Warts%20-%20anogenital Management

• Condoms provide limited protection against genital warts, cervical intraepithelial neoplasia (CIN) II and CIN III
• Frequent cervical screening should start at appropriate age and be based on cytology since not all human papillomavirus (HPV) infection produce cervical cancer

Vaccines

• Safe and highly effective in preventing HPV
• Ideally given prior to sexual activity or exposure to the virus
• Stable protection has been observed for 5 years
• Not recommended for use during pregnancy

Quadrivalent HPV Vaccine

• Contains HPV capsids of type 16, 18, 6 and 11
• Studies show efficacy in preventing type-specific HPV infection

9-valent HPV Vaccine

• Contains HPV types 6, 11, 16 and 18 similar to the quadrivalent HPV vaccine but also has five additional types: 31, 33, 45, 52 and 58  
• For prophylactic use only and has no effect on active HPV infections or established disease

• Patients undergoing therapy should be advised to return weekly for treatment until all the warts are removed in order to:
  
  • Monitor response to therapy, ie treatment response is mostly noted within 3 months of therapy
  • Assess need for changes in treatment modalities
  • Evaluate recurrence
  • Assess need for specialist referral
• Patients whose original lesions have responded well to treatment but in whom new lesions are developing can continue with current regimen
• Change in therapy is indicated if the patient is not tolerating current therapy, with severe side effects or <50% response to current treatment after 16 weeks for Imiquimod and 6 weeks for other modalities
• Patients concerned about recurrence may be evaluated 3 months after successful treatment
  
  • Relapses should be treated according to the lesion types

• Consider specialist referral in the following patients:
  • Large-volume disseminated disease
  • Intractable lesions
  • Immunocompromised patients
  • Pregnant patients
  • Children