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<p>Anogenital warts (AGW) caused by human papillomavirus (HPV) are a common sexually transmitted infection with high recurrence rates (20–50%) after ablative therapies alone due to persistent subclinical reservoirs. Combination therapies, such as electrocauterization followed by adjuvant imiquimod, aim to enhance viral clearance and reduce relapses. This study evaluated the 12-month efficacy of this regimen, stratified by baseline lesion number and size.&#xa0;This single-center, prospective observational study enrolled 120 adults (≥ 18 years) with histologically confirmed external AGW at Memorial Dicle Hospital, Diyarbakır, Turkey (April 2022–September 2024). All underwent electrocauterization under local anesthesia, followed by self-application of 5% imiquimod cream three times weekly for 12 weeks post-epithelialization. Follow-up assessments at 3, 6, and 12 months measured recurrence rates (primary outcome), stratified by lesion count (1–5, 5–10, &gt; 10) and size (&lt; 1&#xa0;cm², 1–5&#xa0;cm², 5–10&#xa0;cm²). Adverse events were graded per CTCAE v5.0. Statistical analyses used chi-square and Fisher’s exact tests (<i>p</i> &lt; 0.05).&#xa0;Mean age was 36.4 ± 10.4 years; 73.3% were male. Mean lesion count and size were 5.5 and 2.0&#xa0;cm², respectively. Overall recurrence rates were 3.3% at 3 months, 5.0% at 6 months, and 10.8% at 12 months. Subgroup analysis showed zero recurrences (0%) for 1–5 lesions or &lt; 1&#xa0;cm² lesions; rates increased dose-dependently to 13.9% (5–10 lesions), 53.3% (&gt; 10 lesions), 18.8% (1–5&#xa0;cm²), and 50.0% (5–10&#xa0;cm²) (χ² = 45.2 and 42.1, respectively; <i>p</i> &lt; 0.001). Mild adverse events (erythema 25%, pruritus 18%, erosion 12%) resolved with dose adjustment; no serious events occurred.&#xa0;Electrocauterization plus 12-week adjuvant 5% imiquimod achieves low 12-month recurrence (10.8%) in AGW, with 0% in low-burden cases, outperforming historical monotherapy controls. Lesion burden predicts outcomes, supporting personalized adjuvant use. These findings endorse routine combination therapy, particularly for minimal disease, while highlighting need for intensified strategies in high-burden patients.</p>

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Effectiveness of electrocauterization followed by adjuvant 5% imiquimod cream in treating anogenital warts: a prospective observational study stratified by lesion burden and recurrence rates

  • 期刊论文

  • 发表日期：

    2026年6月18日

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  • Kemal Ertaş,
  • Süleyman Bağlam

摘要

Anogenital warts (AGW) caused by human papillomavirus (HPV) are a common sexually transmitted infection with high recurrence rates (20–50%) after ablative therapies alone due to persistent subclinical reservoirs. Combination therapies, such as electrocauterization followed by adjuvant imiquimod, aim to enhance viral clearance and reduce relapses. This study evaluated the 12-month efficacy of this regimen, stratified by baseline lesion number and size. This single-center, prospective observational study enrolled 120 adults (≥ 18 years) with histologically confirmed external AGW at Memorial Dicle Hospital, Diyarbakır, Turkey (April 2022–September 2024). All underwent electrocauterization under local anesthesia, followed by self-application of 5% imiquimod cream three times weekly for 12 weeks post-epithelialization. Follow-up assessments at 3, 6, and 12 months measured recurrence rates (primary outcome), stratified by lesion count (1–5, 5–10, > 10) and size (< 1 cm², 1–5 cm², 5–10 cm²). Adverse events were graded per CTCAE v5.0. Statistical analyses used chi-square and Fisher’s exact tests (p < 0.05). Mean age was 36.4 ± 10.4 years; 73.3% were male. Mean lesion count and size were 5.5 and 2.0 cm², respectively. Overall recurrence rates were 3.3% at 3 months, 5.0% at 6 months, and 10.8% at 12 months. Subgroup analysis showed zero recurrences (0%) for 1–5 lesions or < 1 cm² lesions; rates increased dose-dependently to 13.9% (5–10 lesions), 53.3% (> 10 lesions), 18.8% (1–5 cm²), and 50.0% (5–10 cm²) (χ² = 45.2 and 42.1, respectively; p < 0.001). Mild adverse events (erythema 25%, pruritus 18%, erosion 12%) resolved with dose adjustment; no serious events occurred. Electrocauterization plus 12-week adjuvant 5% imiquimod achieves low 12-month recurrence (10.8%) in AGW, with 0% in low-burden cases, outperforming historical monotherapy controls. Lesion burden predicts outcomes, supporting personalized adjuvant use. These findings endorse routine combination therapy, particularly for minimal disease, while highlighting need for intensified strategies in high-burden patients.