Extensive Wart and Low-Grade Squamous Intraepithelial Lesion (LSIL) clearance with Human Papillomavirus Vaccine and Topical Treatment: A Case Report

Abstract

Aims: Genital warts, caused by the human papillomavirus (HPV), are one of the most commonly contracted sexually transmitted infections, but have limited treatment options. In this paper, we present a case of treatment involving two interventions: a topical wart treatment (Isdin Verrutop) and an HPV vaccine (Gardasil 4). Study Design: Case report. Place and Duration of Study: Instituto de Infertilidad y Genética, INGENES México. Between November 2021 and October 2023. Methodology: A patient at our clinic presented with vaginal warts; lesions were confirmed by colposcopy, cytology and HPV was detected via PCR. The patient refused surgical treatment; instead, she agreed to treatment with Isdin Verrutop (3x every two weeks) and Gardasil® 4 (3x every three months). Case Presentation: A 33-year-old patient presented with warty lesions on the labia of the vagina, consistent with condylomas. The warts were associated with itchiness and mild pain and were initially treated with Imiquimod (three times a week for one month). No improvement was observed. Low-Grade Squamous Intraepithelial Lesion (LSIL) was determined by colposcopy, and HPV type 31 was detected. As an alternative treatment, Isdin Verrutop and Gardasil® 4 were applied. By the second application, the vulva presented without lesions in the perianal region. Nine months post-treatment, one small lesion was visible. The patient was negative for intraepithelial lesion or malignancy. Discussion: Although Gardasil® 4 is approved as a preventive vaccine, this case suggests it may reduce HPV Type 31-related lesions after infection, likely through immunogenic effects. Combined with Isdin Verrutop, a topical agent, the treatment reduced warts, relieved pain, and minimized scarring. Isdin Verrutop showed early improvement, while full recovery occurred after the second Gardasil® 4 dose. This suggests a potential synergistic benefit and highlights the need to investigate dual-treatment strategies for HPV-related conditions. Conclusion: Here, using the Isdin Verrutop combined with the Gardasil®4 vaccine, we demonstrate that a dual treatment resolved lesions caused by an HPV type 31 infection.