Anogenital warts

Virus-associated benign tumors Anogenital warts... 

Cidofovir (Fig. 2) has been formally approved for the treatment of CMV retinitis in AIDS patients, where it is administered intravenously at a dose not exceeding 5 mg/kg once weekly during the first two weeks (and every other week thereafter). Cidofovir is also used off label for the treatment of human papilloma virus (HPV) infections (i.e., cutaneous warts, anogenital warts, laryngeal and pharyngeal papilloma), polyomavirus [i.e., progressive (i.e., multifocal leukoencephalopathy (PML)], adenovirus, herpesvirus, and poxvirus (i.e., molluscum contagiosum) infections, where it can be administered intravenously (at a dose of < 5 mg/kg once weekly or every other week) or topically as a 1% gel or cream (De Clercq and Holy 2005). Especially in immunosuppressed patients (i.e., transplant recipients), local treatment of HPV-associated lesions has often yielded spectacular results (Bonatti etal.2007). 

Anogenital warts (condylomata acuminata) are caused by the human papillomavirus and are usually sexually transmitted. The average incubation period is 2-3 months. During pregnancy, the warts may become more widespread, favouring an even more rapid growth. Spontaneous resolution may occur. However, they tend to recur in some patients. 

Imiquimod cream is used for the treatment of external anogenital warts, where it may be used for both keratinised and non-keratinised lesions. It is also used in superficial basal cell carcinoma and actinic keratosis. Side-effects include local reactions such as itching, burning sensation, erythema, erosion, oedema, excoriation and stabbing and, less commonly, local ulceration. Patients should be advised to rub it in and to allow it to stay on the treated area for 6-10 hours for warts. The cream should then be washed off with mild soap and water. 

Imiquimod (Aldara) is a topical immune response modifier approved for the treatment of anogenital warts... 

Cidofovir is approved for the treatment and prophylaxis of CMV retinitis in AIDS patients. It has also been used in the treatment of acyclovir-resistant (viral thymidine kinase-dehcient) HSV infections, polyomavirus-associated progressive multifocal leukoencephalopathy, condylomata acuminata (anogenital warts), and mollus-cum contagiosum. 

Anogenital warts Topical Apply 0.5% gel for 3 days, then withhold for 4 days. Repeat cycle up to 4 times. 

In one study, there was no deleterious effect on disease progression in HIV-infected patients, and the incidence of local adverse events with imiquimod (5% three times a week) for the treatment of anogenital warts was lower than has previonsly been reported in healthy individuals (3). In an uncontrolled trial of topical imiquimod 5% for the treatment of common warts and molluscum contagio-sum in otherwise healthy patients, fever, healing with scarring, and healing with hyperpigmentation were each reported by one participant (4). 

Gilson RJ, Shupack JL, Friedman-Kien AE, Conant MA, Weber JN, Nayagam AT, Swann RV, Pietig DC, Smith MH, Owens ML. A randomized, controlled, safety study using imiquimod for the topical treatment of anogenital warts in HIV-infected patients. Imiquimod Study Group. AIDS 1999 13(17) 2397-404. 

Anogenital warts require specialist diagnosis and screening for other sexually transmitted diseases. Treatment is with prescription-only medications and is not considered here. 

Topical cidofovir gel eliminates virus shedding and lesions in some HIV-infected patients with acyclovir-resistant mucocutaneous HSV infections and has been used in treating anogenital warts and molluscum contagiosum in immunocompromised patients and cervical intraepithelial neoplasia in women. Intralesional cidofovir induces remissions in adults and children with respiratory papillomatosis. 

Podophyllin (podophyllum resin) is a mixture of chemicals from the plant Podophyllum peltatum (mandrake or May apple). The major constituent of the resin is podophyllotoxin (podofilox). It binds to microtubules and causes mitotic arrest in metaphase. Podophyllum resin (10 0%) is applied and left in place for 2-6 hours weekly for the treatment of anogenital warts. Irritation and ulcerative local reactions are the major side effects. It should not be used in the mouth or during pregnancy. Podofilox (CONDYLOX, others) is available as a 0.5% solution for application twice daily for 3 consecutive days. Weekly cycles may be repeated. 

P.J. Lynch (1985). Condylomata acuminata (anogenital warts) (Review). Clin. Obstet. Gynecol 28(1), 142-151. 

Rosenblatt A, de Campos Guidi HG. Local and systemic adverse effects of imiquimod therapy for external anogenital warts in men report of three cases. Int J STD AIDS 2012 23(12) 909-10. 

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