Condylomata Acuminata

• • 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

Epidemiology

• • 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

Symptoms and Signs

• • 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

• • Condylomata lata lesions of secondary syphilis

  • Anal squamous cell carcinoma

Rule Out

• • Malignancy

• • 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

• • 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

Surgery

Indications

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

Medications

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

Treatment Monitoring

• • 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

Complications

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

Prognosis

• • Laser fulguration: Recurrence rates are low

  • Disease may respond to excision or ...