I read with interest Dr Virenda Parikh's case of a young woman with extensive
anal condylomata acuminata (CONSULTANT, April 15, 2001, page 737).
Dr Parikh noted that large warts, such as this patient had, require excision and
The various methods used to remove anal condylomata acuminata (eg, electrodesiccation
and curettage, surgical excision, and cryosurgery) are destructive. I believe
it is best to avoid such methods, because all warts will disappear spontaneously
without leaving a scar as a result of the development of an immune response to these
lesions. If the warts have not disappeared in 3 to 5 years, the lack of an immune response
may be the cause. An immune treatment can be effective in such cases.
-- Spyridon Koudouris, MD
San Antonio, Tex
This patient had extensive, large, bulky condylomata that covered the
entire anal orifice (Figure). Surgical electrofulguration was necessary
because an immune treatment might have taken a very long time.
While postsurgical scarring may be a problem on other parts of
the body, scarring in the anorectal area is minimal because of the
excellent blood supply to this location. Also, cosmetic concerns are not of primary
importance in this anatomic region.
I agree that for a few small, scattered anal warts, immune therapy
(eg, imiquimod cream) is an appropriate initial treatment.
-- Virenda Parikh, MD
Fort Wayne, Ind