Insects are Crawling in My Genital Warts

Area of Science:

• Dermatology
• Infectious Diseases
• Surgical Pathology

Background:

• Genital warts, caused by human papillomavirus (HPV), can present as large exophytic lesions.
• Severe itching and formication are distressing symptoms that can accompany extensive dermatological conditions.

Observation:

• A 23-year-old woman presented with extensive genital warts affecting the perineum, vulva, vaginal introitus, and inner thighs.
• The patient reported severe itching and formication, with no visible insects on examination.
• During planned radiofrequency excision, numerous maggots were discovered within the wart lesions.

Findings:

• The presence of maggots (myiasis) in genital warts is an extremely rare occurrence, with this being the second reported case.
• Manual removal of maggots was performed, followed by radiofrequency excision of the genital warts.
• No recurrence of the excised warts was observed during a 3-month follow-up period.

Implications:

• This case highlights the importance of thorough examination in patients with extensive genital warts, as rare infestations like myiasis can occur.
• It underscores the need for prompt and appropriate management of both the warts and any co-existing infestations to alleviate patient distress and prevent complications.
• Further investigation into the potential for maggot infestation in neglected or extensive dermatological conditions may be warranted.