Clinical Course and Treatment Outcomes of Vulvar Condylomas in Immunocompromised Women: A Retrospective Cohort Study

Human papillomavirus (HPV) infection is highly prevalent worldwide and is associated with a broad spectrum of anogenital diseases, including vulvar condylomas and malignancies. Immunosuppression plays a key role in HPV persistence, recurrence, and progression; however, data on the clinical course of vulvar condylomas in immunocompromised women remain limited. This retrospective cohort study evaluated clinical progression, treatment response, recurrence, and neoplastic outcomes in women diagnosed with vulvar condyloma between January 2008 and January 2021 at a tertiary referral center in Brazil. Immunosuppressed patients, including women living with HIV, those receiving immunosuppressive therapy for autoimmune diseases, and patients undergoing chemotherapy, were compared with an age-matched immunocompetent group. Among 294 women included, 41 (13.9%) were immunosuppressed. Lesion extent was significantly greater in immunosuppressed patients, although lesion number did not differ between groups. Clinical remission after first-line treatment was significantly lower among immunosuppressed women (21.9%vs55.0%; p < 0.0001; OR = 4.5) with a higher need for multiple treatment sessions. Similarly, the complete remission rate at the end of follow-up was higher for the immunocompetent patients (75.9% vs. 48.8%; p < 0.0001; OR = 3.3). Immunosuppressed women had a 2.3-fold increased risk of recurrence and a higher risk of progression to vulvar intraepithelial neoplasia (OR = 6.7) and invasive disease (OR = 8.5). In the HIV patients, recurrence was not associated with CD4T-lymphocyte count or HIV viral load. These findings indicate that immunosuppressed women with vulvar condylomas experience more extensive disease, poorer treatment response, higher recurrence rates, and an increased risk of neoplastic progression, highlighting the importance of closer surveillance and individualized management in this high-risk population.