BACKGROUND

The anogenital skin of organ transplant recipients (OTR) is commonly affected by a variety of inflammatory, infective, and premalignant conditions. Inflammatory dermatoses including lichen sclerosus and lichen planus are not increased in incidence, but carry an increased risk of malignancy. As a result, nonspecific symptoms such as itching and soreness require careful examination of the skin, combined with appropriate samples for microscopy and culture. Biopsy of clinically suspicious lesions should be undertaken early and repeated if a definitive diagnosis cannot be made or if an appropriate response to therapy is not encountered. Female transplant recipients are at higher risk of developing anogenital carcinoma than male transplant recipients. Anogenital diseases seen more frequently or with increased clinical significance in OTR include those conditions listed in Table 18.1. All are associated with human papillomavirus (HPV) infection.

CONDYLOMATA ACUMINATA

(GENITAL VIRAL WARTS)

Genital warts are a common infection caused by HPV with an increased incidence in OTR. Clinical and virological features of anogenital HPV-related lesions in transplant recipients suggest they may represent a marker for profound immunosuppression rather than the more common association with sexual partners and sexual practices. A study of 1002 OTR revealed anogenital warts in 2.1% (21/1002) of patients. Ninety-five percent (20/21) had multifocal disease involving the vulva (8/10), anus (5/10), and cervix (3/10).