Wart medical therapy

Revision as of 01:29, 4 October 2015 by YazanDaaboul (talk | contribs)
Jump to navigation Jump to search

Wart Microchapters

Home

Patient Information

Overview

Classification

Pathophysiology

Causes

Differentiating Wart from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Wart medical therapy On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Wart medical therapy

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Wart medical therapy

CDC on Wart medical therapy

Wart medical therapy in the news

Blogs on Wart medical therapy

Directions to Hospitals Treating Wart

Risk calculators and risk factors for Wart medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Maliha Shakil, M.D. [2]

Overview

Medical therapies for human papillomavirus infection include either imiquimod, sinecatechins, or podofilox.[1]

Medical Therapy

Medical Therapy

  • Human papillomavirus therapy[1]
  • Anogenital warts[1]
  • 1.Preferred regimen for External Anogenital Warts(i.e., penis, groin, scrotum, vulva, perineum, external anus, and perianus)
  • 1.1 Patient-applied: Imiquimod 3.75% or 5% cream OR Podofilox 0.5% solution or gel OR Sinecatechins 15% ointment
  • 1.2 Provider-administered: Cryotherapy with liquid nitrogen or cryoprobe 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[1]
  • 2.1 Urethral meatus warts
  • Preferred regimen: Cryotherapy with liquid nitrogen
  • 2.2 Vaginal warts
  • Preferred regimen: Cryotherapy with liquid nitrogen 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
  • Preferred regimen: Cryotherapy with liquid nitrogen 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
  • Preferred regimen: Cryotherapy with liquid nitrogen OR TCA OR BCA 80%–90% solution
  • Note: Management of intra-anal warts should include consultation with a specialist.
  • 3. Specific considerations[1]
  • 3.1 Management of sex partners
  • Persons should inform current partner(s) about having genital warts because the types of HPV that cause warts can be passed on to partners. Partners should receive counseling messages that partners might already have HPV despite no visible signs of warts, so HPV testing of sex partners of persons with genital warts is not recommended.
  • 3.2 Pregnancy
  • Podofilox (podophyllotoxin), Podophyllin, and Sinecatechins should not be used during pregnancy. Imiquimod appears to pose low risk but should be avoided until more data are available.
  • Cesarean delivery is indicated for women with anogenital warts if the pelvic outlet is obstructed or if vaginal delivery would result in excessive bleeding.
  • Pregnant women with anogenital warts should be counseled concerning the low risk for warts on the larynx of their infants or children (recurrent respiratory papillomatosis).
  • 3.3 HIV infection
  • Data do not support altered approaches to treatment for persons with HIV infection.
  • Squamous cell carcinomas arising in or resembling anogenital warts might occur more frequently among immunosuppressed persons, therefore requiring biopsy for confirmation of diagnosis for suspicious cases
  • 3.4 High-grade squamous intraepithelial lesions
  • Biopsy of an atypical wart might reveal HSIL or cancer of the anogenital tract. In this instance, referral to a specialist for treatment is recommended.

Follow-up

  • Most anogenital warts respond within 3 months of therapy.
  • Factors that might affect response to therapy include immunosuppression and treatment compliance.
  • In general, warts located on moist surfaces or in intertriginous areas respond best to topical treatment.
  • A new treatment modality should be selected when no substantial improvement is observed after a complete course of treatment or in the event of severe side effects; treatment response and therapy-associated side effects should be evaluated throughout the course of therapy.

References

  1. 1.0 1.1 1.2 1.3 1.4 Workowski, Kimberly A.; Bolan, Gail A. (2015-06-05). "Sexually transmitted diseases treatment guidelines, 2015". MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control. 64 (RR-03): 1–137. ISSN 1545-8601. PMID 26042815.

Template:WH