Clinical Images  |   October 2020
Recurrent Condylomata Acuminata in a Transplant Patient
Author Notes
  • From the Department of Gynecologic Surgery (Drs Delara and Wassoon); the Division of Anatomic Pathology, Department of Laboratory Medicine and Pathology (Dr Chen); and the Division of Colon and Rectal Surgery, Department of Surgery (Dr Young-Fadok) at the Mayo Clinic in Phoenix, Arizona. 
  • Financial Disclosures: None reported. 
  • Support: None reported. 
  •  *Address correspondence to Ritchie Delara, MD, 5777 E Mayo Blvd, Phoenix, AZ 85054. Email:
Article Information
Gastroenterology / Hypertension/Kidney Disease / Obstetrics and Gynecology
Clinical Images   |   October 2020
Recurrent Condylomata Acuminata in a Transplant Patient
The Journal of the American Osteopathic Association, October 2020, Vol. 120, 711-712. doi:
The Journal of the American Osteopathic Association, October 2020, Vol. 120, 711-712. doi:
A 49-year-old woman presented with recurrent vulvar and perianal condyloma for 1 year (image A). Her medical history included deceased donor renal transplant. She was taking 500 mg of mycophenolate orally twice per day and 2 mg of tracrolimus orally twice per day for immunosuppressive therapy. She had prior wide local excision of bilateral vulva with laser fulguration of a condyloma and subsequent trichloroacetic acid ablation. An anal Papanicolaou test was positive for low-grade squamous intraepithelial lesion (image B). Vulvar and anorectal condyloma excision was performed (image C and image D). Vulvar condylomas were negative for dysplasia and high-risk human papillomavirus. Perianal condylomas were positive for squamous cell carcinoma in situ and positive for (other high-risk) human papillomavirus (image E). 
Women who are immunosuppressed and aged 40 years or older with a history of vulvar or cervical dysplasia have an increased risk for anogenital cancer.1-5 Abnormal cytologic findings should prompt high-resolution anoscopy or referral to colorectal surgery.1,3 When managing benign conditions like vulvar condylomas, gynecologists should strongly consider anal cancer screening using history, examination, and anal cytology with cotesting. 
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Nadhan KS, Larijani M, Abbott J, Doyle AM, Linfante AW, Chung CL. Prevalence and types of genital lesions in organ transplant recipients. JAMA Dermatol. . 2018;154(3):323-329. doi: 10.1001/jamadermatol.2017.5801 [CrossRef] [PubMed]
Stier EA, Sebring MC, Mendez AE, Ba FS, Trimble DD, Chiao EY. Prevalence of anal human papillomavirus infection and anal HPV-related disorders in women: a systematic review. Am J Obstet Gynecol. 2015;213(3):278-309. doi: 10.1016/jajog.2015.03.034. [CrossRef] [PubMed]
Vegunta S, Files JA, Wasson MN. Screening women at high risk for cervical cancer: special groups of women who require more rrequent screening. Mayo Clin Proc. 2017;92(8):1272-1277. doi: 10.1016/j.mayocp.2017.06.007 [CrossRef] [PubMed]
Workowski KA, Bolan GA; Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015 [published correction appears in MMWR Recomm Rep. 2015;64(33):924]. 2015;64(RR-03):1-137. MMWR Recomm Rep. 2015;64(RR-03):1-137.