What are the treatment options for Human Papillomavirus (HPV)?

Treatment Options for Human Papillomavirus (HPV)

There is no specific treatment that can eradicate HPV infection itself, but treatment focuses on removing visible warts and managing symptoms while the immune system typically clears the infection over time. 1, 2

Understanding HPV Infection

• HPV is the most common sexually transmitted infection, with approximately 80% of the population exposed by age 50 3
• Without treatment, genital warts may resolve spontaneously (20-30% within 3 months), remain unchanged, or increase in size/number 1
• Most HPV infections are cleared by the immune system without causing clinical complications 4

Treatment Goals and Limitations

• The primary goal is removal of visible warts and amelioration of symptoms, not eradication of the virus 1
• No therapy has been proven to completely eliminate HPV infection 5, 2
• Treatment can induce wart-free periods but does not eliminate the underlying viral infection 1
• Recurrence rates are high (at least 25% within 3 months) with all treatment modalities 5, 1

Treatment Options for Genital Warts

Patient-Applied Therapies:

1. Podofilox 0.5% solution

   • Apply twice daily for 3 days, followed by 4 days without treatment
   • May repeat for up to 4 cycles
   • Total wart area treated should not exceed 10 cm²
   • Contraindicated during pregnancy 5, 1

2. Imiquimod 5% cream

   • Apply 3 times per week for up to 16 weeks
   • Apply before bedtime and leave on for 6-10 hours
   • Wash off with mild soap and water
   • Immune response modifier that may induce cytokines 6

Provider-Applied Therapies:

1. Cryotherapy with liquid nitrogen

   • First-line treatment option for many wart types
   • Can be repeated every 1-2 weeks as needed 1, 7

2. Trichloroacetic acid (TCA) 80-90%

   • Apply only to warts
   • Powder with talc or sodium bicarbonate to remove unreacted acid 5, 1

3. Surgical options (for extensive or refractory warts)

   • Surgical excision (93% efficacy, 29% recurrence)
   • Carbon dioxide laser therapy (43% efficacy, 95% recurrence)
   • Electrodesiccation/electrocautery 5, 1

Treatment Selection Factors

• Patient preference should guide treatment choice 1
• Consider wart characteristics (size, number, location) 1
• Consider cost, convenience, and potential adverse effects 1
• Change treatment modality if no improvement after a complete course or if side effects are severe 1
• Warts on moist surfaces or in intertriginous areas respond better to topical treatments 1

Special Considerations

HIV-Infected Individuals

• May have larger or more numerous warts
• May not respond as well to therapy and experience more frequent recurrences
• Higher risk for squamous cell carcinomas arising in warts 1, 7

Biopsy Indications

• Uncertain diagnosis
• Lesions unresponsive to standard therapy
• Worsening during therapy
• Immunocompromised patients
• Atypical lesions 7

Prevention Strategies

• HPV vaccination (Gardasil) prevents infection with HPV types that cause 90% of genital warts (types 6 and 11) 1, 7
• Vaccination is recommended even for those already diagnosed with HPV 1
• Consistent condom use may reduce but not eliminate transmission risk 1, 4

Patient Counseling Points

• Most recurrences result from reactivation of subclinical infection rather than reinfection 1
• HPV diagnosis does not necessarily indicate sexual infidelity 1
• Treatment targets visible warts but does not eliminate the virus itself 5, 1