Effect of topical 5-aminolevulinic acid-mediated photodynamic therapy combined with CO2 laser pretreatment for vaginal condyloma acuminate

Condyloma acuminatum (CA) of the vagina is a sexually transmitted disease due to infection by human papilloma virus (HPV). The treatment efficacy of the conventional methods for vaginal CA is often unsatisfactory with a high recurrence rate. Topical 5-aminolevulinic acid-mediated photodynamic therapy (ALA-PDT) combined with CO2 laser pretreatment is a feasible approach for vaginal CA, but the effectiveness and safety need further evaluation. This study enrolled 15 patients with vaginal CA. All patients underwent CO2 laser ablation and then ALA-PDT for two or three cycles. The clinical efficacy and side effects were evaluated and analyzed during the treatment and 6 months after the treatment. The wart lesions in 4 cases (26.7%) disappeared after the first treatment. The wart lesions in 5 cases (33.3%) disappeared after the second treatment. And 6 cases (40%) needed three treatment cycles before the lesions disappeared completely. The complete response (CR) rate was 93.3% (14/15) at 2 weeks after three treatment cycles. There were 5 cases (83.3%) which have complete remission after 2 treatments in warts diameter <1 cm group. There were only 4 cases (44.4%) which have complete remission after 2 treatments in diameter>1 cm group. All patients had CR without reoccurrence at 6 months after treatment. The side effects mainly included a mild or moderate burning or stinging sensation (26.7%). There were no infection, ulcers and scars after treatment. Topical 5-aminolevulinic acid-mediated photodynamic therapy combined with CO2 laser pretreatment is a safe and effective treatment for vaginal CA.