Genital warts, treatment

Due to the variable appearance of genital warts, treatment maybe based on the size, site, and morphology of the lesions. Additionally, switching to alternate therapy is appropriate if there has been no response after three treatment cycles. 

TABLE 77-2. Comparison of Adverse Effects Seen with Treatments for Genital Warts... 

A 10% to 25% solution of podophyllin resin has been the standard in-office treatment for genital warts. 

Several ablative options have been employed in the treatment of genital warts and include cryotherapy, surgical removal, and vaporization. 

Actinic keratosis For the topical treatment of clinically typical, nonhyperkeratotic, nonhypertrophic actinic keratoses on the face or scalp in immunocompetent adults. Genital and perianal warts Treatment of external genital and perianal warts/condyloma acuminata in patients 12 years of age and older. 

Genital warts (condylomata acuminata) Topical Apply 10% 25% solution in compound benzoin tincture to dry surface. Use 1 drop at a time allowing drying between drops until area is covered. Total volume should be limited to less than 0.5 ml per treatment session. 

IFN-a may be used for the treatment of condylomata acuminata (venereal or genital warts), malignant melanoma, hairy cell leukemia and hepatitis B and C, and other types of cancer including skin, kidney and bone cancers. 

IFN-p-la is used to treat patients with a relapsing form of MS. It is not a cure for MS however, it may slow some disabling effects of the disease. IFN-p-la may also decrease the number of relapses of MS. The possible mechanisms of action for the treatment of MS include the antagonism of IL-4 and IFN-7. It also modifies the mechanics of blood barrier since it inhibits cell adhesion, cell migration and metalloproteinase activity. IFN-P induces IL-10 and TGF-p, which are anti-inflammatory cytokines. It is also used for the treatment of genital warts. 

Beutner KR, et al. (1998) Imiquimod, a patient-applied immune-response modifier for treatment of external genital warts. Antimicrob Agents Chemother 42(4) 789-794... 

Beutner KR, et al. (1998) Treatment of genital warts with an immune-response modifier (imiquimod). J Am Acad Dermatol 38(2 Pt 1) 230—239... 

First clinical trials of antisense oligonucleotide (ISIS 2105) are initiated for treatment of genital warts caused by human papilloma virus. 

An antisense oligonucleotide, ISIS 2105, is in clinical trials for the treatment of genital warts caused by the human papilloma virus. ISIS 2105 is designed for subcutaneous injection directly into the wart (Sterling, 1992). Antisense oligonucleotides for antiviral applications against infection by herpes and other viruses are also under development (Crooke, 1992b). 

Gross G, Roussaki A, Ikenberg H, Drees N (1991) Genital warts do not respond to systemic recombinant interferon alpha-2a treatment during cannabis consumption. Dermato-logica 183 203-207... 

Eiley DJ, Douglas J, Beutner K, et al. External genital warts Diagnosis, treatment, and prevention. CUn Infect Dis 2002 35(suppl 2) S210-224. 

Clinical trials are still few. Several of the earliest reported to date are only from the early 1990s. To illustrate, a treatment trial on genital warts induced by papilloma virus was reported (Anonymous A, 1993). An AIDS infection trial (Anonymous B, 1993) and an acute myelogenous leukemia test (Anonymous C, 1993) are also in the literature. 

Podofilox, a keratolytic agent with antimimetic properties (0.5% in 95% alcohol to be applied q. 12 hours for three days), is used in the treatment of external genital warts. 

In refractory condylomata acuminata (genital warts), intralesional injection of various IFNs is associated with complete clearance in 36-62% of patients, but other treatments are preferred. Relapse occurs in 20-30% of patients. Verruca vulgaris may respond to intralesional IFN-CC. Intramuscular or subcutaneous administration is associated with regression in wart size but greater toxicity. Systemic IFN may provide benefit in recurrent juvenile laryngeal papillomatosis and laryngeal disease in older patients. 

Approved for the treatment of genital warts imiquimod is applied to genital or perianal lesions three times a week usually for a 16-week period that may be repeated as necessary. Imiquimod is also approved for the treatment of actinic keratoses. In this capacity, imiquimod is applied three times a week for 16 weeks to the face, scalp, and arms. Phase 2 trials evaluating imiquimod for the... 

Use P. is used experimentally as an antitumor principle. Like podophyllin, it is suitable for the topical treatment of genital warts. Semisynthetic glycosides of P., namely etoposide and teniposide (C32H32O13S, Mr 656.66) are used clinically as cytostatic agents. ... 

Beutner KR, von Krogh G (1990) Current status of podophyllo-toxin for the treatment of genital warts. Semin Dermatol 9 148-151... 

Interferon is a protein wth antiviral and antiproliferative properties that has been approved for treatment of hair) cell leukemia, genital warts, and Kaposi s sarcoma. In vitro studies performed using hylan vehicles loaded with alpha-interferon indicate that hylan gel-fluid mixtures have a substantial effect on the release period of interferon. In the presence of hylan vehicles, there was up to an eight fold reduction in the levels of interferon released over a 24-hour period, as compared with controls not containing hylan. 

It is widely used in biochemistry for the precipitation of macromolecules such as proteins, DNA and RNA. Its sodium salt is used as a weedkiller. Solutions containing trichloroacetic acid as an ingredient are used for cosmetic treatments such as chemical peels and tattoo removal and the treatment of warts, including genital warts. It can kill normal cells as well. It is considered safe for use for this purpose during pregnancy. 

Skin A 36-year-old Chinese woman receiving 5% topical imiquimod cream for treatment of genital warts. After six weeks the patient reported localised depigmentation attributed to localised vitiligo. Her husband, a 37-year-old man, received the same treatment for genital warts. After four weeks he complained of a macular rash limit to the areas treated with topical imiquimod. Histopathological features of a punch biopsy sample confirmed lichen planus [353 ]. 

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