Topical medication as an initial therapeutic option for protruding and non-protruding condylomata acuminata of the distal urethra

Abstract

Genital warts (also known as condylomata acuminata) caused by the human papillomavirus (HPV) represent one of the most common sexually transmitted infections. Although they are usually found in the outer genital region, a small proportion of men can present with (often unrecognised) intraurethral warts, generally limited to the distal urethra and urethral meatus. This poses a treatment challenge not adequately addressed by the current guidelines. Here, we present two cases of low-risk HPV-positive patients with protruding and non-protruding condylomata acuminata of the distal urethra, which were treated successfully by using two different topical regimens (ie, a combination of policresulen and imiquimod for one patient and 5-fluorouracil monotherapy for the other). Although this type of management results in lower rates of tissue destruction and complications and may be given preference as an initial therapeutic option, additional prospective comparative clinical studies are needed to elucidate its potential in similar cases.

Treatment of urethral and bladder condyloma acuminata

“…13 More recent data were primarily case reports with protocols ranging from once a nightly application for one month to once weekly for eight weeks and variable response rates were reported. [32][33][34][35] Regimens included inoffice and at-home topical applications. Side effects included mild irritative symptoms and dysuria.…”

“…One case report described alternating intraurethral application of a 36% policresulen solution and 5% imiquimod cream used over a 6-week period with no recurrence after six months. 35 Ingenol mebutate (IM) is a component of milkweed (Euphorbia peplus) sap and is Food and Drug Administration (FDA) approved for the treatment of actinic keratosis. It is thought to function by mediating immune responses that rapidly induce cell death.…”