Medication Summary
Various topical and systemic treatments are available for the treatment of condyloma acuminatum, including options for home use by the patient (eg, purified podophyllotoxin, imiquimod, sinecatechins). Other treatments that are administered in the physician’s office or emergency department may include acetic acid applications or interferon injections.
An important preventive therapy for condyloma acuminatum and other dysplasias is the human papillomavirus vaccine (9vHPV, Gardasil 9). The FDA has expanded the age to receive the vaccine through age 45 years. [7]
Interleukin 10 (IL-10), which is not approved for use in the United States, is a cytokine with multiple biological activities. IL-10 suppresses the inflammatory response and regulates the differentiation and proliferation of T cells, B cells, natural killer cells, antigen-presenting cells, mast cells, and granulocytes. IL-10 acts on antigen-presenting cells (APCs) by down-regulating the expression of MHC class II and co-stimulatory molecules and the production of reactive oxygen and nitrogen intermediates. IL-10 also acts directly on IL-10 receptor-expressing T cells to reduce their cytokine production and pathological effects.
Cytotoxic agents
Class Summary
Inhibit proliferation of cells at various stages of the cell cycle.
Podophyllum resin (Podocon-25)
Extract of various plants, which are cytotoxic. Effective in arresting mitosis in metaphase. Expect cure rate of 20-50% if used as single agent.
Podofilox (Condylox)
Purified podophyllotoxin that is antimitotic, cytotoxic, and available for patient's home use. While exact mechanism of action on condyloma is unknown, podofilox results in necrosis of genital condyloma acuminatum. Condylox is one agent containing podofilox. Slightly higher cure rates can be expected with podofilox than with podophyllin. Additionally, useful for prophylaxis.
Trichloroacetic acid topical (Tri-Chlor)
At various concentrations (up to 80%), these agents rapidly penetrate and cauterize skin, keratin, and other tissues. Bichloracetic acid is one such agent. Although caustic, this treatment causes less local irritation and systemic toxicity. Additionally, has low cost. Response is often incomplete, and recurrence is frequent.
5-Fluorouracil (Carac, Efudex, Fluoroplex, Tolak)
No longer recommended for routine use.
Has antimetabolic and/or antineoplastic and immunostimulative activity. Useful in prevention of recurrence after condyloma ablation if started within 4 wk, especially in immunocompromised patients.
Bleomycin
Composed of cytotoxic glycopeptide antibiotics, which appear to inhibit DNA synthesis with some evidence of RNA and protein synthesis inhibition to a lesser degree; used in management of several neoplasms as a palliative measure; may cause a variety of adverse effects; observe patients frequently and carefully during and after treatment.
Imiquimod (Aldara, Zyclara)
Induces interferon production and is a cell-mediated immune response modifier. Has minimal systemic absorption but causes erythema, irritation, ulceration, and pain. Burning, erosion, flaking, edema, induration, and pigmentary changes may occur at application site.
Imiquimod 5% cream comes in single-use packets.
Kunecatechins (Veregen)
Botanical drug product for topical use consisting of extract from green tea leaves. Mode of action unknown but does elicit antioxidant activity in vitro. Indicated for topical treatment of external genital and perianal warts (condylomata acuminatum) in immunocompetent patients.
Interferons
Class Summary
Interferons are not recommended as a primary treatment modality. [3]
Naturally produced proteins with antiviral, antitumor, and immunomodulatory actions. Alpha, beta, and gamma interferons exist and may be administered topically, systemically, and intralesionally. Topical, systemic, and intralesional interferons are not efficacious.
Interferon alfa-n3 (Alferon N)
Alpha interferon has been approved by FDA for injectional use in refractory condyloma acuminatum with some possible benefit. Alferon N is interferon alpha-n3, which has been used effectively for this purpose.
Recurrence rate of 20-40% exists with intralesional interferon, but recurrence rate after successful treatment is lower than with other treatment modalities. Additionally, intralesional interferon is expensive and requires repeat office visits.
Furthermore, numerous adverse reactions may occur, including myalgias, fever, chills, GI symptoms, transient leukopenia, thrombocytopenia, LFT abnormalities, serum lipid abnormalities with intramuscular interferon, and theoretical risk of viral transmission with natural interferon products. Viral symptoms do abate with time, and all adverse effects resolve once therapy is stopped. Viral symptoms can be treated with acetaminophen or NSAIDs in the interim.
Vaccines
Class Summary
One human papillomavirus (HPV) vaccine (9vHPV, Gardasil 9) is available in the United States for the prevention of HPV-associated neoplasias and dysplasias, including genital warts (condylomata acuminata). [7]
Human papillomavirus vaccine, nonavalent (Gardasil 9)
Recombinant vaccine that targets 9 HPV types (6, 11, 16, 18, 31, 33, 45, 52, 58). It is indicated for females and males aged 9-45 years to prevent genital warts and also dysplasias and neoplasia (eg, cervical, vulvar, vaginal, and anal cancers).
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Genital wart in pubic area
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Genital wart in pubic area (close-up view)
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Genital wart in pubic area (very close-up view)
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Genital wart in pubic area (look at bottom middle of picture)
