I recently completed a seven-part series on cervical dysplasia and cancer in pregnancy. The incentive to begin that series came from a young patient who had a mildy abnormal Pap test and extensive involvement of her vagina, vulva, and perianal areas with anogenital warts (Condylomata acuminata). In my comments related to her care, I mentioned that we had discussed options for treatment of her warts. Subsequently, one of our readers contacted me and wanted to know specific details about my approach to the treatment of anogenital warts during pregnancy "because the problem seems to be getting worse rather than better." I used that query as an opportunity to complete a set of 'guidelines for managment of anogenital warts' that our residents could use in their clinics. It's rather long and rather 'clinical' but it also contains some useful information and a few 'pearls' so it is presented in its entirety below...
Approaches to Therapy
A recommended approach to therapy of both internal and external disease using these compounds is as follows:
External disease (minimal)
External disease (extensive)
Imiquimod 5% cream can be used externally in conjunction with intravaginal TCA. The patient should be given a prescription for Imiquimod 5% cream and the following instructions:
Adjuncts to Therapy
Management of Delivery
Genital Warts and Recurrent Respiratory Papillomatosis (RRP)
Reeves WC, Ruparelia SS, Swanson KI, et al. National registry for juvenile-onset recurrent respiratory papillomatosis. Arch Otolaryngol Head Neck Surg. 2003;129:976-82.
Silverberg MJ, Thorsen P, Lindeberg H, et al. Condyloma in pregnancy is strongly predictive of juvenile-onset recurrent respiratory papillomatosis. Obstet Gynecol. 2003;101:645-52.
Stamataki S, Nikolpoulos TP, Korres S, Felekis D, et al. Juvenile recurrent respiratory papillomatosis: still a mystery disease with difficult management. Head Neck 2007;29:155-62.
Wiatrak BJ, Overview of recurrent respiratory papillomatosis. Curr Opin Otolaryngol Head Neck Surg. 2003;11:433-41.
Wiatrak BJ, Wiatrak DW, Broker TR, Lewis L. Recurrent respiratory papillomatosis: a longitudinal study comparing severity associated with human papilloma viral types 6 and 11 and other risk factors in a large pediatric population. Laryngoscope. 2004;114:1-23.