Combined approach for the treatment of anorectal condyloma: endoscopic argon plasma coagulation and carbon dioxide laser excision.

Condyloma acuminatum (CA) is a sexually transmitted disease, caused by human papillomavirus (HPV) infection that has been increasing during the last decade 1. Infection with HPV is a major risk factor for development of anal or cervix squamous cell carcinoma 2,3. Despite over 100 genotypes of the virus, HPV 16 and 18 are considered pathogenic as they are seen in the majority of cervical and anal cancers 2. Epidemiologic studies identify high risk groups in: adolescents, young adults, persons with multiple sexual partners and human immunodeficiency virus (HIV) affected patients 4-8. There is not an agreement on the influence of sex, racial or demographics factors 4,9. Most HPV infections are cleared by the immune system and do not result in clinical manifestations. HPV viral subtype, immune status of the patient and environmental co-carcinogenes determin the clinical presentation of infection. Anogenital lesions can be flat, dome-shaped, keratotic, peduncolated and cauliflower-shaped; they may occur singularly, in clusters or as plaques 8. Symptoms are mostly typical (anal itch/burning and external anal tags) but can be underestimated by patients that often delay treatment. Gold treatment for anogenital warts is still debated and not all methods have been completely tested.