Venereal Warts: When to Consider Surgical Removal

I read with interest Dr Virenda Parikh's case of a young woman with extensiveanal condylomata acuminata (CONSULTANT, April 15, 2001, page 737).Dr Parikh noted that large warts, such as this patient had, require excision andelectrofulguration.The various methods used to remove anal condylomata acuminata (eg, electrodesiccationand curettage, surgical excision, and cryosurgery) are destructive. I believeit is best to avoid such methods, because all warts will disappear spontaneouslywithout leaving a scar as a result of the development of an immune response to theselesions. If the warts have not disappeared in 3 to 5 years, the lack of an immune responsemay be the cause. An immune treatment can be effective in such cases.
-- Spyridon Koudouris, MD
    San Antonio, TexThis patient had extensive, large, bulky condylomata that covered theentire anal orifice (Figure). Surgical electrofulguration was necessarybecause an immune treatment might have taken a very long time.While postsurgical scarring may be a problem on other parts ofthe body, scarring in the anorectal area is minimal because of theexcellent blood supply to this location. Also, cosmetic concerns are not of primaryimportance 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