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Anal Condyloma Treatment and Recurrence in HIV-negative Men Who Have Sex With Men

Silvera, Richard J. M.P.H.1; Smith, Casey K. J.D.1; Swedish, Kristin A. M.D., M.P.H.2; Goldstone, Stephen E. M.D.3

Diseases of the Colon & Rectum: June 2014 - Volume 57 - Issue 6 - p 752–761
doi: 10.1097/DCR.0000000000000080
Original Contributions: Anorectal Disease
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BACKGROUND: Men who have sex with men have increased prevalence of both human papillomavirus and anogenital condyloma.

OBJECTIVE: Risk factors for multiple treatment and recurrence of anal condyloma were examined.

DESIGN: This is a retrospective study of HIV-negative men who have sex with men who were treated for anal condyloma.

SETTINGS: This study was conducted in a private surgical practice.

PATIENTS: The patients were HIV-negative men who have sex with men, aged 18 years or older.

INTERVENTION(S): Ablation with electrocautery or CO2 laser was performed, as well as excision and topical imiquimod condyloma treatment adjuvant.

MAIN OUTCOME MEASURES: Primary clearance, defined as 4 months of condyloma-free survival posttreatment, and recurrence, defined as any anal condyloma diagnosis after primary clearance.

RESULTS: Of 231 participants, 207 achieved primary clearance (median age, 32.0 years) and were followed (median, 18.2 months) after primary treatment. Most had intra-anal and perianal condyloma (56%), were treated with electrocautery ablation (79.2%), and required 1 treatment (range, 1–6) for clearance. There were 57 recurrences (median, 12 months). One-third each had minimal, moderate, or extensive disease. Forty-six percent of patients received imiquimod posttreatment adjuvant. High-grade dysplasia was found in 31% at presentation and 43% during follow-up. Factors associated with requiring multiple treatments for clearance were participants having moderate disease (adjusted odds ratio, 6.0 (1.7–21.4)) and receiving imiquimod adjuvant (adjusted odds ratio, 4.7 (2.0–10.6)). No single factor predicted recurrence, but those with moderate disease experienced recurrences significantly sooner (median, 25 months of follow-up).

LIMITATIONS: This was a retrospective chart review, it was limited to a single practice, and it excluded those who did not achieve primary clearance.

CONCLUSIONS: Most men who have sex with men have intra-anal and perianal condyloma and concomitant high-grade dysplasia is common. Most achieved clearance with 1 treatment. Having both intra-anal and perianal condyloma, increased severity of disease, and imiquimod adjuvant were significant predictors of requiring multiple treatments for clearance. No identified risk factors proved a significant predictor of recurrence.

1Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York

2Department of Medicine, Montefiore Medical Center, New York, New York

3Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York

Funding/Support: Mr Silvera’s participation was funded by the Icahn School of Medicine at Mount Sinai Summer Scholars Program. Dr Smith’s participation was funded by a grant through a Clinical and Translational Science Award from the NIH to the Icahn School of Medicine at Mount Sinai. No other funding was received.

Financial Disclosure: None reported.

Presented at the meeting of the International Papillomavirus Conference, San Juan, Puerto Rico, November 30 to December 6, 2012.

Correspondence: Stephen E. Goldstone, M.D., 420 West 23rd St, New York, NY 10011. E-mail: Goldstone.stephen@gmail.com

© 2014 The American Society of Colon and Rectal Surgeons