Electrosurgery and 5% Imiquimod Cream as a Combination Therapy for Perianal Condyloma Acuminata in a HIV Patient
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Background: Condyloma acuminata (CA) is a common sexually transmitted infection caused by the human Papillomavirus (HPV) infection. It is characterized by single or multiple lesions in the anogenital area accompanied by itching, discharge, or bleeding. CA in HIV (human immunodeficiency virus) - positive patients can experience a low response to various therapeutic modalities, which may lead to consideration of choosing combination therapy to increase the effectiveness of therapy. Case: We report a case in a twenty-one-year old male with multiple warts on the perianal area. Within four months, the warts had covered the perianal area, with hemorrhoids emerging as complications. The patient had trichloroacetic acid treatment three times but did not respond. The patient is male who have sex with male, and there has been a history of multisexual partners. The diagnosis was made by clinical and histopathological examinations. The patient is HIV-positive and has been receiving antiretrovirals regularly. He got a combination therapy of electrosurgery and 5% imiquimod cream for 9 weeks and showed excellent results. Discussion: Standard topical medication is an effective treatment for condyloma acuminata, but infiltrative and recurrent lesions often require ablative and surgical treatment. Conclusion: Electrosurgery in combination with imiquimod proved to be effective and shortening the treatment regimen in the treatment of perianal CA.
Benevolo M, Donà MG, Ravenda PS, Chiocca S. Anal human papillomavirus infection: prevalence, diagnosis and treatment of related lesions. Expert Rev Anti Infect Ther 2016;14(5):465-477.
O'Mahony C, Gomberg M, Skerlev M, Alraddadi A, de las Heras‐Alonso ME, Majewski S, et al. Position statement for the diagnosis and management of anogenital warts. J Eur Acad Dermatology Venereol 2019;33(6):1006-1019.
Chelimo C, Wouldes TA, Cameron LD, Elwood JM. (2013). Risk factors for and prevention of human papillomaviruses (HPV), genital warts and cervical cancer. J Infect 2013;66(3):207-217.
Fleischer AB, Parrish CA, Glenn R, Feldman SR. Condylomata acuminata (genital warts): patient demographics and treating physicians. Sex Transm Dis 2001;28(11):643-647.
Kaderli R, Schnüriger B, Brügger LE. The impact of smoking on HPV infection and the development of anogenital warts. Int J Colorectal Dis 2014;29(8):899-908.
Park IU, Introcasso C, Dunne EF. Human Papillomavirus and Genital Warts: A Review of the Evidence for the 2015 Centers for Disease Control and Prevention Sexually Transmitted Diseases Treatment Guidelines. Clin Infect Dis 2015;61 Suppl 8:S849-S855.
Vela S, Videla S, Ornelas A, Revollo B, Clotet B, Sirera G, et al. Effectiveness of physically ablative and pharmacological treatments for anal condyloma in HIV-infected men. PloS one 2018 Aug 1;13(8):e0199033.
Aldikha I, Kusumaningsih RW, Budiastuti A. Perianal Giant Condyloma Acuminatum with HIV Treated with Surgical Excision 2020;(Ictromi 2019):375-379.
Meng X, Li Y, Luan H, Shi X. Therapeutic effect of photodynamic therapy combined with imiquimod in the treatment of anal condyloma acuminatum and its effect on immune function. Exp Ther Med 2018;16(5):3909-3912.
#Gilson R, Nugent D, Werner RN, Ballesteros J, Ross J. 2019 IUSTI-Europe guideline for the management of anogenital warts. J Eur Acad Dermatology Venereol 2020;34(8):1644-1653.
Asnawi V, Murtiastutik D, Lumintang H. Terapi Kombinasi TCA dan Elektrokauter pada Kondilomata Akuminata Berulang pada Penderita AIDS (TCA and Electrocautery as a Combination Theory for Recurrent Condyloma Accuminata in AIDS Patient). (318):75-79.
Mawardi P, Febrianto B, Yuliarto D, Sumandjar T. Comparing the Efficacy of Chemical Cautery to Cryosurgery on CD4+ Status of HIV Patients with Condyloma Acuminata. Clin Cosmet Investig Dermatol 2021 Oct 7;14:1453-1458
Rohanda BA, Hutapea R, Nadeak K. Identification of the type of Human Papilloma Virus ( HPV ) in condyloma acuminata in the genital and / or anal areas in men who have sex with men ( MSM ). Bali Medical Journal 2021;10(2):885-890.
Cranston RD, Carballo-Diéguez A, Gundacker H, Richardson BA, Giguere R, Dolezal C, et al. Prevalence and determinants of anal human papillomavirus infection in men who have sex with men and transgender women. Int J STD AIDS 2019 Feb;30(2):154-162.
James W, Hosler GA, Prenshaw KL. Weedon’s Skin Pathology :1272. 5th edition. Charlotteville: Elsivier 2021. Chapter 27. p. 777
Nieves-Condoy JF, Acuña-Pinzón CL, Chavarriá-Chavira JL, Hinojosa-Ugarte D, Zúñiga-Vázquez LA. Giant Condyloma Acuminata (Buschke-Lowenstein Tumor): Review of an Unusual Disease and Difficult to Manage. Infect Dis Obstet Gynecol 2021;2021.
Sharma N, Sharma S, Singhal C. A comparative study of liquid nitrogen cryotherapy as monotherapy versus in combination with podophyllin in the treatment of condyloma acuminata. J Clin Diagnostic Res 2017;11(3):WC01-WC05.
Schöfer H. Evaluation of imiquimod for the therapy of external genital and anal warts in comparison with destructive therapies. British Journal of Dermatology 2007 Dec 1;157(s2):52-5.
Kunduz E. Evaluation for Outcomes of Perianal Condyloma Accuminatum Patients treated with Surgical Resection and Electrocauterization. Turkish J Color Dis 2018;28(3):121-124.
Pekmezci E. Higher Lesion Numbers Result in Higher Recurrence Rates : A Retrospective Cohort Study in Condylomata Acuminata Treated 2020;(July).
Irisawa R, Tsuboi R, Saito M, Harada K. Treatment of intra-anal warts with imiquimod 5% cream: A single-center prospective open study. J Dermatol 2021;48(4):476-480.
Yuan J, Ni G, Wang T, Mounsey K, Cavezza S, Pan X, Liu X. Genital warts treatment: Beyond imiquimod. Human vaccines & immunotherapeutics 2018 Jul 3;14(7):1815-9.
Dianzani C, Pierangeli A, Avola A, Borzomati D, Persichetti P, Degener AM. Intra-anal condyloma: Surgical or topical treatment? Dermatol Online J 2008;14(12).
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