Genital Warts Regimens
Treatment of genital warts should be guided by the preference of the patient, the available resources, and the experience of the health-care provider.
No definitive evidence suggests that any of the available treatments is superior to the others, and no single treatment is ideal for all patients or all warts.
The use of locally developed and monitored treatment algorithms has been associated with improved clinical outcomes and should be encouraged.
Because of uncertainty regarding the effect of treatment on future transmission and the possibility for spontaneous resolution, an acceptable alternative for some patients is to forego treatment and await spontaneous resolution.
Most patients have <10 genital warts, with a total wart area of 0.5--1.0 cm 2. These warts respond to most treatment modalities.
Factors that may influence selection of treatment include wart size, wart number, anatomic site of wart, wart morphology, patient preference, cost of treatment, convenience, adverse effects, and provider experience.
Many patients require a course of therapy rather than a single treatment. In general, warts located on moist surfaces and/or in intertriginous areas respond better to topical treatment than do warts on drier surfaces.
The treatment modality should be changed if a patient has not improved substantially after three provider-administered treatments or if warts have not completely cleared after six treatments.
The risk-benefit ratio of treatment should be evaluated throughout the course of therapy to avoid overtreatment. Both patient-applied therapies and provider-administered therapies are available.
Providers should be knowledgeable about, and have available to them, at least one patient-applied and one provider-administered treatment.
Complications rarely occur if treatments for warts are employed properly. Patients should be warned that persistent hypopigmentation or hyperpigmentation are common with ablative modalities.
Depressed or hypertrophic scars are uncommon but can occur, especially if the patient has had insufficient time to heal between treatments. Rarely, treatment can result in disabling chronic pain syndromes (e.g., vulvodynia or hyperesthesia of the treatment site).
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