LARGE ANO-GENITAL WARTS: CLINICAL FEATURES AND MANAGEMENT

Abstract

The management of the large anogenital warts (LAW) is a challenge due to limited treatment options, high recurrence rates, association with immunosuppression and the risk of malignant transformation. We analyzed the clinical records of 53 patients with LAW (total wart area more than 5 cm2) attended in our Sexual Transmitted Infections Unit du- ring 10 years (2000-2009). The study included 50 men and 3 women, with a mean age of 39,9 years (range 21-74). The majority (n=47, 88,6%) was heterosexual . and 21 patients (39,6%) had the human immunodeficiency virus infection (HIV). Buschke-Lowenstein giant condyloma was seen in 33,3% of the HIV+ patients comparing with 6,2% of the HIV- patients. Different therapeutic methods, as monotherapy or in combination, were used: cryosurgery (n=44), electrosurgery (n=9), CO2 laser (n=2) and excision (n=3), with a mean number of 4,7 sessions in the HIV+ patients and 2,6 in the HIV- patients. Clinical clearance patients achieved in 31 patients (no lesions and no evidence of disease at 6 months follow-up) and 22 patients showed initial improvement but were lost at follow-up. Recurrence of the lesions, although of lesser extent, was seen after a mean interval of 2,7 years in 69% of the HIV+ patients and in 38% of the HIV- patients. The patient low compliance adds to the problems encountered in the treatment of LAW, as 41% of the patients abandoned the follow-up. Cryotherapy is effective in the lesion’s volume reduction, allowing further clearance with the same or another surgical method.

KEYWORDS – Human Papillomavirus (HPV); Condyloma Acuminatum, Anogenital; Buschke-Lowenstein Tumor; Human Immunodeficiency Virus (HIV).