CO(2) laser surgery for extensive, cauliflower-like anogenital condylomata acuminata: retrospective long-term study on 19 HIV-positive and 45 HIV-negative men.

BACKGROUND

Extensive 'cauliflower-like' condyloma acuminatum (CA) in males is commonly treated with CO(2) laser surgery or with electrosurgery. Studies on the long-term outcome in this specific situation are scarce.

OBJECTIVES

To determine the cure and recurrence rate in relation to the HIV status and endoanal location of lesions. To determine the complication rate and patient satisfaction.

METHODS

Questionnaire-based retrospective long-term study on 64 consecutive men (answer rate 60% or 64/107 addressed persons). The mean follow-up was 25 months (range 7-75).

RESULTS

The overall cure rate after 1 intervention was 67%. The cure rate in HIV-positive versus HIV-negative patients was 58 versus 71% (odds ratio = 1.79; p = 0.38). Endoanal versus perianal location was associated with a cure rate of 56 versus 84% (odds ratio = 4.06; p = 0.03). After a second treatment session, the cure rate increased to 79% or higher in all subgroups. Painful defecation for an average of 4-5 weeks was the main postoperative complaint. Severe complications were not seen or reported.

CONCLUSIONS

The CO(2) laser is a valuable and safe treatment to debulk extensive 'cauliflower- like' anogenital CA in males. The healing rate in HIV-positive patients is not significantly lower than in HIV-negative patients. Endoanal location of lesions is a risk factor for recurrence.