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

From the Guidelines

There is no specific treatment for HPV (human papillomavirus) infection itself, as most HPV infections clear on their own within 1-2 years through the body's immune system. Treatment focuses on managing visible symptoms like genital warts or precancerous lesions. For genital warts, options include patient-applied treatments such as imiquimod 3.75% or 5% cream (applied 3 times weekly for up to 16 weeks), podofilox 0.5% solution/gel (applied twice daily for 3 days, followed by 4 days of no treatment, for up to 4 cycles), or provider-administered treatments like cryotherapy (freezing with liquid nitrogen every 1-2 weeks), trichloroacetic acid (80-90% solution applied weekly), surgical removal, or laser therapy. For precancerous lesions detected through abnormal Pap tests or HPV testing, treatments may include LEEP (Loop Electrosurgical Excision Procedure), cryotherapy, laser therapy, or surgical excision depending on the severity. Prevention is crucial through HPV vaccination (recommended for ages 9-26, and up to age 45 in some cases) and regular cervical cancer screening, as supported by the most recent guidelines from 2019 1. HPV treatments work by either physically removing affected tissue or stimulating the immune system to clear the infection, but they don't eliminate the virus completely from the body.

Some key points to consider in the management and prevention of HPV include:

• The importance of HPV vaccination, which has been shown to be highly effective in preventing HPV-related cancers and genital warts, as demonstrated in studies such as the one published in 2017 1.
• The recommendation for routine vaccination with the HPV vaccine for individuals 11 through 12 years of age, with the option to vaccinate as early as 9 years of age, as per the Advisory Committee on Immunization Practices (ACIP) guidelines.
• The use of a 2-dose schedule for persons 9 through 14 years of age, and a 3-dose schedule for those 15 years of age or older, as approved by the FDA and recommended by the ACIP.
• The importance of healthcare provider recommendation and strong endorsement for HPV vaccination, as it has been shown to significantly influence the decision to vaccinate, as highlighted in the study from 2017 1.

Overall, the management of HPV infection focuses on the treatment of symptoms and prevention through vaccination, with the goal of reducing the risk of HPV-related cancers and genital warts.

From the FDA Drug Label

Veregen is a topical ointment indicated for the treatment of external genital and perianal warts (Condylomata acuminata) in immunocompetent patients 18 years and older (1. 1). Veregen should not be used to treat urethral, intra-vaginal, cervical, rectal, or intra-anal human papilloma viral disease (5).

The treatment of HPV with Veregen (sinecatechins) is limited to external genital and perianal warts in immunocompetent patients 18 years and older.

• Key points:
  • Veregen is for topical use only.
  • It is not for ophthalmic, oral, intravaginal, or intra-anal use.
  • Avoid exposure of Veregen treated areas to sun/UV-light.
  • Common adverse reactions include local skin and application site reactions. 2

From the Research

HPV Treatment Options

• Treatment for HPV-related diseases, such as genital warts, may be patient- or physician-administered, with the choice of treatment informed by shared decision-making 3.
• Podofilox 0.5% solution is the most effective patient-administered therapy, while carbon dioxide laser therapy, surgery, and electrosurgery are the most effective for wart removal at the end of treatment 3.
• Treatment options may be limited by physician skills and clinic availability 3.
• The use of podofilox, imiquimod, and sinecatechins should be avoided in pregnancy 3.

Prevention of HPV Infection

• Vaccination is the primary method of prevention for HPV infection, with the nonavalent HPV vaccine effective in preventing the development of high-grade precancerous cervical lesions in noninfected patients 4.
• Vaccination is ideally administered at 11 or 12 years of age, irrespective of the patient's sex, with a two-dose series recommended if administered before 15 years of age 4.
• Use of condoms and dental dams may decrease the spread of the virus, although the current evidence regarding the effects of condom use on the prevalence of genital warts is conflicting 3, 4.

Diagnosis and Screening

• Screening for HPV infection is effective in identifying precancerous lesions and allows for interventions that can prevent the development of cancer 4.
• The diagnosis of HPV-related diseases, such as genital warts, is made clinically by the appearance of single or multiple lesions, with biopsy indicated in some cases, such as for atypical lesions 3.
• 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 5.

HPV-Related Cancers

• HPV infection is responsible for various types of cancer, including cervical, anal, oropharyngeal, penile, vaginal, and vulvar cancers 4, 6, 7, 5.
• Persistent infection with high-risk HPV types, especially HPV-16 and HPV-18, can cause cancer 4, 7, 5.
• Risk factors for persistent HPV infections include a history of multiple sex partners, initiation of sexual activity at an early age, not using barrier protection, other sexually transmitted infections, including HIV, an immunocompromised state, alcohol use, and smoking 4.