Insects are Crawling in My Genital Warts

A 23-year-old woman presented with large exophytic genital wart arising from perineum, vulva, introitus of the vagina, and inner aspect of thighs. Patient developed severe itching and formication (insect-crawling sensation) in the lesions for past 1 week, though careful examination did not reveal any insects. Considering that the disease was causing psychological stress and physical symptoms, radiofrequency excision was planned. However, during the procedure, several maggots appeared from the crypts. The procedure was abandoned and maggots were removed manually. Subsequently external giant warts were removed using radiofrequency device. There was no recurrence of excised warts during 3 month follow-up. To our knowledge, this is the second reported case of maggots in genital warts.