What are the treatment options for a Human Papillomavirus (HPV) flare-up?

From the Guidelines

There is no specific treatment for an HPV flare-up as the virus itself cannot be cured, and management focuses on treating the symptoms and visible lesions. For genital warts caused by HPV, treatment options include:

• Topical medications like imiquimod (Aldara, applied 3 times weekly for up to 16 weeks), podofilox (Condylox, applied twice daily for 3 days, followed by 4 days of no treatment, for up to 4 cycles), or trichloroacetic acid (TCA, applied weekly by a healthcare provider) 1.
• Provider-administered treatments include cryotherapy (freezing the warts with liquid nitrogen every 1-2 weeks), surgical removal, or laser therapy for extensive cases 1. For cervical HPV manifestations, monitoring through regular Pap tests is essential, with colposcopy or LEEP procedures if abnormal cells are detected. During flare-ups, it is recommended to:
• Avoid sexual contact to prevent transmission
• Maintain good hygiene
• Boost your immune system through healthy lifestyle choices
• Avoid smoking which can worsen HPV infections 1. Remember that even after treatment, the virus remains dormant in your body, and recurrences are possible, so regular follow-up with healthcare providers is important for monitoring. The selection of treatment should be guided by the preference of the patient, available resources, and the experience of the health-care provider, as no single treatment is ideal for all patients or all 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.

The treatment for an HPV flare-up, specifically for external genital warts, is Imiquimod Cream applied 3 times per week. Treatment should continue until total clearance of the warts or for a maximum of 16 weeks 2.

• Application schedule: Examples include Monday, Wednesday, Friday or Tuesday, Thursday, Saturday.
• Duration of application: The cream should be left on the skin for 6-10 hours before being removed with mild soap and water.
• Management of skin reactions: A rest period of several days may be taken if required by the patient's discomfort or severity of the local skin reaction. Treatment may resume once the reaction subsides.

From the Research

Treatment for HPV Flare Up

• There is no cure for HPV, but treatment mainstays are destruction and excision of the lesions 3
• Most people will clear HPV spontaneously, but those who do not are at high risk for developing malignancy 3
• Screening for HPV infection is effective in identifying precancerous lesions and allows for interventions that can prevent the development of cancer 4
• Vaccination is the primary method of prevention, and the nonavalent HPV vaccine is effective in preventing the development of high-grade precancerous cervical lesions in noninfected patients 4
• Prophylactic vaccines are unable to provide protection to individuals with existing HPV infections or HPV-associated diseases, and therapeutic HPV vaccines capable of generating T cell-mediated immunity against HPV infection and associated diseases are needed to ameliorate the burden of disease in individuals with existing HPV infection 5

Prevention Strategies

• Use of condoms and dental dams may decrease spread of the virus 4
• Vaccination is ideally administered at 11 or 12 years of age, irrespective of the patient's sex 4
• A two-dose series is recommended if administered before 15 years of age; however, individuals who are immunocompromised require three doses 4
• HPV testing in the secondary prevention of cervical cancer is clinically valuable in triaging low-grade cytological abnormalities and is also more sensitive than cytology as a primary screening 6

HPV-Associated Diseases

• HPV infection is recognized as the etiologic factor for numerous cancers, including cervical, vulval, vaginal, penile, anal, and a subset of oropharyngeal cancers 5
• The prevalence of HPV infection and its associated diseases are a significant problem, affecting millions of individuals worldwide 5
• Between 2011 and 2015, there were an estimated 42,700 new cases of HPV-associated cancers each year in the United States alone 5