Treatment of external genital warts with 5% imiquimod cream during pregnancy: a case report


  • R.D. Maw

Dr R. D. Maw, Department of Genito-urinary Medicine, Royal Victoria Hospital, Grosvenor Road, Belfast, BT12 6BA, Northern Ireland, UK.

Case report

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.


As in this case, treatment options for anogenital warts can be restricted because of physical discomfort associated with ablative therapy. Furthermore in pregnancy, podophyllin and podophyllotoxin are contraindicated because of concerns as to possible teratogenicity. Imiquimod is the most recent addition to the treatment options for anogenital warts. Its mode of action is as an immune response modifier and has been shown to be effective in randomised, double-blind, placebo-controlled trials.1 It has also been shown to be well tolerated.2 In preclinical studies on animals, there was no evidence of teratogenic, mutagenic or carcinogenic effects [Data on file, 3M Pharmaceuticals, St Paul, Minnesota]. It remains unlicensed for use in pregnancy. Anecdotally, imiquimod has been used on a number of occasions in pregnancy and the manufacturing company has been keeping a register of its usage in pregnancy. From all that is known of imiquimod, it would seem to be a safe alternative for the treatment of anogenital warts in pregnancy.

Accepted 26 March 2004