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24-year-old man with positive HIV, with a giant exofitic anal condyloma, with a clinical presentation of a painfull suppurative anal condyloma with a pathology report of an in situ squamous cell carcinoma. The purpose of the investigation is a case report and the procedure was observational. The finding was a Buschke-Lowenstein tumor.

Varón de 24 años, con infección por el virus de la inmunodeficiencia humana, que presenta una tumoración exofítica, dolorosa y supurativa, con reporte positivo de virus de papiloma humano y reporte histopatológico de carcinoma espinocelular sin evidencia de diseminación (in situ). El propósito de la investigación es un reporte de caso y el procedimientos fue observacional. El hallazgo fue un tumor de Buschke-Lowenstein.

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Introducción: El condiloma acuminado gigante es una rara enfermedad que se manifiesta en el 0,1 % de las personas con vida sexual activa, su tratamiento es variable; la cirugía es el más radical y definitivo, aunque la recurrencia no es despreciable. Ante grandes defectos de la región perianal luego de la resección es útil la rotación de colgajos para recubrir el defecto. Objetivos: Exponer el tratamiento quirúrgico reconstructivo realizado a un paciente con tumor de Büschke-Löwenstein perianal. Caso clínico: Paciente masculino de 47 años, afroamericano, con antecedentes de infección por el VIH, diagnosticado 8 meses antes de la consulta por el cuadro actual; en tratamiento con antirretrovirales. Acude a consulta con una lesión anal en forma de coliflor, que ocupa un diámetro de aproximadamente 10 cm; se le realizó un procedimiento quirúrgico para tratamiento definitivo, mediante escisión y anoplastia con colgajo en V-Y y se extirpó a lesión vegetante sobre el borde interno del glúteo derecho, cuya área formó parte del colgajo V-Y. Conclusiones: Las técnicas reconstructivas en la región perianal se deben individualizar en cada caso, en dependencia del tipo de defecto, su topografía y las condiciones locales; aunque pudiese existir la preferencia de una sobre otras, la literatura científica no aporta suficiente evidencia al respecto. La técnica reconstructiva realizada al paciente demostró que, aun con altas tasas de recurrencia y complicaciones, resultó efectiva para el paciente pese a tener comorbilidades que pudieron influir en una evolución tórpida.

Introduction: The giant condyloma acuminata is a rare disease that manifests itself in 0.1% of people with an active sexual life, its treatment is variable, surgery being the most radical and definitive, although recurrence is not negligible. In case of large defects in the perianal region after resection, flap rotation is useful to cover the defect. Objectives: To expose the reconstructive surgical treatment performed on a patient with perianal Büschke-Löwenstein tumor. Clinical case: A 47-year-old African American male patient with a history of HIV infection diagnosed 8 months prior to the current consultation, in treatment with antiretrovirals. Who came to the clinic with an anal lesion in the shape of a cauliflower, which occupies a diameter of approximately 10 cm, a surgical procedure was performed as a definitive treatment through excision and anoplasty with a V-Y flap, and the vegetative lesion on the edge was excised, internal of the right gluteus whose area was part of the V-Y flap. Conclusions: Reconstructive techniques in the perianal region must be individualized in each case, depending on the type of defect, its topography, and local conditions, and although there may be a preference for one over others, the scientific literature does not provide sufficient evidence in this regard. The reconstructive technique performed on the patient showed that even with high rates of recurrence and complications, it was effective for the patient despite having comorbidities that could influence a torpid evolution.

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Resumen Objetivo: Describir la experiencia en cirugía electiva de condilomas anales en pacientes mayores de 15 años en un hospital terciario de la Región Metropolitana. Material y Método: Estudio observacional retrospectivo y descriptivo, en el cual se analizan las intervenciones quirúrgicas electivas realizadas entre 2008 a 2021. Resultados: Dentro del período analizado se obtuvo 165 cirugías de condilomas anales, lo que corresponde a 137 pacientes en total. El 85% de los pacientes son de sexo masculino, el 68% de los pacientes son VIH positivo, un 87% de los pacientes MSM (hombres que tienen sexo con otros hombres) son VIH positivo, el 34% de los pacientes tiene antecedente de ETS, el 46% de los pacientes recibió terapia tópica como tratamiento preoperatorio o posoperatorio. Un 25% de los pacientes presenta recidiva en su historia personal, un 21% de los pacientes presenta lesiones anales intraepiteliales de alto grado, un 6% presenta carcinoma escamoso infiltrante. No hubo mortalidad descrita. Discusión: El presente estudio, describe la experiencia en cirugía de condilomas de un hospital terciario de la Región Metropolitana de Chile, cuya población corresponde a un estrato socioeconómico medio y bajo. Se logra describir a la población que es intervenida de condilomas acuminados, además de sus resultados quirúrgicos precoces y a largo plazo. Conclusión: El presente estudio, presenta una población de 137 pacientes operados de condilomas anales, a partir de los hallazgos de la cirugía. Se cumple el objetivo del estudio de caracterizar en un período de 12 años los resultados quirúrgicos de dicha serie, algo no reportado previamente en la literatura chilena.

Objective: To describe the experience in elective surgery for anal condylomas in patients over 15 years of age in a tertiary hospital in the Metropolitan Region. Materials and Method: Retrospective and descriptive observational study about elective surgical interventions performed between 2008 to 2021. Results: Within the analyzed period, 165 anal warts surgeries were obtained, corresponding to 137 patients. 85% of the patients are male, 68% are HIV positive, 87% of the MSM patients are HIV positive, 34% of the patients have a history of STDs, 46% of the patients received topical therapy as preoperative or postoperative treatment. 25% present recurrence in their personal history, 21% present high-grade anal intraepithelial lesions, 6% present infiltrating squamous carcinoma. There was no reported mortality. Discussion: The present study describes the experience in condyloma surgery in a tertiary hospital in the Metropolitan Region of Chile, whose population corresponds to a medium and low socioeconomic stratum. It is possible to describe the population that undergoes surgery for this reason, in addition to its early and long-term surgical results. Conclusion: The present study presents a population of 137 patients operated on for anal condylomas, based on the findings of the surgery. The objective of the study to characterize the surgical results of this series over a 12-year period is fulfilled, something not previously reported in the Chilean literature.

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Abstract: The approach to children with anogenital warts in the context of sexual abuse is a challenge in clinical practice. This study aims to review the current knowledge of anogenital warts in children, the forms of transmission, and the association with sexual abuse and to propose a cross-sectional approach involving all medical specialties. A systematic review of the literature was conducted in Portuguese and English from January 2000 to June 2016 using the ISI Web of Knowledge and PubMed databases. Children aged 12 years or younger were included. The ethical and legal aspects were consulted in the Declaration and Convention on the Rights of Children and in the World Health Organization. Non-sexual and sexual transmission events of human papillomavirus in children have been well documented. The possibility of sexual transmission appears to be greater in children older than 4 years. In the case of anogenital warts in children younger than 4 years of age, the possibility of non-sexual transmission should be strongly considered in the absence of another sexually transmitted infection, clinical indicators, or history of sexual abuse. The importance of human papillomavirus genotyping in the evaluation of sexual abuse is controversial. A detailed medical history and physical examination of both the child and caregivers are critical during the course of the investigation. The likelihood of an association between human papillomavirus infection and sexual abuse increases directly with age. A multidisciplinary clinical approach improves the ability to identify sexual abuse in children with anogenital warts.

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Condyloma acuminata is caused by the proliferation of squamous epithelial cells in the presence of human papilloma virus (HPV) infection. There are several treatment options available for anogenital warts, however, none have proven to be more efficacious. We present the case of a 3 year-8 months-old male, diagnosed with human immunodeficiency virus (HIV) infection, who presented with multiple warts in the anogenital region. Lesions were treated with imiquimod 5%, electrosurgical resection and interferon α-2b. Combination of electrofulguration and interferon α-2b is an effective treatment option for children with giant condyloma accuminatum although recurrence is expected within a short follow-up period.

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El condiloma gigante acuminado (Tumor de Buschke-Lowenstein) es una rara enfermedad que afecta frecuentemente a pacientes inmunodeprimidos, presenta un alto porcentaje de malignización, tasa de recidiva y mortalidad. Existe poco consenso respecto de su tratamiento y controles post-operatorios, donde juegan un importante papel los estudios imagenológicos, existiendo escasa literatura al respecto. En la presente revisión, presentamos los casos de 7 pacientes, junto con sus características fundamentalmente en resonancia magnética como también en tomografía computada, además de realizar una revisión de la literatura. En general se observan lesiones exofíticas pediculadas en "coliflor". A la tomografía computada presentan densidad de partes blandas y vascularización. En resonancia magnética son isointensas en T1, levemente hiperintensas en T2, restringen a la difusión y captan heterogéneamente el medio de contraste paramagnético, manteniendo su realce en fases tardías.

Giant condyloma acuminata (Buschke - Lowenstein tumor ) is a rare disease that commonly affects immunocompromised patients, presenting a high percentage of malignancy, recurrence rate and mortality. There is little consensus regarding treatment and post-operative controls, where imaging studies play an important role, existing sparse literature regarding this. In this review, we present the cases of seven patients, along with their characteristics mainly on MRI as well as CT scan, in addition to a revision of the literature. In most cases, pedunculated exophytic "cauliflower-like" lesions are observed. Which are of soft-tissue density and vascularized. In magnetic resonance imaging they are isointense on T1, slightly hyperintense on T2, with restricted diffusion on DWI, and heterogenous enhancement on gadolinium administration, with a late progressive enhancement pattern.

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Introducción: las infecciones de transmisión sexual se propagan de persona a persona, principalmente a través de contactos sexuales; entre estas se encuentra el condiloma acuminado. Objetivo: determinar la manifestación del virus del papiloma humano en su forma de condiloma acuminado, en un área de salud. Métodos: se realizó un estudio transversal de 63 pacientes con dicha infección, pertenecientes a 5 consultorios del médico de la familia del Policlínico Universitario "Tula Aguilera Céspedes" del municipio de Camagüey (provincia de Camagüey), de febrero a agosto del 2008. Los datos se obtuvieron del modelo de cuestionario que constituyó el registro primario. Resultados: en la serie el grupo etario más vulnerable fue el de 15-19 años, el mayor número de infectados correspondió al sexo masculino y al estado conyugal soltero, y entre las afecciones asociadas más frecuentes figuraron el herpes simple y la candidiasis. Conclusiones: se observó un incremento del número de individuos con condiloma acuminado en los meses de junio, julio y agosto, con predominio en los varones, fundamentalmente los adolescentes.

Introduction: sexually transmitted infections are spread from person to person, mainly through sexual contacts; among them is the condyloma acuminata Objective: to determine the manifestation of the human papillomavirus in its form of condyloma acuminata in a health area. Methods: a cross-sectional study was carried out in 63 patients with this infection, belonging to 5 family doctor's offices of "Tula Aguilera Céspedes" University Polyclinic in Camagüey municipality (province of Camagüey), from February to August 2008. The data were obtained from questionnaire model, which constituted the primary record. Results: in the series the most vulnerable age group was that of 15-19 years, the highest number of people infected corresponded to the male sex and those who were single, and among the most frequent associated conditions were the herpes simplex and candidiasis. Conclusions: an increase of number of individuals with condyloma acuminata was observed in June, July and August, with predominance in males, especially in adolescents.

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Se realizó un ensayo clínico abierto, controlado y aleatorizado, para comparar la eficacia terapéutica entre la radiocirugía y la criocirugía en el tratamiento del condiloma acuminado de localización anal en el período comprendido entre enero y marzo del 2005, en el Policlínico docente 'Ángel A. Aballí'. Se incluyeron 20 pacientes adultos con éste diagnóstico. Se formaron de manera aleatoria dos grupos de tratamientos de 10 pacientes cada uno. El primer grupo recibió radiocirugía de las lesiones en el policlínico docente 'Antonio Guiteras'. El segundo grupo recibió criocirugía de las lesiones en el policlínico docente 'Joaquín Albarrán'. La frecuencia con que se realizaron ambos tratamientos fue la misma (quincenal). La duración de ambos tratamientos fue la misma (6 semanas). La eficacia terapéutica fue evaluada dos semanas después de culminar el tratamiento, comparando el estado inicial y final de las lesiones. A los pacientes respondedores al medicamento se les realizó seguimiento trimestral durante un año para detectar posibles recidivas. El análisis pareado inicio-final demostró respuesta significativa al tratamiento en cada grupo. El grupo tratado con radiocirugía respondió significativamente mejor desde el punto de vista estadístico que el grupo tratado con criocirugía. Las tasas de recidivas fueron elevadas en ambos grupos. Los principales eventos adversos observados en el grupo II fueron: ardor y dolor en el momento de la aplicación del tratamiento, de intensidad leve y de desaparición espontánea en pocos minutos. Se demostró que la radiocirugía tiene una mayor eficacia terapéutica que la criocirugía en el tratamiento del condiloma acuminado de localización anal.

An open controlled and randomized clinical trial was carried out to compare the therapeutical effectiveness between the radiosurgery and the cryosurgery in the treatment of the anal condyloma acuminata in the time period comprised between January and March 2005 in the 'A. A. Aballí' teaching polyclinic. 20 adult patients with this diagnosis were included. Two groups of 10 patients each were created in the randomized way, applying a different therapeutical scheme in each case. These were: group I received radiosurgery in the 'Antonio Guiteras' teaching polyclinic and group II received application of cryosurgery in the 'Joaquín Albarrán' teaching polyclinic. The frequently of application of both treatments was the same (each two weeks in each group). The length of both treatments was the same (six weeks in each group). The therapeutical effectiveness was assessed a couple of weeks after completing the treatment, comparing the initial and final state of lesions. The patients who responded to the medicine were followed up quarterly during a year in order to spot possible relapses. The start-end comparative analysis showed an outstanding response to the treatment in each group. The group I (radiosurgery) showed better response than the group II (cryosurgery), there was statistically remarkable difference. The relapse rates were high in both groups. The major adverse events as observed in group II were: burning and pain at the time of treatment, of mild intensity and of spontaneous disappearance in a few minutes. The radiosurgery is better than the cryosurgery for the treatment of anal condyloma acuminata.

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Introdução:a cervicite por Chlamydia trachomatis é reconhecida como uma das doenças sexualmente transmissíveis (DST) de origem bacterianamais prevalentes no mundo e a infecção genital por Papilomavírus Humano (HPV) é uma das DST de origem viral mais frequentes. Objetivo: avaliara taxa de coinfecção de C. Trachomatis e HPV em mulheres com condiloma acuminado. Métodos: foram incluídas no estudo 30 mulheres com diagnóstico clínico e histopatológico de condiloma acuminado em região vulvar, vaginal ou perianal. As lesões genitais foram excisadas e seccionadas em duas metades, uma para exame histopatológico e outra para extração de DNA. A detecção do DNA de HPV nas amostras foi realizada empregando-se a técnica da reação em cadeia da polimerase (PCR), com posterior genotipagem pela reação de PCR multiplex com primers específicos para diferentes tipos virais. A pesquisa de C. trachomatis também foi realizada por PCR, empregando-se os primers PCT1 e PCT2. Resultados: a positividade de DNA-HPV nas amostras de condiloma acuminado foi de 100%, sendo detectados genótipos 6/11 em 33,3% das amostras, genótipo 18 em 6,7% e infecção por múltiplos genótipos em 56,7% das lesões, e em apenas uma amostra (3,3%) o genótipo não foi identificado. A positividade de C. trachomatis no canal cervical das mulheres com condiloma acuminado foi de 33,3%. Conclusão: a taxa de coinfecção de C. trachomatis e HPV, em mulheres com condiloma acuminado, é alta e a estratégia de rastreamento e tratamento da infecção clamidiana poderia ser incorporada na rotina ginecológica desse grupo de pacientes.

Introduction: Chlamydia trachomatis is worldwide recognized as one of the most prevalent sexually transmitted diseases (STD) of bacterial origin,whereas genital Human Papillomavirus (HPV) infection is one of the most important STD caused by virus. Objective: evaluate the coinfection rateof C. trachomatis and HPV in women with condyloma acuminata. Methods: thirty women were included in the study based on clinical and histopathological diagnosis of condyloma acuminata in vulvar, vaginal or perianal region. The excised lesions were divided into two halves, one was submitted to a histopathological exam and the other to DNA extraction. C. trachomatis was detected by PCR using CTP1 and CTP2 primers and the HPV DNA was detected by PCR and subsequent typed by PCR with HPV specific primers. Results: the HPV DNA positivity was 100% in all samples. HPV type 6/11 was found in 33.3% of the samples, type 18 in 6.7%, and we also found infection with multiple HPV types in 56.7% of HPV induced lesions, and only one sample (3,3%) was not genotyped. The C. trachomatis positivity in cervical secretions of women with condyloma acuminata was 33.3%. Conclusion: the coinfection rate of C. trachomatis and HPV in women with condyloma acuminata is high and the screen and treat strategy for chlamydial infection should be incorporated to gynecology routine care in these patients.

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