多次電燒治療後以 5% Imiquimod 乳膏成功控制年輕男性反覆性肛門口尖形濕疣：病例報告與文獻回顧

蕭亞芝¹、蘇文彬²、陳曉芳¹、林大鈞¹、鄭如惠³、蔡蔓綺⁴、黃品叡⁵

1李綜合醫療社團法人大甲李綜合醫院 醫療部 專科護理師小組

2李綜合醫療社團法人苑裡李綜合醫院 醫療部 專科護理師小組

3李綜合醫療社團法人苑裡李綜合醫院 護理部

4疾病管制署中區管制中心 檢疫科

5李綜合醫療社團法人大甲李綜合醫院 外科部 泌尿外科

Successful Management of Recurrent Perianal Condyloma Acuminatum in a Young Male Using 5% Imiquimod Cream After Multiple Electrocautery Sessions: A Case Report and Literature Review

Ya-Chih Hsiao¹, Wen-Pin Su ², Hsiao-Fang Chen¹, Ta-Chun Lin ¹, Ru-Hui Cheng³, Man-Chi Tsai⁴,
Pin-Jui Huang⁵

1Division of Nursing Participants, Department of Medical Affairs, Dajia Lee Hospital

2Division of Nursing Participants, Department of Medical Affairs, Yuanli Lee Hospital

3Nursing Department, Yuanli Lee Hospital

4Quarantine Department, Central Regional Center, Centers for Disease Control, Ministry of Health and Welfare

5Division of Urology, Department of Surgery, Dajia Lee Hospital

Background:
Condyloma acuminatum, primarily caused by HPV types 6 and 11, often presents with high recurrence rates even after seemingly adequate ablative therapy. Electrocautery is effective for rapid clearance of visible lesions, but persistent recurrence reflects the presence of subclinical viral infection and insufficient host immune response. This report describes a young male with rapid and repeated recurrence of perianal condyloma despite four electrocautery sessions, and illustrates the successful incorporation of topical 5% imiquimod cream as adjunct therapy.

Case Presentation:
A 35-year-old healthy male presented with multiple perianal warts and underwent initial electrocautery ablation with complete lesion removal. However, the condylomas recurred consistently every four weeks. Over a four-month period, he required three additional electrocautery sessions. The most severe relapse occurred one month after the third procedure, revealing 16 newly developed warts around the anal verge. Screening for immunodeficiency and sexually transmitted infections showed no abnormalities, and the patient reported no high-risk sexual activity during this time. Due to the rapid recurrence pattern, a fourth electrocautery procedure was performed, followed immediately by adjuvant therapy with 5% imiquimod cream (Aldara) applied three times weekly. Imiquimod, an immune response modifier known to enhance local cytokine production such as interferon-α and TNF-α, was selected to strengthen host antiviral immunity and reduce viral persistence. Treatment continued for 12 weeks. Mild transient erythema and pruritus were observed but did not require interruption. Remarkably, after completing the imiquimod course, the patient experienced no further recurrences during a six-month follow-up period. This outcome represented a substantial improvement compared with his pre-treatment pattern of monthly relapse, suggesting that immune modulation played a critical role in long-term disease control.

Discussion:
This case illustrates the inherent limitations of repeated electrocautery in patients with aggressive or rapidly recurring condyloma acuminatum. Ablative procedures remove visible lesions but fail to eradicate subclinical HPV infection, predisposing patients to recurrence. The addition of imiquimod offers a complementary immunomodulatory effect that reduces residual viral burden and improves sustained outcomes. Published evidence supports the use of combined surgical and immune-enhancing therapy, especially in patients with frequent recurrence or heavy lesion burden. This case further reinforces that approach.

Conclusion:
For young, immunocompetent individuals with refractory perianal condyloma, integrating 5% imiquimod cream after electrocautery may markedly reduce recurrence risk. This case highlights the clinical value of combining ablative and immune-enhancing treatments and supports the inclusion of imiquimod in the therapeutic algorithm for recurrent HPV-related disease.