after an individual has engaged in anal intercourse. This may reflect the direct spread of organisms from the primary ulcer to the nearby tissues. Less frequently, they can also develop in the axilla, palms, face, umbilicus, and between the toes. In individuals with a compromised immune system (e.g., individuals with HIV/AIDS, transplanted organs, who undergo chemotherapy), condylomata lata can multiply into large clusters.

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What causes condylomata lata?

Condylomata lata are characteristic of secondary syphilis. Secondary syphilis refers to the two to eight week period after the presentation of the primary syphilis lesion. During the secondary phase, the infection has spread throughout the body, and the infected individual is highly contagious.

How is condylomata lata diagnosed and treated?

Initially, in order to diagnose condylomata lata, a healthcare professional may ask about the individual’s sexual history and any prior episodes of sexually transmitted diseases. In most cases, condylomata lata can be easily identified and diagnosed through physical examination of the genital area. Examination of the lesion under magnification (i.e., colposcope: used to examine cervical, vaginal, or vulvar lesions) may also be needed for a more detailed evaluation. 

Oftentimes, diagnosis can be confirmed by additional diagnostic testing, including serologic tests (i.e., a blood test detecting the presence of antibodies against Treponema pallidum). A biopsy is needed to differentiate syphilitic condylomata from HPV-induced lesions (e.g. genital warts). The visualization of numerous spirochetes by immunostaining (i.e., the process of selectively identifying proteins in cells) can also confirm the diagnosis of condylomata lata. 

Treatment of condylomata lata requires treatment of the underlying syphilis infection. The first-choice treatment for all manifestations of syphilis is an intramuscular injection of the antibiotic, penicillin. For individuals allergic to penicillin, alternatives, such as doxycycline,  ceftriaxone, or penicillin desensitization (i.e., induced tolerance to penicillin), may also be administered. It may take a few months for condyloma lata to resolve completely. On the other hand, alopecia related to secondary syphilis may take up to a year to resolve. The treatment effectiveness can be evaluated by serologic analysis; a four fold decrease in titers (i.e., the concentration of antibodies) indicates adequate syphilis treatment.

What are the most important facts to know about condylomata lata?

Condylomata lata refer to benign, painless, wart-like lesions associated with secondary syphilis. They are mostly skin-colored growths that develop in warm, moist regions, like the mouth, genitals, or anus. Typically, condylomata lata are smooth, soft, flat, and may vary in shapes and sizes. Diagnosis can be accomplished through a review of medical history and a physical exam of the genital area. When necessary, further serologic testing or even a biopsy may follow. Treatment of condylomata lata depends on treating the underlying syphilis infection, typically with the administration of penicillin.

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Related links

Treponema pallidum (Syphilis)
Sexually transmitted infections: Clinical practice
Cell wall synthesis inhibitors: Penicillins
Alopecia: Clinical practice

Resources for research and reference

Bruins, F. G., van Deudekom, F. J., & de Vries, H. J. (2015). Syphilitic condylomata lata mimicking anogenital warts. BMJ, 350(mar17 2). DOI: 10.1136/bmj.h1259   

Deshpande, D. J., Nayak, C. S., Mishra, S. N., & Dhurat, R. S. (2009). Verrucous condyloma lata mimicking condyloma acuminata: An unusual presentation. Indian journal of sexually transmitted diseases and AIDS, 30(2), 100–102. DOI: 10.4103/0253-7184.62766

Ikeda, E., Goto, A., Suzaki, R., Sawada, M., Dekio, I., Ishizaki, S., Fujibayashi, M., Takahashi, H., & Tanaka, M. (2016). Condylomata lata on the ankle: an unusual location. Dermatology practical & conceptual, 6(2), 49–51. DOI: 10.5826/dpc.0602a09 

Soreng, K., Levy, R., & Fakile, Y. (2014). Serologic testing for syphilis: Benefits and challenges of a reverse algorithm. Clinical microbiology newsletter, 36(24), 195–202. DOI: 10.1016/j.clinmicnews.2014.12.001