- Modern Management of External Anogenital Warts
Ferenczy and J. Monsonego
S Tyring, USA
and Natural History
- Almost all cases
of genital warts in adults are transmitted sexually.
- The prevalence
of genital warts in the general population is unknown.
- Current epidemiology
estimates that ano-genital warts afflict about 1% of the sexually active
population and the incidence is in the order of 1/1000 sexually active
individuals per year.
of ano-genital warts
- Acuminate warts
are multi-form, multi-focal and multicentric and most are caused by
lowrisk HPV types 6, 11.
- Acuminate warts
are clinically typical and do not require routine biopsy. For all other
lesions, histologic examination is required.
- Differential diagnoses
include VIN and dermatoses.
- The acetic acid
test is not specific it may be valuable for identifying and delineating
subclinical lesions associated with EGWs.
- Condylomata acuminata
constitute a risk marker for external ano-genital cancer particularly
in the immuno-suppressed and to a lesser degree, for cervical cancer.
- Conventional treatment
of genital condylomata acuminata has been disappointing. Analysis of
available data relating to cytotoxic or destructive therapy has shown
that persistence and recurrences occur in about 50% of the cases.
- The 2 main reasons
for this are the treatments may be incomplete and do not focus on the
etiologic virus, i.e., HPV 6/11.
- Both basic research
and clinical practice indicate that immunity, and in particular local
cellular immunity, is an essential feature of the development, persistence
and regression of this disease.
- The recent introduction
of topical immune system modifiers is considered to be a significant
progress in our efforts to provide improved topical therapy for EGWs.
- The best therapeutic
approach is based on a mutual decision made by the patient and her health-care
provider of a choice of home versus provider-administered treatment
and long-term follow-up of patients with EGWs.
Warts: Screening and Counselling
- No practical screening
tests are available for EGWs and screening is not recommended.
i.e., partner(s) of patients with EGWs may be examined and this is an
opportunity for patient education and counselling.
- Patients should
be counselled in light of today's knowledge of transmission, genital
cancer-risk, therapy and outcome.
- Issues of life-style
modification including mutual monogamy and long-term follow-up should
- Cesarean section
to prevent juvenile onset of recurrent respiratory papillomavirus in
pregnant patients with EGWs is not recommended at present. Cesarean
section is appropriate in cases of extreme ano-genital condylomatosis