Background: Extensive ‘cauliflower-like’ condyloma acuminatum (CA) in males is commonly treated with CO₂ laser surgery or with electrosurgery. Studies on the long-term outcome in this specific situation are scarce. Objectives: To determine the cure and recurrence rate in relation to the HIV status and endoanal location of lesions. To determine the complication rate and patient satisfaction. Methods: Questionnaire-based retrospective long-term study on 64 consecutive men (answer rate 60% or 64/107 addressed persons). The mean follow-up was 25 months (range 7–75). Results: The overall cure rate after 1 intervention was 67%. The cure rate in HIV-positive versus HIV-negative patients was 58 versus 71% (odds ratio = 1.79; p = 0.38). Endoanal versus perianal location was associated with a cure rate of 56 versus 84% (odds ratio = 4.06; p = 0.03). After a second treatment session, the cure rate increased to 79% or higher in all subgroups. Painful defecation for an average of 4–5 weeks was the main postoperative complaint. Severe complications were not seen or reported. Conclusions: The CO₂ laser is a valuable and safe treatment to debulk extensive ‘cauliflower- like’ anogenital CA in males. The healing rate in HIV-positive patients is not significantly lower than in HIV-negative patients. Endoanal location of lesions is a risk factor for recurrence.

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