Question of the Week # 36

A 25 year old woman presents to your office with history of genital lesions. The patient says that she has has read about genital warts on the internet and is now very concerned that she might be suffering from the same. She is sexually active with her boyfriend and does not want him to get infected with her condition. Physical examination reveals lesions that are are flesh-colored, soft pearly papules found on the inner aspects of  labia minora which are  symmetrically distributed on  either side of the vulva and are easily seperable from each other.

A concerned woman in a doctor's office. What is the Next Step?

Next Step in the Management:

A) Topical Imiquimod

B) Trichloroacetic Acid

C) Treat both patient and her partner with Podophyllin

D) Re-assurance

E) Oral Acyclovir

Copy Rights: USMLEGalaxy, LLC

14 Responses

  1. a

  2. guys isnt this a benign condition. i would go for D.

  3. D) Re-assurance

  4. flesh colour pearly papules discrete are diagnostic for molluscum contagiosum and treated with imiqimod

  5. Ans. D

    Vestibular Papillae are common benign lesions that are often mistaken as genital warts and cause unnecessary concern to the patients. So, questions like these are often high yield on the USMLE. Vestibular papillomatosis is a normal vulvar anatomical condition. It is a female counterpart of male pearly penile papules. A correct diagnosis is important and prevents unnecessary stress to the patient.

    Vestibular papillae are flesh-colored, soft pearly papules found on the inner aspects of labia minora. They are usually symmetrically distributed on either side of the vulva and can be easily separated from each other on examination.

    On the other hand, genital warts are not confined to the vestibule. The cauliflower or filiform projections of genital warts tend to fuse at the base and cannot be seperated easily.

    Acetic acid test : When 5% acetic acid is applied to condyloma acuminatum, a whitening occurs. There is usually no whitening with Vestibular papillae.

    • i’ve been looking up pics of herpes and warts knowing that isn’t what i have. You are the first to describe what sounds and looks like what i have.
      thank you. You might of saved my life.

    • so the next best step should be 5% acetic acid, to r/o condyloma actuminatum, to look for whitening of the lesion?? if that was given in the exam as an option??

  6. it is d and i got a similar q like this in my real exam

  7. i was distress that i got std but m relieved to find the exact condition i suffered thank u

  8. A

  9. Answer: option E??

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