Treatment for Human Papillomavirus (HPV)
There is no cure or specific treatment for HPV infection itself; treatment is directed only at the HPV-associated lesions such as genital warts, while most HPV infections clear spontaneously without causing health problems. 1
Understanding HPV Infection
- HPV is the most common sexually transmitted infection worldwide, with most sexually active adults acquiring it at some point in their lives 1, 2
- More than 20 types of HPV can infect the genital tract, with most infections being asymptomatic or subclinical 1
- HPV types 6 and 11 typically cause genital warts, while high-risk types (16,18,31,33, and 35) are associated with cervical and other anogenital cancers 1
- In most cases (70-90%), HPV infections clear spontaneously within 1-2 years without treatment 1, 2
Treatment of HPV-Related Lesions
Genital Warts Treatment
For external genital and perianal warts, treatment options include:
Patient-Applied Therapies:
- Podofilox 0.5% solution: Applied twice daily for 3 days, followed by 4 days of no therapy for up to 4 cycles 1
- Imiquimod: An immunomodulator with antiviral properties 1, 3
- Sinecatechins 15% ointment: Applied three times daily for up to 16 weeks (for immunocompetent patients 18 years and older) 4
Provider-Administered Therapies:
- Cryotherapy with liquid nitrogen: First-line treatment for many wart types 1
- Trichloroacetic acid (TCA) or Bichloroacetic acid (BCA) 80-90%: Applied only to warts, repeated weekly if necessary 1
- Surgical removal: Useful for extensive warts or those not responding to other treatments 1
- Laser therapy: For extensive warts or treatment-resistant cases 1
Important Treatment Considerations
- No single treatment is superior for all patients or all warts; therapy should be selected based on wart number, size, location, and patient preference 1
- Treatment should be changed if no substantial improvement after three provider-administered treatments or if warts haven't cleared after six treatments 1
- Recurrence rates are high (approximately 30%) regardless of treatment method 1, 3
- Warts on moist surfaces generally respond better to topical treatments than those on drier surfaces 1
Treatment Limitations and Caveats
- Current treatments do not eradicate the virus itself or affect the natural history of HPV infection 1, 2
- Treatment of visible warts may not decrease infectivity or prevent transmission 1
- Treatment does not prevent the development of HPV-related cancers 1, 3
- Complications are rare when treatments are properly employed, but scarring (hypopigmentation or hyperpigmentation) can occur with ablative methods 1
- Special considerations apply for pregnant patients, immunocompromised individuals, and children 1, 4
Prevention Strategies
- HPV vaccines provide protection against the most common HPV types that cause genital warts (6 and 11) and cervical cancer (16 and 18) 1, 5
- Vaccines are most effective when administered before sexual debut 1, 5
- Consistent condom use may reduce but not eliminate the risk of HPV transmission, as the virus can infect areas not covered by condoms 1
- Limiting the number of sexual partners can reduce the chance of HPV infection, though infection can occur even with only one lifetime partner 1