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WARTS - ANOGENITAL
Anogenital warts (condylomas) are caused by human papillomavirus (HPV) with >90% of the lesions caused by genotypes 6 & 11.
Patients who present with visible warts may also be infected with high-risk HPVs (eg types 16 & 18) which can cause subclinical lesions that are associated with intraepithelial neoplasia, cervical cancer and anogenital cancer.
Many HPV infections are subclinical, transient, and clear spontaneously within 12 months but may also remain latent and reactivate after several years.

Surgical Intervention

Surgical Removal

  • Warts are usually removed after 1 office visit; however, 30% of patients will develop new lesions after treatment
  • Electrosurgery
    • 3 commonly used electrosurgeries are electrocautery, monopolar surgery and hyfrecator
    • Coagulates proteins of treated tissues
    • Used for external anogenital and oral warts
    • Can be used in pregnant women
    • No known contraindications
    • Local anesthetic is recommended to ease pain during procedure
    • No additional hemostasis is required
    • Need to control depth of cautery to prevent scarring
    • Adequate protection of healthcare workers should be observed as smoke plume may contain human papillomavirus (HPV) DNA
  • Excision/Curettage
    • Useful if there is a small number of keratinized, pedunculated or exophytic warts at accessible sites
    • Can be used in pregnant women
    • Use of eutectic mixture of local anesthetics (EMLA) cream before injection of local anesthetic is suggested
    • May remove warts with fine scissors, scalpel or curettage
    • Hemostasis may be done with electrosurgical unit, chemical styptic or hemostatic solution
    • Wound usually only extends into upper dermis because warts are exophytic
    • Avoid in patients with bleeding abnormalities
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