Treatment of Recurrent Genital Warts by Combination of CO2 Laser and Geniwa Gel

Phase II, randomized, controlled, and double blind clinical trial to evaluate the effectiveness and recurrence of genital warts by CO2 laser combined with Geniwa gel treatment. Sixty to eighty patients with a history of genital warts that were resistant to conventional treatments were enrolled in a randomized, double-blind, placebo-controlled study comparing a combination of CO2 laser and Geniwa gel and a combination of CO2 laser and placebo gel.

In the first phase of the study, 60-80 patients were randomly assigned to 2 groups. The first group received a combination of CO2 laser and Geniwa gel for 6 weeks. The second group received a combination of CO2 laser and placebo gel for 6 weeks.

On day 1, after CO2 laser treatment, Geniwa gel (5% alpha lactalbumin-oleic acid) or saline placebo gel was applied to each lesion by investigator. The lesion was covered with a hydrocolloid dressing fastened with Micropore tape for 6 hours-10 hours (during the night). Thereafter, the patients followed the same procedure at home once a day and received a new coded bottle (Geniwa or placebo gel) weekly in the clinic. The genital wart lesions were inspected, measured, and photographed at enrollment, at week 2- 12 during the treatment period, and three to six months after the completion of treatment. The width, length, and height of each lesion were measured with the use of a slide caliper, and the volume of each genital wart lesion was calculated.

If genital warts recur during the first six-week period, CO2 laser treatment will be applied, followed by the continued use of a placebo or Geniwa topical gel. The randomization code was broken after all patients had completed six weeks of the randomly assigned treatment. Geniwa gel is predicted to be superior to placebo. For this reason, patients in both groups were offered six weeks of open-label treatment with Geniwa gel according to the protocol used in the first, randomized phase of the study. The patients participating in the second phase did not know whether they had received Geniwa or placebo during the first treatment period. After the end of open-label treatment with Geniwa, the patients were allowed to use conventional treatment if they wished.

A short-term follow-up investigation was performed approximately 4-6 months after the completion of the second (open-label) treatment period. The sites of treated lesions and possible new lesions were inspected, and the patients were interviewed about the length of time to the resolution of their lesions, about any other treatment they had received for genital warts, and about any other illness or treatment in the intervening period.

For patients who experience bleeding or significant wound pain after CO2 laser treatment, Geniwa or placebo topical gel application may not be possible until 1-2 days later.

Additionally, patients who undergo CO2 laser treatment are prescribed oral cefotaxime (for 7 days) and topical Tyrosur gel (Tyrothricin) daily (1-3 days) in the morning to reduce infection and promote wound healing. Tyrosur gel is used at different times of the day than placebo/Geniwa gel.