Condylomatous ulcerative lesions in the vulva and introitus: Association with concomitant koilocytotic lesions in the vagina and cervix; effect of carbon dioxide laser vaporization

Abstract

The association of condylomatous ulcerative lesions in the vulva with concomitant koilocytotic lesions in the vagina and cervix indicates the existence of a ‘lower genital tract neoplasia syndrome’. In this study of 54 young women, 90% of the patients with condylomatous lesions in the vulva and introitus had similar concomitant lesions in the lower third of the vagina; 7% had lesions in the upper third; and 13% had lesions in the anus. Furthermore, 80% of the women exhibited koilocytotic, non-neoplastic lesions in the cervix or koilocytotic intraepithelial neoplasia. It has been shown previously that patients with concomitant human papilloma virus infection and cervical intraepithelial neoplasia are younger than patients with cervical intraepithelial neoplasia alone, and that in the former group the lesions are acquired and progress at a faster rate. Epithelial integrity may be an important barrier to viral transmission, and diseases that cause mucosal or squamous epithelial discontinuity are risk factors for acquired immunodeficiency syndrome (AIDS) virus infection. Therefore, to limit the spread of this serious disease, all genital lesions should be treated without delay. Carbon dioxide laser vaporization of cervical and vaginal lesions gives excellent results; laser surgery of vulval lesions, however, creates considerable practical problems.