Abstract
PURPOSE: The aim of this study was to determine whether interferon combined with surgical excision and fulguration could reduce the unacceptably high rate of recurrence of anal condyloma seen after surgical extirpation. METHODS: Forty-three patients with anal condyloma were prospectively randomized into two groups. Group I (n=25) patients underwent surgical excision and fulguration immediately followed by an injection of 500,000 IU (0.1 ml) of interferon alfa-n3 into each quadrant of the anal canal. Group II (n=18) patients underwent surgical excision and fulguration but then received four injections (0.1 ml) of saline into each quadrant of the anal canal. RESULTS: After a mean follow-up of 3.8 months, 10 of 43 (23 percent) patients developed recurrent anal condyloma. Only 3 of 25 (12 percent) interferon-treated patients had recurrences vs. 7 recurrences in 18 (39 percent) saline-treated patients (P=0.046). Interferon was particularly effective in reducing recurrences in patients whose condylomata were present for more than six months (P=0.04) and those condylomata that contained human papillomavirus DNA subtype 6/11 (P=0.05). CONCLUSION: Adjuvant interferon treatment can reduce the high recurrence rate of anal condyloma seen after surgical extirpation.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Abcarian H, Sharon N. The effectiveness of immunotherapy in the treatment of anal condyloma acuminatum. J Surg Res 1977;22:231–6.
Ferenczy A, Mitao M, Nagai N, Silverstein SJ, Crum CP. Latent papillomavirus and recurring genital warts. N Engl J Med 1985;313:784–8.
Turek LP, Byrne JC, Lowy DR, Dvoretzky I, Friedman RM, Howley PM. Interferon induces morphologic reversion with elimination of extrachromosomal viral genomes in bovine papillomavirus-transformed mouse cells. Proc Natl Acad Sci U S A 1982;79:7914–8.
von Krogh G, Syrjanen SM, Syrjanen KJ. Advantage of human papillomavirus typing in the clinical evaluation of genitoanal warts. J Am Acad Dermatol 1988;18:495–503.
Palmer JG, Scholefield JH, Coates PJ,et al. Anal cancer and human papillomaviruses. Dis Colon Rectum 1989;32:1016–22.
Ghosh AK. Cryosurgery of genital warts in cases in which podophyllin treatment failed or was contraindicated. Br J Vener Dis 1977;53:49–53.
O'Connor JJ. Perianal and anal condyloma acuminata. Am J Proctol G E Colon Rectal Surg 1980;31:16–21.
Dodi G, Infantino A, Moretti R, Scalco G, Lise M. Cryotherapy of anorectal warts and condylomata. Cryobiology 1982;19:287–8.
Handley JM, Homer T, Maw RD, Lawther H, Dinsmore WW. Subcutaneous interferon alpha 2a combined -with cryotherapy vs cryotherapy alone in the treatment of primary anogenital warts: a randomised observer blind placebo controlled study. Genitourin Med 1991;67:297–302.
Thomson JP, Grace RH. The treatment of perianal and anal condylomata acuminata: a new operative technique. J R Soc Med 1978;71:180–5.
Gollock JM, Slatford K, Hunter JM. Scissor excision of anogenital warts. Br J Vener Dis 1982;58:400–1.
McMillan A, Scott GR. Outpatient treatment of perianal warts by scissor excision. Genitourin Med 1987;63:114–5.
Khawaja HT. Podophyllin versus scissor excision in the treatment of perianal condylomata acuminata: a prospective study. Br J Surg 1989;76:1067–8.
Duus BR, Philipsen T, Christensen JD, Lundvall F, Sondergaard J. Refractory condylomata acuminata: a controlled clinical trial of carbon dioxide laser versus conventional surgical treatment. Genitourin Med 1985;61:59–61.
Vance JC, Davis D. Interferon alpha-2b injections used as an adjuvant therapy to carbon dioxide laser vaporization of recalcitrant ano-genital condylomata acuminata. J Invest Dermatol 1990;95:146S-8S.
Cauda R, Tyring SK, Grossi CE,et al. Patients with condyloma acuminatum exhibit decreased interleukin-2 and interferon gamma production and depressed natural killer activity. J Clin Immunol 1987;7;304–11.
Spencer ES, Andersen HK. Clinically evident, nonterminal infections with herpesviruses and the wart virus in immunosuppressed renal allograft recipients. BMJ 1970;3:251–4.
Eron LJ, Judson F, Tucker S,et al. Interferon therapy for condylomata acuminata. N Engl J Med 1986;315:1059–64.
Leventhal BG, Kashima HK, Week PW,et al. Randomized surgical adjuvant trial of interferon alfa-n1 in recurrent papillomatosis. Arch Otolaryngol Head Neck Surg 1988;114:1163–9.
Browder JF, Araujo OE, Myer NA, Flowers FP. The interferons and their use in condyloma acuminata. Ann Pharmacother 1992;26:42–5.
Davis BE, Noble MJ. Initial experience with combined interferon-α2b and carbon dioxide laser for the treatment of condylomata acuminata. J Urol 1992;147:627–9.
Miles AJ, Mellor CH, Gazzard B, Allen-Mersh TG, Wastell C. Surgical management of anorectal disease in HIV-positive homosexuals. Br J Surg 1990;77:869–71.
Orkin BA, Smith LE. Perineal manifestations of HIV infection. Dis Colon Rectum 1992;35:310–4.
Beck DE, Jaso RG, Zajac RA. Surgical management of anal condylomata in the HIV-positive patient. Dis Colon Rectum 1990;33:180–3.
Safavi A, Gottesman L, Dailey TH. Anorectal surgery in the HrV+ patient: update. Dis Colon Rectum 1991;34:299–304.
Author information
Authors and Affiliations
Additional information
Read at the meeting of The American Society of Colon and Rectal Surgeons, Chicago, Illinois, May 2 to 7, 1993.
Winner of the Harry E. Bacon Foundation Award.
About this article
Cite this article
Fleshner, P.R., Freilich, M.I. Adjuvant interferon for anal condyloma. Dis Colon Rectum 37, 1255–1259 (1994). https://doi.org/10.1007/BF02257792
Issue Date:
DOI: https://doi.org/10.1007/BF02257792