Treatment of vaginal intraepithelial neoplasia (primarily low grade) with imiquimod 5% cream.
OBJECTIVE
Treatment of human papillomavirus (HPV)-associated vaginal lesions (vaginal intraepithelial neoplasia [VAIN]) can be expensive, tedious, and morbidity inducing. Imiquimod 5% cream, a safe and effective treatment of external genital warts, enhances the immune response to HPV infection.


METHODS
Imiquimod 5% cream was used to treat 56 young women with VAIN. One sachet of cream (0.25 g) was placed in the vagina with an applicator once weekly for 3 weeks (except for the first four patients, who were treated twice weekly).


RESULTS
Thirty-six of the 42 patients (86%) available for follow-up were clear of VAIN lesions (as assessed by colposcopy) 1 week or later after the last dose of treatment. The remaining six patients cleared after a total of two (five patients) and three (one patient) treatment cycles. Vulvar or vestibular excoriation was reported in only 2 of 56 patients. No patients had vaginal ulceration.


CONCLUSIONS
A very low dosing regimen of imiquimod 5% cream appears to be an effective and well-tolerated treatment for VAIN (primarily low grade.).
Buck
Henry W
HW
Department of Gynecology, Watkins Memorial Student Health Center, The University of Kansas, Lawrence, KS 66045-7559, USA. hbuck@ku.edu
Guth
Kathy J
KJ