Condylomata Lata · What Is It, Cause, Presentation, and More

Condylomata lata, also known as condyloma latum, refers to a benign and painless cutaneous manifestation of secondary syphilis. They are hypopigmented, gray or white moist plaques located in the genital area, inner thighs, axillae, or within the oral mucosa. 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 progresses through three distince stages: primary, secondary, and tertiary. If left untreated, secondary syphilis can develop 2 to 8 weeks after the initial infection, and can be associated with systemic symptoms such as fatigue, fever, lymphadenopathy.   

Conditions that can mimic condylomata lata include genital warts (i.e., condyloma acuminatum) from human papillomavirus (HPV) infection and malignancy (e.g., squamous cell carcinoma).  

Differential diagnoses involve considering various possible conditions that could be causing symptoms and then ruling out each one through use of history, clinical evaluation, diagnostic tests, and critical thinking. This process helps to narrow down the list of potential diagnoses to determine the most likely cause of the symptoms. 

Differential diagnoses can be broken down into four categories: most likely, less likely, least likely, and can’t miss. Most likely diagnoses are conditions most probable based on symptoms and clinical presentation. Less likely diagnoses are not as probable but should still be considered. On the other hand, least likely diagnoses can be considered if other, more probable conditions are excluded. Finally, can’t miss diagnoses are less common but critical to promptly identify and treat as they can lead to severe consequences.  

Diagnosis of condylomata lata begins with a history and physical examination. A healthcare provider 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 affected area(s). Examination of the lesion under magnification using a colposcope may also be used if a more detailed evaluation is required.  

Oftentimes, diagnosis can be confirmed by additional diagnostic testing, including serologic tests, which are blood tests detecting the presence of antibodies against Treponema pallidum. Dark-field microscopy, a specialized microscope, can be used to directly visualize the spirochetes. A biopsy may be  needed to better differentiate syphilitic condylomata from HPV-induced lesions (e.g. genital warts) or from cancerous lesions. The visualization of numerous spirochetes by immunostaining, which is 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, where induced tolerance to penicillin occurs, may also be administered. It may take a few months for condyloma lata to resolve completely.