The
“We treat people, not
just problems.”
John
L. Pfenninger, M.D.
(989) 631-4545
Visit our Web site at: MPCenter.net
EFUDEX PROTOCOL FOR GENITAL WARTS
As your doctor has explained, it
is important to treat genital warts.
Recent research indicates they are associated with cervical cancer in
women. Women also have an increased risk
of vaginal cancer and vulvar cancer, especially if they smoke, but less than
cervical cancer. In men, there may be a
slightly increased incidence of penile cancer and rectal cancer. Treatment with freezing or surgery can
protect the cervix 97% of the
time. It is very difficult to treat warts in other areas and they can recur anytime
no matter which of many treatments is used.
One of the drugs that has been
used for your condition is called EFUDEX.
It is a cream that has been approved for 15-20 years for use on the skin
for several different pre-cancerous lesions.
HOWEVER, THE FDA HAS NOT APPROVED EFUDEX FOR THE TREATMENT OF GENITAL
WARTS. You should know that even though
many leaders in the field have used it for 15 years or more, it still must be
considered somewhat experimental for warts.
After evaluation by colposcopy or
androscopy, you and your partner may both need to be treated. There should be approximately a 75% chance of
the visible warts going away following this protocol. Approximately 4-8 weeks after starting
Efudex, you will need to be re-examined.
If you are found to be free of warts at the repeat exam, you will then
need to use the Efudex once a month for six months. Other topical medicines are also available
and may be used for you. They include
Condylox and Aldara. The doctor may also
recommend a variety of surgical procedures.
For Women:
If there are warts in the vagina you
will need to use 1/3 of a vaginal applicator of 5% Efudex cream (1.5g) in the
vagina at bedtime ONCE A WEEK FOR TEN WEEKS.
You may notice that two to three days after use, there will be some
irritation, redness, swelling, and even some discharge. Nothing need be done unless you are extremely
uncomfortable. You may want to put on
some Vaseline ointment or Cortaid cream (over-the-counter) and apply it around
the irritated areas on the outside of the vagina. If this does not help, you can call our office
for further instructions. It is probably
best to wear a pad to bed at night on the nights that you use the Efudex cream
in the vagina. You may want to douche it
out the following morning. You can
shower or bathe as usual. Intercourse is
permitted when you are comfortable but not on the night that you use it. Be
sure to immediately wash off any cream that you may get on your hands or it
will also cause irritation. If your
doctor has indicated, you may want to put a very slight amount of the cream around external warts also. Two weeks after stopping the medication
(three months after starting), you will need to be rechecked with the
colposcope by your doctor. DO NOT USE THE CREAM IF YOU ARE PREGNANT. If you had cryocautery (freezing), begin four
weeks after having it done. DO NOT USE
THIS CREAM MORE THAN ONCE PER WEEK UNLESS INSTRUCTED TO DO SO.
For Men:
Most likely if you have warts,
they will be on the penis, on the sacs, and occasionally also around the
rectum. Your doctor will describe to you
exactly where he wants you to put the cream.
You will also be using 5% Efudex cream.
YOU WILL NEED TO APPLY IT ONLY ONCE A WEEK FOR TEN WEEKS. Use very
little cream since this will cause a lot of irritation in some people (most men
use 1 to 1-1/2 tubes in 10 weeks). If
you do not have a severe reaction, it is OK to apply the cream on the penis and
the rectum all on the same night. If there is going to be a reaction, it
usually occurs on the third or fourth day after application. You can use Vaseline or Cortaid cream or
ointment to calm it down. It is also
permissible to use ibuprofen to control the pain. If there is little reaction when using the
cream every seven days, try using it every six days.
After using the medication for ten
weeks, you will need to wait two weeks before being rechecked by your doctor
with the androscope. If he does not find
any residual warts, you will need to use this cream in the same manner once a
month for six months. If warts are
found, your doctor will instruct you as to what you should do next. If you and your partner are being treated at
the same time, you do not need to use a condom.
If your partner is not being treated, use a condom to protect her.
Generally the penis tolerates the
medication well, but the sacs are very
sensitive. You may want to protect
the sacs by using an athletic supporter and cutting out an opening for the
penis. In this way you can put the cream
on the penis more frequently than the sacs and limit the reaction on the sacs.
SUMMARY
INSTRUCTIONS
FOR USE OF 5-FU (EFUDEXÒ) CREAM
GENERAL INSTRUCTIONS:
Do not use
the 5-FU cream if you are pregnant.
Use adequate birth control to prevent
pregnancy!
Avoid sex
during the nights of treatment.
Have your sexual
partner wear a condom during intercourse while being treated.
If the
treated area is irritated, hold further applications of 5-FU until the
irritation has subsided.
If you
experience severe irritation, please call us.
Your
condition is probably contagious.
Medical xamination of your sexual partner may be beneficial.
Please
call us if you need any of the prescription medications mentioned below.
Stop
smoking.
Eat 5
helpings of fruits and vegetables per day.
Take a good
multivitamin with folic acid.
Be
monogamous.
Women need
to be sure they get regular pap smears.
Call for
the results of any biopsies in 2 weeks.
Vaginal Lesions:
Insert an Ortho
contraceptive cream applicator 1/3 full of 5-FU cream deeply into the vagina
once a week at bedtime for 10 weeks.
Anticipate a watery discharge during the time of treatment.
Urethral Lesions:
(opening where the urine comes out)
Apply a small
amount of 5-FU cream (usually no more than 1/4" out of the tube) with a
cotton-tipped applicator to the urethral opening and (if instructed) into the
urethra once weekly at bedtime for 10 weeks.
Men may need to do this twice a day for a week.
Anticipate
irritation or burning during urination.
If troublesome, apply 2% Lidocaine jelly with a cotton-tipped applicator
every 1-2 hours as necessary.
Vulvar (lips) and Penile Skin/Scrotal Lesions:
Cleanse and dry the vulva (genital lips) carefully. Use a hair dryer to assure dryness.
Apply a small
amount of 5-FU cream (1/4-1/2" out of the tube) and massage into affected
skin at bedtime once a week for 10 weeks.
Cleanse and dry the treated area the next morning.
Anticipate
some irritation. If troublesome, take
sitz baths three times a day and after each urination; apply TucksÒ pads to the irritated area as
needed.
Perianal and Anorectal Lesions:
Cleanse and dry the anus carefully.
Apply a small amount of 5-FU cream (1/4-1/2" out
of the tube) and massage into affected skin at bedtime once a week for 10
weeks.
Cleanse and dry the treated area the next morning.
Take Doxidanâ capsules
100 mg. orally twice a day to keep stools soft.
Anticipate
anal/rectal irritation. If troublesome,
apply Proctofoam HCÒ or Anusol
HCÒ
suppositories or cream and/or take sitz baths three times a day and after each
bowel movement.