H. Foss1, C. Y. Peterson1, K. A. Ludwig1, T. J. Ridolfi1 1Medical College Of Wisconsin,Colorectal Surgery,Milwaukee, WI, USA
Introduction: Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States. An estimated 79 million Americans are currently infected with HPV, and approximately 14 million new infections occur each year. Known risk factors for contracting HPV include high number of lifetime sexual partners, failure to use condoms consistently, history of sexually transmitted infections, immunosuppression, and younger age. Many treatment modalities exist and are largely based on the extent of condyloma present. These treatments may range from simple office based procedures to major full thickness skin resections in those with large volume disease. The aim of this project is to identify risk factors associated with need for surgical intervention as well as extent of disease.
Methods: A retrospective chart review was completed for patients seen at the Medical College of Wisconsin Anal Dysplasia Clinic from April 2014 to June 2016. Information including demographic information, smoking status, HPV subtype, immune condition, need for surgical intervention, and surgical specimen size was then extracted from the medical record. Descriptive statistics were employed to evaluate the patient population. Logistic regression was used to evaluate for statistically significant covariates in predicting need for surgical intervention. Multiple linear regression analysis was used to evaluate for statistically significant covariates in predicting a log transformation of surgical specimen size. Significance was determined using a p-value equal to or less than 0.05.
Results: 283 patients met inclusion criteria, of which 252 (89.05%) were male, 179 (63.25%) had a smoking history, 232 (81.98%) were HIV positive, and 108 (38.16%) had undergone surgical intervention for anal condyloma. HPV subtyping was completed in 236 (83.39%) patients, of which 76 (32.20%) tested positive for HPV 16, 25 (10.59%) tested positive for HPV 18, and 149 (63.40%) tested positive for other high risk HPV subtypes. Of six covariates analyzed with logistic regression, only male gender significantly predicted the need for surgical intervention (p-value 0.04). Of seven covariates analyzed with multiple linear regression, HPV 18 status (p-value 0.05), smoking history (p-value 0.005), and older age (p-value 0.04) significantly predicted larger specimen size.
Conclusion:
Male gender is predictive of needing surgical intervention, while HPV subtype 18, smoking history, and older age are associated with greater burden of disease. The only modifiable risk factor in predicting burden of anal condyloma is smoking status with an average increase of 1 cm3 of condyloma burden in those who smoke. Smoking cessation should be strongly encouraged in those who are HPV positive.