What are the management options for Human Papillomavirus (HPV) infections?

From the Guidelines

Management of HPV infections primarily involves monitoring and treating symptoms, as there is no cure for the virus itself, and prevention through HPV vaccination and regular screening with Pap tests and/or HPV testing according to age-appropriate guidelines. For most people, HPV infections clear on their own within two years without treatment 1. For visible genital warts, 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, for up to 4 cycles), or 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 1.

Key Considerations

• HPV infections can lead to cervical, anal, penile, vulvar, vaginal, and oropharyngeal cancers if persistent, while low-risk types can cause genital warts and respiratory papillomatosis 1
• Prevention is crucial through HPV vaccination (recommended for children ages 11-12, but available through age 45) and regular screening with Pap tests and/or HPV testing according to age-appropriate guidelines 1
• The quadrivalent HPV vaccine is highly immunogenic, safe, and well tolerated in female subjects 9 through 26 years of age, and provides protection against persistent infection, precancerous lesions, and genital warts caused by HPV types within the vaccine 1

Treatment Options

• Patient-applied medications: imiquimod 3.75% or 5% cream, podofilox 0.5% solution or gel
• Provider-administered treatments: cryotherapy, trichloroacetic acid, surgical removal, or laser therapy
• HPV vaccination: recommended for children ages 11-12, but available through age 45
• Regular screening: Pap tests and/or HPV testing according to age-appropriate guidelines

Prevention

• HPV vaccination: provides protection against persistent infection, precancerous lesions, and genital warts caused by HPV types within the vaccine 1
• Regular screening: Pap tests and/or HPV testing according to age-appropriate guidelines
• Safe sex practices: correct and consistent male condom use can lower the chances of giving or getting genital HPV, but such use is not fully protective because HPV can infect areas that are not covered by a condom 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.

The management options for Human Papillomavirus (HPV) infections include:

• Application of Imiquimod Cream 3 times a week to external genital/perianal warts
• Treatment continuation until total clearance of warts or for a maximum of 16 weeks 2
• Imiquimod Cream may induce cytokines and decrease HPV DNA at the treatment site 2

From the Research

Management Options for Human Papillomavirus (HPV) Infections

• Primary prevention strategies include vaccination, with the nonavalent HPV vaccine being effective in preventing high-grade precancerous cervical lesions in noninfected patients 3
• Secondary prevention strategies include screening for precancerous lesions, with primary HPV DNA testing being superior for cervical cancer prevention 4
• Management of abnormal screening results varies by test result, anatomic site, and individual cancer risk, with approaches including close rescreening, high-resolution visualization with biopsy, and removal or destruction of the lesion 5
• High-risk HPV DNA testing and HPV-16/18 genotyping can be used to triage women with equivocal cytology results and to determine the need for colposcopy 6
• Therapeutic HPV vaccines are being developed to generate T cell-mediated immunity against HPV infection and associated diseases, targeting HPV oncoproteins E6 and E7 7
• Current management guidelines recommend the use of condoms and dental dams to decrease the spread of the virus, as well as vaccination and screening for precancerous lesions 3, 5
• Patient-applied and provider-applied therapies can be used to manage anogenital warts caused by low-risk HPV strains 5