Background: The most prevalent sexually transmitted disease is anogenital warts (AGW), which are produced by different
genotypes of the human papilloma virus (HPV). Immunotherapy promotes a delayed type hypersensitive reaction to a variety
of antigens as well as to wart tissue.
Aim: To evaluate the serum level of macrophage migration inhibitory factor (MIF) in patients with external ano-genital warts
before and after intra-lesional purified protein derivative (PPD) injection.
Patients and Methods: This study was carried out as pre–post interventional study on 40 patients with external anogenital
warts. The study was conducted at the dermatology clinic and the andrology, infertility and sexually transmitted diseases
clinic, Suez Canal University Hospital in Ismailia. Using an insulin syringe, each patient was injected 0.2 ml of tuberculin
PPD (containing 10 TU of tuberculin PPD) intra-lesionally in the largest wart at regular interval of 2 weeks for a maximum
of six injections or less in cases of complete clearance of wart. Serum levels of MIF were measured using ELISA before and
after intra-lesional PPD injection.
Results: 22 (55%) patients achieved complete response while 8 (20%) patients achieved partial response. No response
occurred in 10 (25%) patients. Serum level of MIF after PPD injection was significantly higher than serum level of MIF
before PPD injection. There was statistically significant relation between serum MIF level after PPD injection and clinical
response to PPD injection.
Conclusion: Immunotherapy with intralesional PPD injection provides an efficient, financially viable method of treating
genital warts. Serum levels of MIF in patients with anogenital warts after intralesional PPD injection were significantly higher
than serum levels of MIF before intralesional PPD injection and have statistically significant relation to clinical response to
intralesional PPD injection.