Recurrence Rate of Genital Warts Between Treatment With Imiquimod and Polyphenon E: A Systematic Review

OBJECTIVES: Genital warts, a frequent manifestation of human papillomavirus, are commonly treated with Imiquimod 5% or Polyphenon E (10% or 15%), which differ in recurrence rates. This systematic review aimed to investigate the recurrence rates of genital warts following treatment with these agents. METHODS: This study systematically reviewed clinical trials according to PRISMA guidelines. A comprehensive search was performed in the electronic databases PubMed, Web of Science, Scopus, and Embase up to the end of March 2025 using the keywords "genital warts," "recurrence," "Imiquimod," and "Polyphenon E," combined with the Boolean operators "AND" and "OR." Two reviewers independently assessed the methodological quality of included trials using the Joanna Briggs Institute (JBI) critical appraisal tool (2023). RESULTS: Of the 605 studies identified in the initial search, 12 met the inclusion criteria for this systematic review. Based on the tabulated data, in the Imiquimod 5% studies, recurrence estimates ranged from 0% to 28.6%; most studies reported 12.5%-19%, and the 41% estimate was from the only study with 12-month follow-up. In the Polyphenon E studies, the ranges were 4.1%-11.8% for the 10% dose and 6.5%-10.6% for the 15% dose. CONCLUSIONS: Reported recurrence rates varied across studies of imiquimod 5% and Polyphenon E (10% or 15%). Because the evidence was indirect and heterogeneous, no comparative conclusion can be drawn; head-to-head trials are needed.