A 19 year old woman presented to the genitourinary medicine clinic complaining of numerous lumps on her lower abdomen, vulva, and infraorbital region which had been present for 7 years. The lesions were usually asymptomatic but occasionally itched. The patient had attended her general practitioner and been told that they were warts, but treatment with podophyllin had had no effect.

The woman was in good health, was taking the combined oral contraceptive …