Anogenital wart or condyloma acuminatum is a sexually transmitted infection (STI) mainly caused by human papillomavirus (HPV)-6 or -11. 1,2,3 The STI guidelines recommend several regimens for external anogenital warts including treatment with imiquimod, podofilox, cryotherapy and surgical removal. 1,2,3 However, wart recurrence is frequently observed, and there is no single treatment modality effective for all patients.Imiquimod is an immune response modulator. Imiquimod 5% cream, formulated for the treatment of external anogenital warts, is applied three times weekly for 16 weeks and demonstrated a high clearance and low recurrence rate despite the occurrence of adverse events, such as erythema, edema and erosion, at the application sites. 4,5 Imiquimod 5% cream is useful for external anogenital warts but is not formulated for use on mucosal warts due to the risk of severe inflammation.Intra-anal (anal canal) warts frequently occur in men who have sex with men (MSM) and in the HIV-positive population. We previously analyzed 55 cases of anal condyloma acuminatum and found that 27 cases were accompanied by intra-anal lesions whereas five cases had only intra-anal lesions. 6 Intra-anal warts treated with