Topical imiquimod therapy for external anogenital warts in pregnant women

105

This guideline is an update of the 2011 European Guideline for the Management of Anogenital Warts. It is intended to support best practice in the care of patients with anogenital warts by including evidence-based recommendations on diagnosis, treatment, follow-up and advice to patients. It is intended for use by healthcare professionals in sexual healthcare or dermato-venereology clinics in Europe but may be adapted for use in other settings where the management of anogenital warts is undertaken. As a European guideline, recommendations should be adapted according to national circumstances and healthcare systems. Despite the availability of vaccine to prevent HPV types 6 and 11, the cause of >95% anogenital warts, they remain an important and frequent health problem. The previous systematic review of randomized controlled trials for anogenital warts was updated. The changes in the present guideline include the following: Updated background information on the prevalence, natural history and transmission of human papillomavirus (HPV) infection and anogenital warts. Key recommendations for diagnosis and treatment have been graded according to the strength of the recommendation and the quality of supporting evidence. 5-fluorouracil, local interferon and photodynamic therapy have been evaluated and included as potential second-line treatment options. Evidence of the impact of HPV vaccination on the incidence of anogenital warts has been updated.

Section: Managementmentioning

confidence: 99%

2019 IUSTI‐Europe guideline for the management of anogenital warts

Gilson

Nugent

Werner

et al. 2020

105

“…No adverse effects were found on reproduction in a second generation rat study. Two case series of imiquimod use in pregnant women have been published, and no adverse pregnancy outcomes or foetal abnormalities have been reported 28,29 . Nevertheless, more data is needed before imiquimod cream can be considered safe during pregnancy.…”

Section: Managementmentioning

confidence: 99%

2012 European guideline for the management of anogenital warts

Lacey

Woodhall

Wikström

et al. 2012

181

Background Although new HPV vaccines have been developed and are in the process of implementation, anogenital warts remain a very frequent problem in clinical practice. Objective We wished to update previously published European guidelines for the management of anogenital warts. Methods We performed a systematic review of randomized controlled trials for anogenital warts. The primary data were analyzed and collated, and the findings were formulated within the structure of a clinical guideline. The IUSTI Europe Editorial Board reviewed the draft guideline which was also posted on the web for comments which we incorporated into the final version of the guideline. Results The data confirm that only surgical therapies have primary clearance rates approaching 100%. Recurrences, including new lesions at previously treated or new sites, occur after all therapies, and rates are often 20–30% or more. All therapies are associated with local skin reactions including itching, burning, erosions and pain. Conclusions Physicians treating patients with genital warts should develop their own treatment algorithms which include local practice and recommendations. Such patient level management protocols should incorporate medical review of cases at least every 4 weeks, with switching of treatments if an inadequate response is observed. First episode patients should be offered sexually transmitted disease screening. Management should include partner notification and health promotion.

“…18 In another retrospective case series, 17 pregnant women utilized imiquimod cream for 8 weeks (three times daily) and did not have adverse pregnancy outcomes or foetal abnormalities. 19 Finally, four pregnant women who utilized 5% imiquimod cream for 4 weeks (three times daily) did not have foetal abnormalities. 20 Use of topical imiquimod is considered safe, but should be utilized only after other safe alternatives such as cryotherapy, trichloroacetic acid, electrodessication or CO 2 laser.…”

Section: Imiquimod (Category C)mentioning

confidence: 92%

“…They delivered normal infants with appropriate birth weights . In another retrospective case series, 17 pregnant women utilized imiquimod cream for 8 weeks (three times daily) and did not have adverse pregnancy outcomes or foetal abnormalities . Finally, four pregnant women who utilized 5% imiquimod cream for 4 weeks (three times daily) did not have foetal abnormalities .…”

Section: Antiviralmentioning

confidence: 97%

Topical antiviral and antifungal medications in pregnancy: a review of safety profiles

Patel

Schwartz

Lambert

2017

Medications should be employed with caution in women of childbearing age who are pregnant or considering pregnancy. Compared to oral or parenteral agents, topical medications have limited systemic absorption and are deemed safer. However, their safety profile must be assessed cautiously due to the limited available data. In this article, we aggregate human and animal studies to provide recommendations on utilizing topical antiviral and antifungal medications in pregnancy. For antiviral medications, acyclovir and trichloroacetic acid are safe to use in pregnancy. Docosanol, imiquimod and penciclovir are likely safe, but should be utilized as second-line agents. Podofilox and podophyllin resin should be avoided. For antifungal medications, clotrimazole, miconazole and nystatin are considered first-line agents. Butenafine, ciclopirox, naftifine, oxiconazole and terbinafine may be utilized after the above agents. Econazole should be avoided during the first trimester and used sparingly during 2nd and 3rd trimester. Ketoconazole and selenium sulphide are likely safe, but should be employed in limited areas for brief periods.