Venereal Warts: When to Consider Surgical Removal

I read with interest Dr Virenda Parikh’s case of a young woman with extensive anal condylomata acuminata (CONSULTANT, April 15, 2001, page 737). Dr Parikh noted that large warts, such as this patient had, require excision and electrofulguration. The various methods used to remove anal condylomata acuminata (eg, electrodesiccation and curettage, surgical excision, and cryosurgery) are destructive. I believe it is best to avoid such methods, because all warts will disappear spontaneously without leaving a scar as a result of the development of an immune response to these lesions. If the warts have not disappeared in 3 to 5 years, the lack of an immune response may be the cause. An immune treatment can be effective in such cases.
— Spyridon Koudouris, MD
    San Antonio, Tex This patient had extensive, large, bulky condylomata that covered the entire anal orifice (Figure). Surgical electrofulguration was necessary because an immune treatment might have taken a very long time. While postsurgical scarring may be a problem on other parts of the body, scarring in the anorectal area is minimal because of the excellent blood supply to this location. Also, cosmetic concerns are not of primary importance in this anatomic region. I agree that for a few small, scattered anal warts, immune therapy (eg, imiquimod(Drug information on imiquimod) cream) is an appropriate initial treatment.
— Virenda Parikh, MD
    Fort Wayne, Ind