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.