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Anal condyloma treatment and recurrence in HIV-negative men who have sex with men
Richard J Silvera1, Casey K Smith, Kristin A Swedish
11Department 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.
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.
Insights
Men who have sex with men with anal condyloma often have high-grade dysplasia. Most achieved clearance with one treatment, but moderate disease and imiquimod adjuvant predicted multiple treatments.
Area of Science:
- Dermatology
- Infectious Diseases
- Public Health
Background:
- Men who have sex with men (MSM) exhibit a higher prevalence of human papillomavirus (HPV) and anogenital condyloma.
- Anogenital condyloma in MSM is frequently associated with high-grade dysplasia.
Purpose of the Study:
- To investigate risk factors associated with multiple treatments and recurrence of anal condyloma in HIV-negative MSM.
- To identify predictors for clearance and recurrence of anal condyloma in this population.
Main Methods:
- Retrospective study of HIV-negative MSM treated for anal condyloma in a private surgical practice.
- Treatments included ablation (electrocautery or CO2 laser), excision, and topical imiquimod as an adjuvant.
- Primary clearance was defined as 4 months condyloma-free survival; recurrence was any diagnosis post-clearance.
Main Results:
- Of 231 participants, 207 achieved primary clearance. Most had intra-anal/perianal condyloma (56%) and required one treatment (79.2%).
- Factors predicting multiple treatments included moderate disease severity (aOR, 6.0) and imiquimod adjuvant use (aOR, 4.7).
- High-grade dysplasia was found in 31% at presentation and 43% during follow-up. No factors predicted recurrence, though moderate disease correlated with sooner recurrences.
Conclusions:
- Most HIV-negative MSM with anal condyloma achieve clearance with a single treatment session.
- Intra-anal and perianal condyloma, increased disease severity, and imiquimod adjuvant therapy are significant predictors for requiring multiple treatments.
- No specific risk factors were identified for recurrence, but disease severity impacts recurrence timing.
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