A 20 year old woman presented with external genital warts at 14 weeks gestation. Clinical examination confirmed extensive soft, fleshy, condylomata acuminata in the vestibule.
She did not wish to have the lesions surgically removed. Initial treatment with liquid nitrogen under local anaesthetic cream was commenced but after one application she found this painful and there was a poor response. After discussion, she agreed to the use of imiquimod 5% cream. The patient fully understood that this was an off-label use of imiquimod and gave signed consent.
At week 16 she commenced imiquimod therapy, applied to the warty areas three nights a week for four weeks. She was instructed to wash the vulva the morning after treatment. After four weeks, the warts had responded extremely well and clinical examination revealed almost complete resolution. Further imiquimod therapy was prescribed but she did not return for follow up. No adverse events were reported at her uncomplicated vaginal delivery at week 41. Her female child had an Apgar score of 6 at 1 minute and 10 at 10 minutes. Physical examination was recorded as showing no physical abnormality and reflexes were normal. Measurements were head circumference 34.5 cm, crown to heel length 51.5 cm and weight 3740 g. There has been no subsequent report of any abnormality with the child.