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  • • Human papillomavirus (HPV) causes condylomata acuminata

    • Multiple types have been identified

    • -Types HPV-6 and HPV-11 are associated with the common benign genital wart

      -HPV-16 and HPV-18 are associated with the development of high-grade anal dysplasia and anal cancer

    • Most common sexually transmitted viral disease

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Epidemiology

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  • • 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

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Symptoms and Signs

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  • • 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

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  • • Condylomata lata lesions of secondary syphilis

    • Anal squamous cell carcinoma

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Rule Out

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  • • Malignancy

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  • • 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

    • -Representative biopsies of clinically apparent condylomas should be sent for pathologic study because unsuspected low-grade or high-grade dysplasia or squamous cell carcinoma of the anal canal may be found

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  • • 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

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Surgery

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Indications

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  • • Extensive disease may require an initial treatment session under anesthesia so that random lesions can be excised for pathologic evaluation to rule out dysplasia

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Medications

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  • Topical agents: Bichloracetic acid or 25% podophyllum resin in tincture of benzoin

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Treatment Monitoring

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  • • 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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Complications

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  • • Squamous cell carcinoma of the anal canal is the major complication

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Prognosis

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  • Laser fulguration: Recurrence rates are low

    • Disease may respond to excision or destruction followed by intralesional interferon or autogenous vaccine created ...

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