Prise en charge des condylomes acuminés externes: Revue de la littérature

The anogenital infection to human papillomavirus, which is responsible for the external genital warts, is the most frequent sexually transmitted disease today. This infection has a growing incidence in the developped countries and has become a dramatic public health issue as the role for some papillomavirus in the genesis of the cervical cancer is no clear. The methods used for the diagnosis lean upon cytology, fibroscopy and pathology which may be enriched by the detection and specification of the viral-DNA. The rapidly effective treatments, including cryotherapy, electrosurgery and laser therapy, are costly and painful and, despite their efficacy, lead to frequent relapses. Less agressive treatments include the topical application of podophyllin (once or twice weekly) and trichloracetic acid (two or three times a week). These two drugs require numerous applications at the physician's surgery and produce local inflammation with erythema and erosions. Only podophyllin (twice daily application) may be used at home. The irritative action of topical 5-fluorouracile cream makes it less used. Finally, none of these treatments may ensure a liable eradication with a low rate of relapses. The introduction of the costly systemic or intralesional interferon alpha therapy (1 million IU three times weekly) has led to new hopes in the treatment of condylomas, but carries a significative high rate of relapses and generates systemic side-effects. As these treatments did not enough efficacy, local immune therapies were put forward, including the use of imiquimod (applied three times weekly). Although relapses occur with this drug, they are less frequent while the tissue alteration is far less important. A strict surveillance is necessary after the treatment in order to prevent relapses and new occurrences of the infection.