Severe flare of genital warts after intralesional nonvalent HPV vaccine and development of multiple nodules at the sites of injection.

Few effective treatments exists for the elimination of persistant genital warts and recurrences are common. We report the cases of two healthy HIV negative and immunocompetent men with a longstanding history of refractory to treatment and recurrent genital warts were treated with intralesional nonvalent HPV vaccine together with CO2 laser to prevent relapses. One patient developed a severe flare of the disease with multiple tiny lesions and both developed movable, asymptomatic and painless nodules at the sites of injection still present 2 months after treatment. Those are the first reported cases of this adverse reaction after intralesional treatment of HPV vaccine.