Modern aspects of diagnostic and therapeutic approaches in the management of patients with recurrent anogenital warts

Background. The problem of recurrence is topical in the management of patients with anogenital warts (AGWs). Objective. Improvement of diagnostic and therapeutic approaches in the management of patients with recurrent AGWs. Material and methods. An observational prospective cohort study involving 27 patients was carried out. Laboratory examination included diagnosis of sexually transmitted infections, microbiocenosis disorders, genotyping of human papilloma virus and detection of concomitant somatic pathology. Patients received topical immunotherapy with imiquimod 5% cream: 24 patients at the first stage were prescribed the drug for 8—16 weeks with subsequent destruction by physical method while preserving residual elements; 3 patients with presence of AGW up to 5 elements 25—100 mm2 in size underwent the destruction, after healing imiquimod 5% cream for 8 weeks was recommended. Results. AGWs in patients with a recurrence frequency of more than 2 within six months are characterized by the number of elements from 5 and more and lesion area of 100—400 mm 2 Concomitant somatic pathology was detected in 14 (51.9%) patients, sexually transmitted infections — in 4 (14.8%), microbiocenosis disorders — in 14 (51.9%), co-infection with several human papilloma virus genotypes was identified in 17 (63%) patients. Treatment with imiquimod 5% cream and elimination of precipitating factors have led to a complete resolution of AGWs, remission was achieved in 91.7% of cases. Conclusion. Topical immunotherapy using imiquimod 5% cream is one of the most effective approaches to management of patients with recurrent AGWs. Optimization of the therapeutic strategy by eliminating precipitating factors based on careful history taking and additional examination also contributes to reduction of the recurrence risk.