Surgical Treatment of a Severe Anogenital Condyloma Acuminata – Case Report

Abstract

Background

Condyloma acuminata is a medical condition caused by human papillomavirus (HPV). It is manifested in the form of warts of the anogenital region. HPV is one of the most common sexually transmitted diseases. Other factors that increase condyloma prevalence are the number of lifetime sexual partners, chlamydia and gonorrhoea infections, HIV and smoking. Lesions appear as skin-coloured papules which can be pedunculated, flat or in severe cases take a cauliflower shape. An advanced condyloma acuminata may transform into Buschke-Lowenstein tumour, a large mass that occupies the entire anogenital area. Among other medical options, surgical excision is the only treatment with close to 0% recurrence rates.

Case presentation

A 63 years old female patient presents to the surgical consult clinic with the complaint of a gigantic anogenital lesion which occludes the anal canal and vaginal orifice. The lesion causes pruritus, pain and difficulty in passing stool. She refers performing a surgical procedure for the excision of anogenital warts 8 years prior, in a hospital of a foreign country. The mass has grown vastly, hindering normal daily activity. After obtaining patient consent a radical surgical procedure is performed, with the extirpation of the whole vagino-perianal condyloma.

Discussion

Condyloma acuminata remains a serious disorder that, if caught early, has a variety of therapeutic options. In most extreme cases abdominoperineal resection becomes the only option left after malignant transformation as a result of delayed diagnosis. We recommend an aggressive surgical approach to treat advanced ano-genital condyloma acuminata to prevent recurrence and possible malign transformation.

Conclusion

Condyloma acuminata is a complex and difficult to treat condition. Doctors should inform patients upon the diagnosis of condyloma for the route of transmission, safe sexual behaviour, which includes utilizing barrier protection, avoiding anal intercourse and having multiple partners. They should be advised to inform partners of their diagnosis. Surgical resection is the only treatment option with almost 0% recurrence rates. Patients with large lesions, recurrent condyloma or ineffective medical treatment should be referred to a specialist for surgical removal.

Keywords: General Surgery, Condyloma Acuminata, Anogenital Wart, Buschke-Lowenstein Tumor, HPV

DOI: 10.7176/JEP/14-16-01

Publication date:June 30^th 2023