Therapeutic value of trichloroacetic acid in the treatment of isolated genital warts on the external female genitalia.
OBJECTIVE
To evaluate the value of 85% trichloroacetic acid (TCA) in the treatment of human papillomavirus (HPV)-associated genital warts of the external genitalia and to detect the recurrence rate and side effects of this therapeutic regimen.


METHODS
All patients with a suspected HPV-related papillary vulvar lesion after initial examination underwent vulvoscopic evaluation with a magnification of 8-20x using acetic acid and toluidine blue. Under local anesthesia, biopsies were taken from acuminate or papillary warts for histopathologic confirmation and from suspicious areas to exclude preinvasive or invasive diseases. Following histopathologic diagnosis, patients were treated with 85% TCA.


RESULTS
Overall, 51 patients with isolated vulvar and/or perianal genital warts were included. Of those patients, 11 (21.5%) had acuminate and 40 (78.5%) had papular genital warts. All the women had lesions of the labia minora. The other localizations were as follows: labia majora, 18 (35.3%); lateral vulva, 5 (9.8%); clitoris, 9 (17.6%); fourchette, 16 (31.3%); and perianal area, 7 (13.7%). All lesions were successfully treated by the end of the treatment period (median, 4; range 2-5). None of the patients had recurrence or new lesions during the 6-month follow-up period. In the second 6 months, 9 patients (17.6%) were diagnosed with recurrent lesions. Although all the patients experienced transient burning pain during therapy, none of them discontinued the therapy. Ulceration was observed in 8 patients (15.6%). Of those patients only 3 had permanent scarring (5.8%).


CONCLUSIONS
We recommend the use of TCA in patients with external genital warts, especially for mild to moderate cases. It is associated with a high success rate and low morbidity if sufficient care is taken during application.
Taner
Zeki M
ZM
Department of Obstetrics and Gynecology, Gazi University Faculty of Medicine, Ankara, Turkey. mztaner@yahoo.com
Taskiran
Cagatay
C
Onan
Anil M
AM
Gursoy
Rifat
R
Himmetoglu
Ozdemir
O
D000328:Adult; D052685:Alphapapillomavirus / Q000187:drug effects; D002424:Caustics / Q000627:therapeutic use*; D003218:Condylomata Acuminata / Q000188:drug therapy*; D005260:Female; D006801:Humans; D016896:Treatment Outcome; D014238:Trichloroacetic Acid / Q000627:therapeutic use*; D014844:Vulva / Q000187:drug effects* / Q000473:pathology / Q000821:virology
D002424:Caustics; D014238:Trichloroacetic Acid