What should we do about anal condyloma and anal intraepithelial neoplasia? Results of a survey

Aim There is a lack of standardization regarding diagnosis, treatment and surveillance of patients with anal HPV infection. Method An Internet-based survey was sent to members of international, surgical and dermatological societies. Answers were obtained from 1017 dermatologists and 393 colorectal surgeons (n = 1410). Results More dermatologists than surgeons provided noninvasive treatment of anal condyloma with 5% imiquimod (80.4 vs 28.2%; P < 0.001), whereas the situation was reversed for surgical excision (56.8 vs 91.3%; P < 0.001). To detect dysplastic lesions, 42.0% of surgeons used acetic acid only, 23.2% used this in combination with high-resolution anoscopy and 19.5% applied intra-anal cytological smears. Likewise, 64.6% of dermatologists applied acetic acid only, 16.5% combined acetic acid with high-resolution anoscopy and 30.2% performed intra-anal cytological smears (all P < 0.001 compared with surgeons). The therapy for anal intraepithelial lesions was not influenced by the grade of dysplasia, but it was by immune status. Conclusion There were significant differences in practice between colorectal surgeons and dermatologists. These findings highlight the need for international and cross-disciplinary clinical guidelines.