Management of genital warts.
Genital warts caused by human papillomavirus infection are encountered commonly in primary care. Evidence guiding treatment selection is limited, but treatment guidelines recently have changed. Biopsy, viral typing, acetowhite staining, and other diagnostic measures are not routinely required. The goal of treatment is clearance of visible warts; some evidence exists that treatment reduces infectivity, but there is no evidence that treatment reduces the incidence of cervical and genital cancer. The choice of therapy is based on the number, size, site, and morphology of lesions, as well as patient preferences, cost, convenience, adverse effects, and clinician experience. Patient-applied therapy such as imiquimod cream or podofilox is increasingly recommended. Podofilox, imiquimod, surgical excision, and cryotherapy are the most convenient and effective options. Fluorouracil and interferon are no longer recommended for routine use. The cost per successful treatment course is approximately dollars 200 to dollars 300 for podofilox, cryotherapy, electrodesiccation, surgical excision, laser treatment, and the loop electrosurgical excision procedure.
Kodner
Charles M
CM
Department of Family and Geriatric Medicine, University of Louisville School of Medicine, Louisville, Kentucky 40202, USA. charles.kodner@louisville.edu
Nasraty
Soraya
S
D000465:Algorithms; D000634:Aminoquinolines / Q000627:therapeutic use; D003218:Condylomata Acuminata / Q000175:diagnosis / Q000628:therapy*; D017679:Cryotherapy; D003663:Decision Trees; D003937:Diagnosis, Differential; D004598:Electrosurgery; D019317:Evidence-Based Medicine; D005194:Family Practice / Q000379:methods*; D005260:Female; D005831:Genital Diseases, Female / Q000175:diagnosis / Q000628:therapy*; D005832:Genital Diseases, Male / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D000077271:Imiquimod; D007641:Keratolytic Agents / Q000627:therapeutic use; D053685:Laser Therapy; D008297:Male; D018579:Patient Selection; D011034:Podophyllotoxin / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000379:methods*; D016896:Treatment Outcome
D000634:Aminoquinolines; D007641:Keratolytic Agents; D011034:Podophyllotoxin; D000077271:Imiquimod