الفهرس 
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Abstract
Anogenital HPV is a highly prevalent sexually transmitted infection,seen predominantly in young adults (Dunne et al., 2011). There is no clear evidence that one recommended treatment is superior to another, and no single treatment is ideal for all patients or all warts (Workowski and Bolan., 2015). The aim of the work is to compares the safety and efficacy of intraleisional Candidal antigen versus Intralesional MMR vaccine versus podophyllin for treatment of genital warts. A total of 45 patients with resistant or recurrent genital warts (22 males, 23 females) were enrolled in the study.They were selected from the attendants of the outpatients clinic of dermatology and venereology, Assiut University Hospital. Patients were randomly divided into three groups, group A (15 patients) treated with candida antigen injection, group B treated with MMR vaccine injection and group C treated with topical podophyllin. Among patients in group A, 46.7% of the patients had complete response while 40% of patients had partial response and 13.3% showed no response to treatment. In group A, our results showed that there was a statistically significant reduction in mean size and number of the wart lesion (p value = 0.001),with a mean percentage of improvement of 76.90 ± 33.79% and 71.00 ± 35.01% respectively. Among patients in group B, 33.3% of the patients had complete response while 46.7% of patients had partial response, 13.3% of patients had minimal response and 6.7% had no response to treatment. There was statistically significant reduction in size and number of the wart lesion (p value = 0.001), with a mean percentage of improvement of 69.78 ± 33.10% and 61.11± 37.76% respectively . Among patients in group C, 20% of the patients had complete response while 40% of patients had partial response,13.3% of patients had minimal response and 26.7% had no response to treatment. There was a statistically significant reduction in the mean size and number of the wart lesion (p value = 0.003), with a mean percentage of improvement of 50.64 ± 38.10% and 49.21±37.88% respectively Some complications were recorded after treatment among group A & B as pain, fever, erythema , hypopigmentation and hyperpigmentation, while recorded complications in group C included pain and erythema only. There was no statistically significant difference in patient satisfaction between the three groups. There was no correlation between response to treatment and patient’s age , sex ,duration , size and number of warts. There was no statistically significant difference between the three groups regarding the percentage of improvement in size of all warts although the improvement was better in the candida antigen group. The complete response was higher at candida group (46.7%) as compared to MMR group (33.3%) and Podophyllin group (20%), but the difference between the three groups wasn’t statistically significant.: Intralesional candida antigen and Intralsional MMR vaccine are simple, safe and effective treatment and seems to be a promising treatment options in patients in whom the warts are either resistant or recurrent and also may be helpful for treating distant uninjected warts including troublesome internal genital ones. Improvement of size and number of warts was better in the candida antigen group than MMR group and podophyllin group with statistically significant difference in comparing between cadidal antigen and podophyllin while no significant difference in comparing between it and MMR vaccine where the results were comparable in both groups. Side effects to injection were minimal, the most common was pain. Further future studies are recommended with longer follow up periods to detect the safety and efficacy of these two immunotherapies in long term, also future studies on the use of combination therapies are recommended to enhance the efficacy of these immunotherapies.