5-FU for genital warts in nonimmunocompromised individuals

Genital warts is one of the most common types of sexually transmitted infection, with an estimated occurrence of about 32 million cases worldwide each year. The warts affect the genital area and cause such symptoms as itching, burning, discomfort, pain, or bleeding with intercourse. Because of the recurrence and the stigma associated with genital warts, frequently there are psychological burdens associated with the disease that possibly could become traumatic as feeling of shame, worry, fear, anger, and lowered self-esteem develop. Lesions can spread on one person and because they are easily spread between people, genital warts potentially can be a serious public health problem. There are many options for treating genital warts, but none so far are superior to the others. At this time, there is no available evidence that treatment efficiently eliminates genital warts or hinders its progression to malignancy. This review evaluated the effectiveness and safety of topical 5-FU for treatment of genital warts in nonimmunocompromised individuals. Evidence from the studies we reviewed showed that 5-FU had better results for cure than placebo or no treatment; MCSA; and Podophylin 2%, 4% or 25%. No statistical difference was found when 5-FU was compared with CO2 Laser treatment, and results were poor when 5-FU was compared with 5-FU + INFα-2a (high dose) or 5-FU + CO2 Laser INFα-2a (high dose). The weak point of this review was the great variability in the methods and quality of the studies that we included.

Authors' conclusions: 

The reviewed trials were highly variable in methods and quality, and the evidence provided by these studies was weak. Cure rates with several treatments were variable, and although 5-FU presents therapeutic results that are inferior to those seen with 5-FU + Inf α-2a (high dose) and 5-FU + CO2 Laser + Inf α-2a (high dose), the treatment should not be abandoned. Topical treatment with 5-FU has a therapeutic effect; however, the benefits and risks have not been determined clearly and further studies are needed.

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Background: 

Genital warts are common and usually are harmless but can be painful and psychologically burdensome. Several local treatments can be used, including topical 5-Fluorouracil (5-FU).

Objectives: 

To determine the effectiveness and safety of 5-FU topical treatment for genital warts in nonimmunocompromised individuals.

Search strategy: 

Databases searched were Cochrane Central Register of Controlled Trials (The Cochrane Library 2009 Issue 3), MEDLINE (1966 to August 2009), EMBASE (until August 2009), LILACS (1982 to August 2009). The search had no language or publication restrictions.

Selection criteria: 

The review included randomised controlled trials (RCTs) among women, men, or both sexes, aged 18 years and older, comparing: 5-FU versus placebo or no treatment; 5-FU in any dose versus other isolated treatment, topical or systemic; 5-FU in any dose associated with other treatment versus placebo; 5-FU in any dose associated with other treatment versus other isolated treatment, topical or systemic; 5-FU in any dose associated with other treatment versus other associated treatment, topical or systemic.

Data collection and analysis: 

Two authors independently assessed trial quality and extracted data from the original publications.

Main results: 

Six trials involving 988 patients (645 women and 343 men) and reporting eight comparisons were found. Two studies reported withdrawals and dropouts, but none mentioned analysis by intention to treat (ITT). 5-FU presented better results for cure than placebo or no treatment (relative risk (RR) 0.39, 95% confidence interval (CI) 0.23 to 0.67), meta-cresol-sulfonic acid (MCSA) (RR 2.11, 95% CI 0.83 to 5.37), Podophylin 2%, 4% or 25% (RR 1.26, 95% CI 0.86 to 1.82). There were no statistical differences for treatment failure for 5-FU versus CO2 Laser (RR 0.69, 95% CI 0.43 to 1.11) versus 5-FU + INFα-2a (low dose) (RR 1.02, 95% CI 0.87 to 1.119). Worse results were found for 5-FU versus 5-FU + INFα-2a (high dose) (RR 10.78, 95% CI 1.50 to 77.36), and 5-FU + CO2 Laser INFα-2a (high dose) (RR 7.97, 95% CI 2.87 to 22.13).

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