Effective treatment of a giant condyloma with imiquimod and HPV vaccination

Giant condyloma acuminata (GCA) is a sexually transmitted disease caused by human papillomavirus (HPV), mostly types 6 and 11. Only a few cases have been reported in children and young patients. Treating these large tumors in adolescent patients is challenging, due to the disfiguring effects of surgery and the high risk of recurrence. Alternative nonsurgical treatments are available such as imiquimod. Imiquimod is a topically active immunomodulatory agent that is formulated as a 5% cream for application by the patient. In immunocompetent patients, imiquimod stimulates the production of interferon-alpha and various other cytokines, and has indirect antiviral activity.

We present a case of successful treatment of an extensive GCA encompassing the entire vulva in a 14-year-old adolescent patient with a history of sexual abuse with imiquimod and three doses of nonavalent HPV vaccination (9vHPV) leading to complete remission of the GCA after 12 weeks of imiquimod application and nearly complete regression of remaining vulvar condylomas after 6 months.

Imiquimod in combination with intramuscular 9vHPV vaccination can be an effective treatment for GCA in young patients, without the disfiguring side effects of surgery and could be considered as an alternative treatment option.