Comparative Efficacy of Ultrasonic Scalpel Surgery With Photodynamic Therapy Versus Trichloroacetic Acid Application in Treating HPV-Related Condyloma Acuminata: A Randomized Clinical Trial

Abstract

Human papillomavirus (HPV) infections rank as the most prevalent sexually transmitted infections globally. The Brazilian Ministry of Health recommends the topical use of 70%–90% trichloroacetic acid (TAA) for treating condyloma acuminata, yet this method suffers from a high recurrence rate of 36% and requires roughly six applications. Topical photodynamic therapy (PDT) has shown effectiveness in targeting subclinical lesions, but it also necessitates multiple sessions for complete lesion clearance. This randomized clinical trial evaluates the efficacy of 80% TAA monotherapy against a combined approach of ultrasonic scalpel excision followed by a single PDT session (US + PDT). The US + PDT group required fewer treatment sessions, exhibited superior cosmetic outcomes, and reported zero lesion recurrence during an 18-month follow-up, in contrast to the TAA group's recurrence rate of 33.3%. Notwithstanding, patient-reported pain during PDT application emerged as a significant barrier, affecting treatment adherence and completion rates. Innovating new PDT protocols could potentially address this challenge, enhancing patient compliance and therapeutic success.