Atypical urethral condyloma acuminatum presenting diagnostic challenges in a resource-limited setting: a case report

Urethral condyloma acuminatum, caused by human papillomavirus, is uncommon. This report details a unique case in a young, immunocompetent male lacking conventional risk factors, highlighting significant diagnostic and management challenges within a resource-constrained setting.

A 26-year-old male from the Bakonzo tribe (Bantu ethnicity) reported to Kampala International University Teaching Hospital with a 3-week history of a painless, single urethral lesion. He denied sexually transmitted infections or HIV, and physical examination was otherwise unremarkable. While initial urinalysis suggested a urinary tract infection, the lesion's atypical nature (presenting as a solitary, painless mass without coexisting external lesions or high-risk history) significantly lowered suspicion for condyloma, compelling the team to prioritize the exclusion of a low-grade urethral neoplasm or papilloma. This clinical ambiguity, combined with resource constraints on advanced noninvasive diagnostics (such as cystoscopy), necessitated an excisional biopsy for definitive diagnosis and therapeutic clearance. Histopathological analysis confirmed condyloma acuminatum with characteristic koilocytosis but no dysplasia or malignancy. Notably, subsequent high-risk human papillomavirus genotyping (16, 18, 45) was negative. Following surgical excision, the patient experienced complete resolution and no recurrence during 1-year follow-up.

This case compellingly demonstrates the essential requirement for increased clinical vigilance and diagnostic flexibility in the management of urethral condyloma, especially in resource-constrained settings. It demonstrates that atypical presentations, even without classic risk factors or high-risk human papillomavirus detection, mandate reliance on histopathological confirmation for accurate diagnosis and prognostication. The successful outcome via excisional biopsy underscores its practicality and effectiveness as a primary intervention for such complex cases in resource-constrained environments, offering valuable learning for similar global health contexts.