Anal Condylomata Acuminata

A 24-year-old woman had experienced perianal itching and a small amount of rectal bleeding for 6 months. She also complained of a perianal protrusion.

Extensive perianal condylomata acuminata were present. Anal canal condylomata were revealed by anoscopic examination. The patient reported having had anorectal intercourse.

Dr Virenda Parikh of Fort Wayne, Ind, writes that anal condylomata, or venereal warts, are caused by the human papilloma virus. Transmission usually is via anal intercourse, but autoinoculation from the genitals also may occur. These warts can be found on other parts of the body, such as the vulva, vagina, penis, and oral cavity. The usually painless lesions may be accompanied by bleeding, pruritus ani, and drainage. Wart sizes vary from small, scattered lesions to huge, cauliflower-like masses that encircle the anus.

Microscopic examination shows marked acanthosis of the epidermis and underlying chronic inflammatory cell infiltration.

Evaluate patients with anal condylomata for other sexually transmitted diseases. As part of the management of this disease, sex partners need to be examined-and, if necessary, treated-as well.

Small, scattered lesions can be treated with application of caustic agents, including bichloracetic acid and podophyllin. Larger, more extensive and confluent lesions, such as those that affected this patient, require excision and electrofulguration. Cryotherapy and laser therapy have also been used successfully. Despite the use of surgery or caustic agents, recurrence and reinfection rates are high. Regular follow-up is recommended.