Diagnosis and Treatment of Anal Intraepithelial Neoplasia and Condylomata

Abstract

Anal human papilloma virus (HPV) infection causes significant pathology, including condylomata as well as low- and high-grade anal intraepithelial lesions, the precursors of invasive cancer. Men who have sex with men, women with concomitant high-grade cervical/vulvar disease, and immunocompromised patients are particularly vulnerable. The incidence of anal cancer is increasing in men and women, but human immunodeficiency virus-infected patients regardless of immune reconstitution are at greatest risk. A critical review of the literature and evidence-based, comparative analysis and discussion of treatment modalities for anal HPV related diseases was undertaken. Anal cytology screening for high-grade dysplasia has been shown to be sensitive and cost-effective in men who have sex with men; any abnormal anal cytology result should be followed with high-resolution anoscopy. Condylomata must be considered a marker for intraanal HPV disease, and patients should be screened for concomitant high-grade dysplasia. A variety of topical and ablative treatment modalities are available, including pharmacologic, targeted ablation of lesions and surgery. Treatment modality is directed not only by the extent and location of disease but also by available expertise and resources. Currently, there is no pharmacologic therapy approved by the Food and Drug Administration for intraanal HPV-related disease. Once treated, recurrence over time remains high, and patients should be closely monitored.