Richard J Silvera1, Casey K Smith, Kristin A Swedish, Stephen E Goldstone. 1. 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.
Abstract
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.
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.
Authors: Stephen E Goldstone; Shelly Y Lensing; Elizabeth A Stier; Teresa Darragh; Jeannette Y Lee; Annemieke van Zante; Naomi Jay; J Michael Berry-Lawhorn; Ross D Cranston; Ronald Mitsuyasu; David Aboulafia; Joel M Palefsky; Timothy Wilkin Journal: Clin Infect Dis Date: 2019-03-19 Impact factor: 9.079
Authors: Richard Silvera; Tyler Martinson; Michael M Gaisa; Yuxin Liu; Ashish A Deshmukh; Keith Sigel Journal: AIDS Date: 2021-11-01 Impact factor: 4.177