Sandbox mona

• 1.Preferred regimen for External Anogenital Warts (i.e., penis, groin, scrotum, vulva, perineum, external anus, and perianus)

• 1.1Patient-Applied::Imiquimod 3.75% or 5% cream ORPodofilox 0.5% solution or gel OR Sinecatechins 15% ointment
• 1.2Provider-Administered:Cryotherapy with liquid nitrogen or cryoprobe OR Surgical removal either by tangential scissor excision, tangential shave excision, curettage, laser,or electrosurgery OR Trichloroacetic acid (TCA) or Bichloroacetic acid (BCA) 80%-90% solution
• Note(1):Many persons with external anal warts also have intra-anal warts. Thus, persons with external anal warts might benefit from an inspection of the anal canal by digital examination, standard anoscopy, or high-resolution anoscopy.
• Note(2):Might weaken condoms and vaginal diaphragms.

• 2.Alternative Regimens for External Genital Warts

• 2.1 Urethral Meatus Warts
• Regimens :Cryotherapy with liquid nitrogen OR Surgical removal
• 2.2Vaginal Warts
• Regimens:Cryotherapy with liquid nitrogen. OR Surgical removal OR TCA or BCA 80%–90% solution
• Note: The use of a cryoprobe in the vagina is not recommended because of the risk for vaginal perforation and fistula formation
• 2.3 Cervical Warts
• Regimen: Cryotherapy with liquid nitrogen OR Surgical removal OR TCA or BCA 80%–90% solution
• Note: Management of cervical warts should include consultation with a specialist.For women who have exophytic cervical warts, a biopsy evaluation to exclude high-grade SIL must be performed before treatment is initiated.
• 2.4 Intra-anal Warts
• Regimens :Cryotherapy with liquid nitrogen OR Surgical removalOR TCA or BCA 80%–90% solution
• Note:Management of intra-anal warts should include consultation with a specialist.

• Granuloma Inguinale (Donovanosis)

• Preferred regimen:Azithromycin 1 g PO once per week OR 500 mg PO qd for 3 weeks
• Alternative regimen:Doxycycline 100 mg PO bid for 3 weeks ORCiprofloxacin 750 mg PO bid for 3 weeks ORErythromycin base 500 mg PO qid for 3 weeks OR Trimethoprim-sulfamethoxazole one double-strength (160 mg/800 mg) PO bid for 3 weeks
• Note:continue treatment until all lesions have completely healed

• Pregnant and lactating women

• Preferred regimen:treated with a macrolide regimen (erythromycin or azithromycin). The addition of an aminoglycoside (gentamicin 1 mg/kg IV every 8 hours) can be considered if improvement is not evident within the first few days of therapy.

• HIV Infection

• Preferred regimen:Azithromycin 1 g PO once per week OR 500 mg PO qd for 3 weeks and until all lesions have completely healed
• Alternative regimen:Doxycycline 100 mg PO bid for 3 weeks ORCiprofloxacin 750 mg PO bid for 3 weeks OR Erythromycin base 500 mg PO qid for 3 weeks OR Trimethoprim-sulfamethoxazole one double-strength (160 mg/800 mg) PO bid for 3 weeks
• Note:The addition of an aminoglycoside (gentamicin 1 mg/kg IV every 8 hours) can be considered if improvement is not evident within the first few days of therapy.