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.
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
a
A
guys isnt this a benign condition. i would go for D.
D) Re-assurance
D
flesh colour pearly papules discrete are diagnostic for molluscum contagiosum and treated with imiqimod
a
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 for the past few days I’ve had slight vaginal itching and when I looked at my inner labia I began to freak out because I saw this! This saved my sanity. Thank you so much!
thankyou for this, i was so worried i had hpv or warts or herpes, but once i saw this i immediately knew this is what i have, how do i get rid of it?
It’s the first time i hear about vestibular papillae and i’m sort of amazed there is so little info about it on the web, cause aparently is not that uncommon since there were 4 comments in just a few months.
Just a few days ago i realized about this in my labia minora, I had rarely checked me down there, even though i have regular visits to my gyn and had never before made any comments about this.
When i realized about the small papules, I started to freak out because my first thought was HPV, and I was planning to immediatly visit the doctor again.
Anyhow thanks for the explanation above, may be vestibular papillae is much more common than it looks like considering women oftenly do not check themselves with a mirror, and since they are so small might not represent anything severe to the doctor.
I have read about the male pearly penile papules during my medical studies but never thought about the female one until I accidentally discovered that I have it myself.
The first thing I thought was: omg…what the… After careful thoughts…there seems to be no way I should have anything like genital warts….
I later looked on the internet for more information and surprisingly there isn’t much….But I reassured myself that it must be the female version of the male pearly penile papules…And here I am….
Thanks for the informtion.
I first time discovered those Vestibular papillomatosis when I was about 18 and I suddenly went to see the doctor. ‘It’s nothing to worry’ She replied to me. But about 2 years later those VP were bigger! And I totally got freaked out.
I went so see the doctor again, now she told me there were another symptom caused by HPV on my inner labia and used 5% acetic acid on them. About 3 weeks and 3 times of using acetic acid, those new symptom turned white and got off of my labia while the VP stalled still.
I wondered how could I had those HPV symptom since I was exactly virgin and never ever did anything to my inner labia before.
Anyway you make me feel out of anxiety now because I hadn’t knew what were the world those papules, the doctor said it was nothing again, but know everything is OK now…
It is an uncommon case I guess since there’s not much information about these VP..
again you saved me.. Thanks!
a trade name Aldara
I will go for option reassure