The management of condylomata acuminata depends on the extent and location of the lesions. Treatment options include destructive therapy (podophyllin, trichloroacetic acid, bichloroacetic acid, electrocautery, and laser surgery), excisional therapy, and immunotherapy. We prefer bichloroacetic acid 89 to 90%, a caustic agent that, unlike podophyllin, can be used on the perineum and inside the anal canal, has no systemic toxicity, and does not cause the histological changes resembling carcinoma in situ, which can occur after podophyllin application. Application can be done at 7 to 10 day intervals. Surgical excision has the immediate advantage of reliably eliminating warts and allowing tissue collection for histopathologic analysis. However, it is associated with significant pain, potential stricture formation, and cost for the anesthesia. Thus, topical therapy is preferred unless there is extensive condyloma. Immunotherapy is reserved for patients with recurrent warts.
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