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Thread: Rectal Condyloma Pictures - Atlas of Colon and Ileum

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    Default Rectal Condyloma Pictures - Atlas of Colon and Ileum

    What are anal warts?
    Anal warts, also known as condyloma, are growths found on the skin around the anus (rectal opening) or in the lower rectum.

    What causes anal warts?
    Anal warts are caused by the human papilloma virus, which is usually transmitted through sexual contact but not necessarily through anal intercourse. There are many types of human papilloma virus; some cause warts on the hands and feet and others cause genital and anal warts. The same type of warts may occur on the penis, scrotum, vagina or labia. The time from exposure to the virus and growth of the warts is commonly from one to six months, but it can be longer. During that time, the virus remains in the tissues but is inactive.

    What are symptoms of anal warts?
    Many patients with anal warts have no symptoms. Some patients may notice small growths in the anal area. Others have minor complaints of itching, occasional bleeding, or moisture in the anal canal.

    How are anal warts diagnosed?
    Diagnosis is made by the doctor, who inspects skin around the anus and checks the anal canal with an anoscope (a short instrument inserted into the anus).

    How are anal warts treated?
    There are several ways anal warts can be treated, depending on the location, number and size of the warts. If the warts are small, they can be treated with podophyllin or bichloracetic acid, which are solutions applied directly to the warts intended to cause sloughing of the wart. This is an office procedure that takes just a few minutes. Occasionally, an ointment will be prescribed that is applied by the patient at home. This supplements the treatment provided in the office. Another form of treatment is cauterization. If the area contains numerous warts, the doctor may choose to remove them surgically. This is done as a same-day procedure in a hospital or surgery center.
    Rectal Condyloma Pictures Atlas Colon attachment.php?s=4316815be1476ebfd8e876c8d5d70d53&attachmentid=2078&d=1442248600

    Will a single treatment cure anal warts?
    A single treatment will not cure anal warts in most cases. Close follow-up is critical because the virus may continue to be present and cause new anal warts to form. Even after there are no visible warts, the virus may remain in the tissue. Small warts that reappear are easily treated in the office. Follow-up visits are necessary even after there are no visible warts. Visits may be necessary for several months. There is a possibility of serious problems if the warts are left untreated. Rarely, these warts can become cancerous, so it is important to keep the follow-up appointments the doctor suggests.

    HUMAN PAPILLOMAVIRUS INFECTION
    Genital human papillomavirus (HPV) infection is increasingly common and affects an estimated 24 million Americans.1 It is the most common sexually transmitted disease and is second only to human immunodeficiency virus (HIV) infection in causing morbidity and mortality. Perianal HPV infection produces a wide range of disease presentations, from asymptomatic infection to benign genital warts to invasive cancer.

    Human papillomaviruses are members of the Papovaviridae family of epitheliotropic double-stranded DNA viruses and are considered tumor viruses because of their ability to immortalize normal cells. Currently more than 130 types of HPV have been identified, with more than 40 types infectious for the lower genital tract, of which ~15 are oncogenic.2 These are generally characterized as “low-risk” types , which are primarily associated with genital warts and respiratory papillomatosis, or as “high-risk” types , which are associated with low-grade and high-grade squamous intraepithelial lesions (LSIL and HSIL) and invasive cancer.

    HPV infection is extremely common in the cervix and affects between 2% and 43% of the female population worldwide.6 In the United States, the prevalence is 22.5% overall and significantly higher among the young.7 The prevalence of HPV infection among 600 young women attending family planning clinics in an urban setting was 82%.8 In another study of over 2011 young women aged 15 to , the 3-year cumulative risk of acquiring HPV infection was 44%.9 Clearly, not all of these individuals go on to develop cervical cancer, and in fact HPV infection in most women demonstrates a pattern of regression or latency with HPV DNA becoming undetectable even by polymerase chain reaction (PCR) assays by 1 to 2 years.10 Only a small percentage of women develop persistent and progressive disease. Other cofactors such as smoking, history of sexually transmitted infections, and individual immune responses to HPV may be necessary along with oncogenic HPV infection for carcinogenesis.

    The true prevalence of anal HPV infection in the general population is not currently known, but it is present in virtually all HIV-positive men who have sex with men (85 to 93%) and also in a high proportion of HIV-positive injection drug users who did not engage in anal-receptive intercourse (46%). Anal HPV prevalence is more common in HIV-positive men, at more than 60%, versus 17% in HIV-negative men. Another risk factor for HPV infection is the number of sexual partners. Up to two thirds of sexual partners of patients with condylomata acquire HPV infection. Among HIV-negative homosexual men, the prevalence of anal HPV infection has been reported to be as high as 78% by PCR. In an earlier study of 71 heterosexual male patients with anal fissure or hemorrhoids in a surgical outpatient department, the incidence of cytologic evidence of anal HPV infection was 25%. This figure rose to 98% in 225 men seen for anal condylomata. Additionally, infection by multiple HPV types is common and carries an increased risk for anal squamous intraepithelial lesions (SIL, also known as anal intraepithelial neoplasia or AIN) and progression to HSIL over time. Multiple HPV types were found in 73% of HIV-positive and 23% of HIV-negative homosexual men.
    Rectal Condyloma Pictures Atlas Colon attachment.php?s=4316815be1476ebfd8e876c8d5d70d53&attachmentid=2079&d=1442248611

    Women with cervical HSIL are also at a high risk for anal HPV infection (51%) when compared with control women without cervical intraepithelial neoplasia (CIN) (14%). This control group is validated by a 24% prevalence of cervical HPV infection which is comparable to the general population. In a subsequent study of women with invasive vulvar cancer, histologic evidence of anal HPV-16 infection was identified in 48.5% of patients with vulvar cancer versus 13.7% of control women with no prior history of anogenital HPV infection or neoplasia. In a San Francisco cohort study of 319 at-risk young women (high-risk for HIV), the prevalence of anal HPV infection by PCR was 76% among HIV-positive women and 42% of HIV-negative women.

    The actual prevalence of anal HPV infection will depend upon the sum effect of risk factors such as smoking, number of sexual partners, sexual behavior, presence of other sexually transmitted diseases (STDs), and so on. But it may be in the range of 5 to 15% in women, with autoinoculation being a potentially significant mechanism, and the range may be somewhat lower in men. These figures would explain the reason for the higher prevalence of anal cancer in the general population of women than in men. Improving sensitivities of the tests for HPV DNA detection in recent years should be considered when examining the data prior to second-generation hybrid capture or PCR.

    CONDYLOMA ACUMINATA
    Genital warts, or condylomata acuminata, are now the most common virally transmitted STD, surpassing even genital herpes. Condylomata acuminata affects ~5.5 million Americans each year and is estimated to have a prevalence of ~20 million. It is the most common anorectal infection affecting homosexual men. However, it also frequently occurs in bisexual and heterosexual men and women. Although the most common mode of transmission is through sexual contact, nonsexual routes of transmission via fomites and nonsexual contact can also occur.

    Anal lesions occur most frequently in men who engage in anal-receptive intercourse, where the association has been observed to be as high as 95% in patients However, there is significant variability in this association and the presence of anal condylomata does not necessarily imply that a patient engages in anal-receptive intercourse. The virus pools in the vagina and at the base of the scrotum and penis from where it can track along the perineum to the anus. Patients who are immunosuppressed are also at higher risk. Following renal transplantation the anal condylomata incidence has been reported to be 2.4% to 4%.

    In HIV-positive patients the HPV prevalence is 30%. The effect of HIV infection on the course of HPV disease is unclear but may be influenced by the severity of immunocompromise and the use antiretroviral therapy. Infection by high-risk HPV types is associated with SILs, which are the putative precursors to invasive cancer. The impact of HIV on HPV infection, as well as the associated biologic and behavioral risk factors in patients with HIV and HPV, may contribute to the 30- to 80-fold higher rates of anal cancer in HIV-positive patients versus the general population.
    Rectal Condyloma Pictures Atlas Colon attachment.php?s=4316815be1476ebfd8e876c8d5d70d53&attachmentid=2080&d=1442248624

    SYMPTOMS
    Most patients with anal condylomata present with minor complaints. The most frequent complaint is that of perianal growth. Pruritus ani may be present and to a lesser degree, discharge, bleeding, odor, tenesmus, and difficult perianal hygiene may be noted.

    References:
    Sexually Transmitted Diseases of the Colon, Rectum, and Anus: Human Papillomavirus, Condylomata Acuminata, and Anal Neoplasia
    Anal Warts (Condyloma) - Colon Rectal Surgery Associates











    Last edited by Medical Photos; 09-14-2015 at 04:38 PM.

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