Genital condylomas in immunosuppressed women: a therapeutic challenge

Of 30 immunosuppressed women with genital condylomas, 20 (67%) had associated neoplasia of the lower genital tract. We retrospectively studied 11 patients with flat condylomas confined to the cervix; all lesions were eradicated by conventional therapy. Three patients studied retrospectively and 16 studied prospectively had condylomatous lesions involving several sites within the lower genital tract. These lesions were unusually resistant to various treatment methods. Maintenance therapy with 5-fluorouracil (5-FU) cream resulted in a significantly higher control rate (6/7 patients, 86%) than could be achieved otherwise (2/9 patients, 22%; P less than .025). We conclude that ablative therapy by surgery or topical chemical agents followed by maintenance therapy with 5-FU cream may be the treatment of choice for condylomas and other human papillomavirus-associated lesions of the lower genital tract in immunosuppressed women.