AIM: There is a lack of standardization regarding diagnosis, treatment and surveillance of patients with anal HPV infection.
METHOD: An Internet-based survey was sent to members of international, surgical and dermatological societies. Answers were obtained from 1017 dermatologists and 393 colorectal surgeons (n = 1410).
RESULTS: More dermatologists than surgeons provided noninvasive treatment of anal condyloma with 5% imiquimod (80.4 vs 28.2%; P < 0.001), whereas the situation was reversed for surgical excision (56.8 vs 91.3%; P < 0.001). To detect dysplastic lesions, 42.0% of surgeons used acetic acid only, 23.2% used this in combination with high-resolution anoscopy and 19.5% applied intra-anal cytological smears. Likewise, 64.6% of dermatologists applied acetic acid only, 16.5% combined acetic acid with high-resolution anoscopy and 30.2% performed intra-anal cytological smears (all P < 0.001 compared with surgeons). The therapy for anal intraepithelial lesions was not influenced by the grade of dysplasia, but it was by immune status.
CONCLUSION: There were significant differences in practice between colorectal surgeons and dermatologists. These findings highlight the need for international and cross-disciplinary clinical guidelines.