• Human papillomavirus (HPV) causes condylomata acuminata
• Multiple types have been identified
• Most common sexually transmitted viral disease
• 1 million new cases reported per year in the United States
• Most common anorectal infection of homosexual men and is particularly prevalent in HIV-positive patients
• Disease is not limited to men or women who practice anoreceptive intercourse
• In women, the virus may track down from the vagina, and in men it may pool and track from the base of the scrotum
• Immunosuppression, either from drugs after transplantation or from HIV, increases susceptibility to condylomatous disease with prevalence rates of 5% and 85%, respectively
• Complaint is a perianal growth
• Pruritus, discharge, bleeding, odor, and anal pain common complaints
• Classic cauliflower-like lesion, which may be isolated, clustered, or coalescent
• Warts tend to run in radial rows out from the anus
• History and physical exam
• Anoscopy and proctosigmoidoscopy are essential because the disease extends internally in more than 75% of patients
• HPV-16 and HPV-18 are causally associated with squamous cell carcinomas of the anal canal
• Extent of the disease and the risk of malignancy determine the treatment
• Minimal disease is treated in the office with topical agents
• Warts respond promptly to therapy
• More extensive disease may require an initial treatment session under anesthesia so that random lesions can be excised for pathologic evaluation to rule out dysplasia and the remainder coagulated
• Laser therapy is another method of condyloma destruction
• Patients should be seen at regular intervals until resolution is complete
• Follow-up evaluation may reveal residual disease, but this is often easily treated with topical agents in the office
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