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home - Colon - Anal Diseases - Condylomata Accuminata Written by Dr Sebastian Zeki
Knowledge

Understands the clinical anatomy of the rectum and anus
Knows the causes of rectal bleeding and the methods of investigation
to determine the cause

Has awareness of the range of perianal conditions (which includes
abscesses and fistula), their clinical presentation and their
complications

Knows the techniques of investigation and the possible medical and
surgical treatments

Is aware of the treatment options for radiation proctitis
Skills
Take a history and appropriately examines the anus and rectum
Refers the patient for the appropriate endoscopic and radiological
investigations

Behaviours
Manages patients with anorectal disease in a sympathetic manner,
recognising and addressing the concerns caused by such conditions

Condylomata Accuminata

Podophyllin It contains podophyllotoxin-which arrests the cell cycle in metaphase leadings to cell death.25% Podophyllin solution TOP ow to small area of skin- gives 40% clearance at 3 mnths.Use with another tx eg.cryotherapy. Incubation 1-8 months HPV (dsDNA) infec-tion- usuallly HPV 6 and 11, which do not integrate into the host genome. Usually resolve after 2 years Persist if immunosup-pressedthe lower the CD4 count, the higher the chance Sexual activity Skin coloured lesions range from smooth flattened papules to a verrucous, papilliform appearanceCan be better defined with acetic acidBiopsy lesions that do not respond after three provider administered treatments or have not resolved after six months Differential diagnosis:Condyloma lata-(secondary syphilis)-appear flat and velvety.Micropapillomatosis of the vulva-is a normal variant.Painful verrucous perianal lesions assoc.with herpes simplex in patients with AIDS.Can get co-existent squamous cell carcinoma and condylomata acuminata.Molluscum contagiosum. Recurrence rate of up to 50% Imiquimod — It induces a local cytokine production as a 5% cream.It should be applied 3x/week for 4 months.80% get clearance and 10% get recurrence.DONT use internally. SurgeryExcisional surgery for v large lesions may be needed. Condylomata acuminata (anogenital warts) Cryotherapy This uses liquid nitrogen.Clearance rates are 75% at 3m. Laser therapy — Tissue absorbs laser energy as heat to 1mm depth, vaporizing the wart.Clearance rates are100 % over 1 yr.Recurrence occurs in 45 %. Excisional procedures 3-month clearance rates are 36 %. Immune modulation — Cidofovir — After undergoing cellular phosphorylation, cidofovir competitively inhibits the incorporation of dCTP into viral DNA by viral DNA polymerase.Incorporation of the drug disrupts further DNA chain elongation. Interferon alfa — 50 % get clearance with systemic interferon.It can also be given intral-esionally. Chemical agents — Contraindications: Large areas (neurotoxicity and necrosis)Pregnancy (teratogenic)Mucosal membranes Trichloroacetic acid It causes protein coagulation of wart.The clearance rates and adverse effects are similar to podophyllin.It can be used internally and during preg-nancy, when it is considered first line therapy.DONT apply to skin around a lesion as is very caustic. 5-fluorouracil epinephrine gel This is a pyrimidine antimetabolite that blocks methylation of deoxyuridylic acid, leading to cell death.It is often used with epinephrine as intral-esional injection.It has clearance and recurrence rates of 50%. Topical antimicrobialsThese need more study. Written by Dr Sebastian Zeki

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