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

This article focuses on the use of intralesional nonavalent human papillomavirus (HPV) vaccine combined with CO2 laser treatment in two immunocompetent, HIV-negative men with longstanding, recurrent genital warts resistant to conventional therapies. Both patients developed multiple movable, painless nodules at the injection sites, an adverse reaction not previously reported, and one experienced a severe flare of genital warts after treatment. The report highlights that while HPV vaccines have proven prophylactic benefits, their intralesional therapeutic use for persistent genital warts remains unproven and may cause significant side effects. The authors suggest that intralesional HPV vaccination should be reconsidered due to these adverse outcomes.