From the Guidelines
There is no specific treatment for HPV infection itself, but management focuses on treating the symptoms and complications, with the most recent guidelines recommending HPV vaccination for all people ages 9-45, and treatment of genital warts with patient-applied medications or provider-administered treatments such as cryotherapy or surgical removal 1.
Treatment Options
- For genital warts caused by HPV, treatment options include:
- Patient-applied medications like imiquimod 3.75% or 5% cream (applied 3 times weekly for up to 16 weeks)
- Podofilox 0.5% solution or gel (applied twice daily for 3 days, followed by 4 days of no treatment, repeated for up to 4 cycles)
- Provider-administered treatments such as cryotherapy (freezing the warts with liquid nitrogen every 1-2 weeks), trichloroacetic acid (80-90% solution applied weekly), surgical removal, or laser therapy
- For cervical cell changes caused by high-risk HPV types, treatment depends on the severity and may include monitoring with regular Pap tests and HPV testing, or procedures like LEEP (Loop Electrosurgical Excision Procedure), cryotherapy, or conization to remove abnormal cells
Prevention
- Prevention is crucial through HPV vaccination (recommended for all people ages 9-45) 1
- Regular screening with Pap tests and HPV testing
- Using barrier methods during sexual contact
Key Considerations
- HPV infections often clear on their own within 1-2 years as the immune system fights the virus, but persistent infections with high-risk types require monitoring and possible intervention to prevent progression to cancer
- The most recent guidelines recommend HPV vaccination for all people ages 9-45, with the 9-valent HPV vaccine (Gardasil 9) offering protection against the HPV types that cause 70% of cervical cancers, as well as the types that cause 90% of genital warts 1
From the FDA Drug Label
Imiquimod Cream should be applied 3 times per week to external genital/perianal warts. Imiquimod Cream treatment should continue until there is total clearance of the genital/perianal warts or for a maximum of 16 weeks. A study in 22 subjects with genital/perianal warts comparing imiquimod cream and vehicle shows that imiquimod cream induces mRNA encoding cytokines including interferon-ɑ at the treatment site. In addition HPVL1 mRNA and HPV DNA are significantly decreased following treatment.
Treatment of HPV:
- Apply imiquimod cream 3 times a week to external genital/perianal warts
- Treatment should continue until total clearance of warts or for a maximum of 16 weeks
- Imiquimod cream may decrease HPV DNA and induce cytokines, but the clinical relevance of these findings is unknown 2, 2
From the Research
Treatment Options for HPV
- The goal of treatment is clearance of visible warts, with some evidence suggesting that treatment reduces infectivity 3
- Treatment options include:
- The cost per successful treatment course is approximately $200 to $300 for podofilox, cryotherapy, electrodesiccation, surgical excision, laser treatment, and the loop electrosurgical excision procedure 3
Vaccination Strategies
- Vaccines are available to prevent infection by the most common HPV viruses, but usage is low 5, 6
- Prophylactic vaccines have been demonstrated to be safe and efficacious in preventing HPV infection 6
- Therapeutic HPV vaccines capable of generating T cell-mediated immunity against HPV infection and associated diseases are being developed 6
- Quadrivalent HPV vaccination is effective in preventing infection and disease, but its therapeutic effect is not known 4
Current Research and Trials
- A randomized controlled trial is being conducted to investigate the efficacy of clearance and prevention of recurrence of external anogenital warts by topical treatments, podophyllotoxin 0.15% cream or imiquimod 5% cream, in combination with a three-dose regimen of qHPV or control vaccination 4
- The trial aims to provide high-quality evidence of the comparative efficacy and cost-effectiveness of the two topical treatments, as well as investigate the potential benefit of HPV vaccination in the management of anogenital warts 4