Flat Warts: Symptoms, Causes & Treatment

Flat condyloma are rare skin lesions associated with secondary syphilis. They appear as large, raised, grayish-white patches and may develop in the perineal region, mouth, or around the anus.

Also called condyloma lata, these lesions occur when the bacterium Treponema pallidum reactivates after a period of dormancy. This reactivation can happen if syphilis is not treated adequately, allowing the infection to spread throughout the body and cause symptoms.

Treatment is typically managed by an infectious disease specialist, gynecologist, or urologist. The aim is to eliminate the infection using antibiotics effective against T. pallidum, such as benzathine penicillin or doxycycline.

Main symptoms

Flat condyloma is one of the characteristic symptoms of secondary syphilis and is characterized by:

• Large, raised skin lesions that usually appear around the mouth or in the perineal area
• Pink or grayish-white raised areas on the skin
• Smooth, soft, flat skin lesions
• No pain in the lesions

Flat condyloma lesions usually appear in moist areas of the body and, therefore, may also affect the anus, vaginal lips, or penis.

Symptoms of secondary syphilis appear about 6 weeks after the lesions from primary syphilis disappear. In addition to flat condyloma, other symptoms may include swollen lymph nodes, headache, muscle pain, malaise, low-grade fever, loss of appetite, and red spots on the body.

It is common for secondary syphilis symptoms to appear in flare-ups that go away on their own. This means symptoms may come and go over time.

However, the disappearance of symptoms does not mean the bacteria have been eliminated.

For this reason, it is important to see a doctor regularly so that blood tests can be done and the progression of the disease can be monitored.

Confirming a diagnosis

The diagnosis of flat condyloma is made by an infectious disease specialist, gynecologist, or urologist through a physical examination. The doctor will evaluate the skin lesions and review any history of syphilis or other sexually transmitted infections.

To confirm the diagnosis, the doctor may order blood tests, such as the VDRL test, to check for antibodies against the bacterium Treponema pallidum. A biopsy of the lesion may also be done so it can be analyzed in a laboratory.

In cases of lesions on the vulva, vagina, or cervix, the doctor may perform a colposcopy. This exam helps assess the lesions in more detail and rule out other conditions with similar symptoms, such as genital warts caused by HPV.

Possible causes

Condyloma lata is caused by the reactivation of the bacterium Treponema pallidum. It is one of the manifestations of secondary syphilis.

Secondary syphilis is the second stage of syphilis and is highly contagious. It can appear 2 to 8 weeks after the symptoms of primary syphilis improve.

Treatment options

Treatment for flat condyloma should be guided by an infectious disease specialist, gynecologist, or urologist. It involves the use of antibiotics to treat syphilis and eliminate the bacterium Treponema pallidum.

The doctor may recommend treatment with intramuscular injections of penicillin g benzathine. For people who are allergic to penicillin, oral doxycycline may be recommended.

The dose and duration of treatment can vary depending on the severity of the person’s other symptoms.

A VDRL test should also be done between 3 and 6 months after starting treatment to check whether it is working or if more injections are needed.