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Human papilloma virus in condyloma acuminata of the anus Carcinoma of the anal canal is rare, but evidence suggests that an increasingly high incidence occurs in male homosexuals.' It has been reported that carcinoma in situ in the epithelium of the anal canal is more common in patients with condyloma acuminata,' and human papilloma virus (HPV) infection is considered to be a risk factor.3 The association of certain HPV types (particularly HPV16) with in situ and invasive carcinoma of the penis.4 and cervix5 and with in situ carcinoma of the anorectal area in women with multicentric neoplasia of the lower genital tract6 has been shown to be significant.In a study of homosexual, bisexual, and heterosexual patients with persistent perianal and intra-anal condyloma acuminata HPV types 6 and 11 (which are the commonest types found in condylomas) were detected in 75 of 105 lesions from 17 heterosexual and 16 homosexual or bisexual men. HPV6 and HPV1 1 occurred in both groups with about the same frequency (Table). HPV16 was shown in nine lesions from five patients (Table). Condylomas containing HPV16 in the homosexual and bisexual group were perianal (four lesions) and intraanal (four lesions), while in the heterosexual group the condyloma was on the perineum.The histology of the lesions containing HPV16 was similar to that of the general series in three patients and showed typical filiform, well differentiated squamous cell papillomas. Keratinisation was heavy in perianal tumours but absent from intra-anal tumours, which tended to be flatter. In two cases the number of mitoses was obviously greater, and there were abnormal cell forms, intracellular keratinisation, and loss of the usual maturation of the epithelium towards the surface. In the heterosexual patient infected with HPV16 perineal and perianal condylomas recurred almost two years after the initial presentation and required extensive further surgery.Although the numbers in this study were small, the finding of HPV16 in mitotically