Long-term follow-up of endoscopic therapy of anal canal condylomata acuminata with podophyllotoxin.

BACKGROUND

Condylomata acuminata of the anal canal, a common sexually transmitted disease, are difficult-to-treat lesions with a high recurrence rate after initial successful treatment.

OBJECTIVE

Our aim was to evaluate by anoscopy the efficacy of podophyllotoxin 0.5% solution topically applied for the treatment of anal warts.

METHODS

We prospectively studied consecutive patients with condylomata acuminata of the anal canal that spared the rectum. They were treated with 0.5% podophyllotoxin solution topically applied on the warts, by anoscopy. Podophyllotoxin solution was administered on days 1, 2 and 3 every week (a treatment cycle) for a maximum of 4 weeks. Patients whose warts were not completely eradicated were classified as failures. Follow-up anoscopy was performed monthly for the first 6 months and every 6 months thereafter. Those who relapsed during the follow-up period were retreated.

RESULTS

Twenty-two immunocompetent patients entered the study. The primary clearance rate was 22.7, 54.5, 68.1 and 86.3% after 1, 2, 3 and 4 treatment cycles, respectively. During the follow-up period (46, 12-60 months), seven patients (36.8%) relapsed. Four of them were successfully retreated. Thus, a complete cure was achieved in 16 out of 22 patients (72.7%). Adverse side-effects were mild. They included proctalgia in six (27.2%), bleeding in four (17.2%), and both proctalgia and bleeding in two (9%) patients.

CONCLUSIONS

Endoscopic topical application of 0.5% podophyllotoxin solution is an effective and well-tolerated method for the treatment of condylomata acuminata of the anal canal.