Abstract

Aim: Perianal condyloma acuminata (CA) is a common sexually transmitted disease caused by human papillomavirus (HPV), characterized by high recurrence rates following monotherapies. While surgical modalities provide rapid clearance, they often fail to eliminate subclinical viral reservoirs in surrounding tissue. This study evaluates the long-term efficacy and recurrence outcomes of a combined therapeutic protocol involving surgical excision followed by delayed adjuvant topical imiquimod.
Materials and Methods: In this single-center retrospective cohort study, 31 patients treated for perianal CA between 2014 and 2022 were analyzed. The treatment protocol consisted of surgical excision and electrocauterization of all macroscopic lesions, with wounds left for healing by secondary intention. Delayed adjuvant 5% imiquimod cream was initiated on postoperative day 15 and applied once daily for 16 weeks. Recurrence was assessed at two levels: clinical recurrence (new visible lesions on examination) and virological recurrence (positive HPV DNA detection).
Results: Thirty-one patients (24 males, 7 females; mean age 38.5±17.7 years) were included. Lesions were confined to the perianal region in 80.6%. The mean follow-up duration was 29.4 months (range: 12–72 months). All patients completed the protocol without major complications or treatment discontinuation. Among 20 patients (64.5%) with regular clinical follow-up, no clinical recurrence was observed (0/20). Among 10 patients with complete follow-up including HPV DNA screening, virological recurrence was detected in 2 patients (20%).
Conclusion: Surgical excision followed by delayed adjuvant imiquimod therapy appears to be a safe and effective strategy for the management of perianal CA, yielding 0% clinical recurrence and 20% virological recurrence over a median follow-up of 22 months. These findings should be confirmed by prospective studies with larger cohorts.

Key words: Condylomata acuminata, surgical excision, imiquimod, recurrence, human papillomavirus, anogenital warts