infectious diseases
Human Papillomavirus (HPV) Infection
Treatment of HPV Infection
Cytodestructive therapy or excision (eg, by caustics, cryotherapy, electrocauterization, laser, or surgical excision) Topical medications (eg, with antimitotics or interferon inducers) No treatment of anogenital warts is completely satisfactory, and relapses are frequent and require retreatment. In immunocompetent patients, genital warts may resolve without treatment. In immunocompromised patients, warts may be less responsive to treatment. Because no treatment is clearly more efficacious than others, treatment of anogenital warts should be guided by other considerations, mainly wart size, number, and anatomic site; patient preference; cost of treatment; convenience; adverse effects; and the practitioner's experience (see the Centers for Disease Control and Prevention [CDC]2021 Sexually Transmitted Infections Treatment Guidelines: Anogenital Warts). Genital wartsmay be treated with Caustics Topical medications Cryotherapy Electrocauterization Laser Surgical excision A local or general anesthetic is used depending on the size and number to be removed. Extensive vulvovaginal warts may require laser ablation. For anal warts, removal with a resectoscope may be the most effective treatment; a general anesthetic is used. Topical treatments include antimitotics (eg, podophyllotoxin, podophyllin, 5-fluorouracil), caustics (eg,trichloroacetic acid), interferon inducers (eg,imiquimod), andsinecatechins(a botanical product with an unknown mechanism). These are widely used but usually require multiple applications over weeks to months and are frequently ineffective. Before topical treatments are applied, surrounding tissue should be protected with petroleum jelly. Patients should be warned that after treatment, the area may be painful. Interferon alfa (eg,interferon alfa-2b,interferon alfa-n3), intralesionally or IM, has cleared intractable lesions on the skin and genitals, but optimal administration and long-term effects are unclear. Also, in some patients with bowenoid papulosis of the genitals (caused by type 16 HPV), lesions initially disappeared after treatment with interferon alfa but reappeared as invasive cancers. By removing the moist underside of the prepuce, circumcision may prevent recurrences in uncircumcised men. Current sex partners of people with genital warts should be examined and, if infected, treated. Forintraurethral lesions,thiotepa(an alkylating medication), instilled in the urethra, is effective. In men, 5-fluorouracilapplied 2 to 3 times a day is highly effective for urethral lesions, but rarely, it causes swelling, leading to urethral obstruction. Intraurethral lesions are typically managed by a urologist. (CIN) is monitored with Cervical Cancer . Vulvar and vaginal intraepithelial neoplasiaare treated with surgical excision. Sex partners of patients with cervical intraepithelial neoplasia or carcinoma and of patients with bowenoid papulosis should be counseled and screened regularly for HPV-related lesions. A similar approach can be used for HPV in the rectum. Management of cancers caused by HPV is discussed elsewhere in THE MANUAL. 