Human papillomavirus medical therapy: Difference between revisions
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There is no definitve medical treatment of HPV infection. However, treatment is mainly aimed to treat warts or precancerous lesions. Two types of medical therapy may be considered: | There is no definitve medical treatment of HPV infection. However, treatment is mainly aimed to treat warts or precancerous lesions. Two types of medical therapy may be considered: | ||
*Cytodestructive therapy: aimed to destroy warty lesion | *Cytodestructive therapy: aimed to destroy warty lesion | ||
*Immunotherapy: acts by enhancing patient's immune system to clear infection | *Immunotherapy: acts by enhancing patient's immune system to clear infection (imiquimod, sinecatechins, interferons, bacillus calmette-Guerin, HPV vaccine)<ref name="pmid18360317">{{cite journal| author=Gotovtseva EP, Kapadia AS, Smolensky MH, Lairson DR| title=Optimal frequency of imiquimod (aldara) 5% cream for the treatment of external genital warts in immunocompetent adults: a meta-analysis. | journal=Sex Transm Dis | year= 2008 | volume= 35 | issue= 4 | pages= 346-51 | pmid=18360317 | doi=10.1097/OLQ.0b013e31815ea8d1 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18360317 }} </ref><ref name="pmid16820073">{{cite journal| author=Garland SM, Waddell R, Mindel A, Denham IM, McCloskey JC| title=An open-label phase II pilot study investigating the optimal duration of imiquimod 5% cream for the treatment of external genital warts in women. | journal=Int J STD AIDS | year= 2006 | volume= 17 | issue= 7 | pages= 448-52 | pmid=16820073 | doi=10.1258/095646206777689161 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16820073 }} </ref><ref name="pmid9449906">{{cite journal| author=Edwards L, Ferenczy A, Eron L, Baker D, Owens ML, Fox TL et al.| title=Self-administered topical 5% imiquimod cream for external anogenital warts. HPV Study Group. Human PapillomaVirus. | journal=Arch Dermatol | year= 1998 | volume= 134 | issue= 1 | pages= 25-30 | pmid=9449906 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9449906 }} </ref><ref name="pmid18292715">{{cite journal| author=| title=Veregen: a botanical for treatment of genital warts. | journal=Med Lett Drugs Ther | year= 2008 | volume= 50 | issue= 1280 | pages= 15-6 | pmid=18292715 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18292715 }} </ref><ref name="pmid3531860">{{cite journal| author=Eron LJ, Judson F, Tucker S, Prawer S, Mills J, Murphy K et al.| title=Interferon therapy for condylomata acuminata. | journal=N Engl J Med | year= 1986 | volume= 315 | issue= 17 | pages= 1059-64 | pmid=3531860 | doi=10.1056/NEJM198610233151704 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3531860 }} </ref> | ||
*No treatment is considered superior to the other. However, selection of the treatment may depend on the following factors: | *No treatment is considered superior to the other. However, selection of the treatment may depend on the following factors: | ||
:*Wart size | :*Wart size | ||
| Line 20: | Line 20: | ||
===Medical Therapy=== | ===Medical Therapy=== | ||
*'''Human papillomavirus therapy'''<ref name=CDC>{{Cite journal| issn = 1545-8601| volume = 64| issue = RR-03| pages = 1–137| last1 = Workowski| first1 = Kimberly A.| last2 = Bolan| first2 = Gail A.| title = Sexually transmitted diseases treatment guidelines, 2015| journal = MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control| date = 2015-06-05| pmid = 26042815}}</ref> | *'''Human papillomavirus therapy'''<ref name=CDC>{{Cite journal| issn = 1545-8601| volume = 64| issue = RR-03| pages = 1–137| last1 = Workowski| first1 = Kimberly A.| last2 = Bolan| first2 = Gail A.| title = Sexually transmitted diseases treatment guidelines, 2015| journal = MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control| date = 2015-06-05| pmid = 26042815}}</ref> | ||
:* ''' Anogenital warts'''<ref name=CDC>{{Cite journal| issn = 1545-8601| volume = 64| issue = RR-03| pages = 1–137| last1 = Workowski| first1 = Kimberly A.| last2 = Bolan| first2 = Gail A.| title = Sexually transmitted diseases treatment guidelines, 2015| journal = MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control| date = 2015-06-05| pmid = 26042815}}</ref> | :* ''' Anogenital warts'''<ref name=CDC>{{Cite journal| issn = 1545-8601| volume = 64| issue = RR-03| pages = 1–137| last1 = Workowski| first1 = Kimberly A.| last2 = Bolan| first2 = Gail A.| title = Sexually transmitted diseases treatment guidelines, 2015| journal = MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control| date = 2015-06-05| pmid = 26042815}}</ref><ref name="pmid8192173">{{cite journal| author=Bonnez W, Elswick RK, Bailey-Farchione A, Hallahan D, Bell R, Isenberg R et al.| title=Efficacy and safety of 0.5% podofilox solution in the treatment and suppression of anogenital warts. | journal=Am J Med | year= 1994 | volume= 96 | issue= 5 | pages= 420-5 | pmid=8192173 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8192173 }} </ref> | ||
::* 1.'''Preferred regimen for External Anogenital Warts'''(i.e., penis, groin, scrotum, vulva, perineum, external anus, and perianus) | ::* 1.'''Preferred regimen for External Anogenital Warts'''(i.e., penis, groin, scrotum, vulva, perineum, external anus, and perianus) | ||
:::* 1.1 '''Patient-applied''': [[Imiquimod]] 3.75% or 5% cream {{or}} [[Podofilox]] 0.5% solution or gel {{or}} [[Sinecatechins]] 15% ointment<ref name="pmid17508490">{{cite journal| author=Brodell LA, Mercurio MG, Brodell RT| title=The diagnosis and treatment of human papillomavirus-mediated genital lesions. | journal=Cutis | year= 2007 | volume= 79 | issue= 4 Suppl | pages= 5-10 | pmid=17508490 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17508490 }} </ref><ref name="pmid9798036">{{cite journal| author=Beutner KR, Reitano MV, Richwald GA, Wiley DJ| title=External genital warts: report of the American Medical Association Consensus Conference. AMA Expert Panel on External Genital Warts. | journal=Clin Infect Dis | year= 1998 | volume= 27 | issue= 4 | pages= 796-806 | pmid=9798036 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9798036 }} </ref> | :::* 1.1 '''Patient-applied''': [[Imiquimod]] 3.75% or 5% cream {{or}} [[Podofilox]] 0.5% solution or gel {{or}} [[Sinecatechins]] 15% ointment<ref name="pmid17508490">{{cite journal| author=Brodell LA, Mercurio MG, Brodell RT| title=The diagnosis and treatment of human papillomavirus-mediated genital lesions. | journal=Cutis | year= 2007 | volume= 79 | issue= 4 Suppl | pages= 5-10 | pmid=17508490 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17508490 }} </ref><ref name="pmid9798036">{{cite journal| author=Beutner KR, Reitano MV, Richwald GA, Wiley DJ| title=External genital warts: report of the American Medical Association Consensus Conference. AMA Expert Panel on External Genital Warts. | journal=Clin Infect Dis | year= 1998 | volume= 27 | issue= 4 | pages= 796-806 | pmid=9798036 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9798036 }} </ref><ref name="pmid9486679">{{cite journal| author=Beutner KR, Spruance SL, Hougham AJ, Fox TL, Owens ML, Douglas JM| title=Treatment of genital warts with an immune-response modifier (imiquimod). | journal=J Am Acad Dermatol | year= 1998 | volume= 38 | issue= 2 Pt 1 | pages= 230-9 | pmid=9486679 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9486679 }} </ref><ref name="pmid18292715">{{cite journal| author=| title=Veregen: a botanical for treatment of genital warts. | journal=Med Lett Drugs Ther | year= 2008 | volume= 50 | issue= 1280 | pages= 15-6 | pmid=18292715 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18292715 }} </ref><ref name="pmid18515521">{{cite journal| author=Tatti S, Swinehart JM, Thielert C, Tawfik H, Mescheder A, Beutner KR| title=Sinecatechins, a defined green tea extract, in the treatment of external anogenital warts: a randomized controlled trial. | journal=Obstet Gynecol | year= 2008 | volume= 111 | issue= 6 | pages= 1371-9 | pmid=18515521 | doi=10.1097/AOG.0b013e3181719b60 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18515521 }} </ref><ref name="pmid3336177">{{cite journal| author=Friedman-Kien AE, Eron LJ, Conant M, Growdon W, Badiak H, Bradstreet PW et al.| title=Natural interferon alfa for treatment of condylomata acuminata. | journal=JAMA | year= 1988 | volume= 259 | issue= 4 | pages= 533-8 | pmid=3336177 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3336177 }} </ref><ref name="pmid9310221">{{cite journal| author=Dinsmore W, Jordan J, O'Mahony C, Harris JR, McMillan A, Radcliffe KW et al.| title=Recombinant human interferon-beta in the treatment of condylomata acuminata. | journal=Int J STD AIDS | year= 1997 | volume= 8 | issue= 10 | pages= 622-8 | pmid=9310221 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9310221 }} </ref><ref name="pmid18720702">{{cite journal| author=Cook K, Brownell I| title=Treatments for genital warts. | journal=J Drugs Dermatol | year= 2008 | volume= 7 | issue= 8 | pages= 801-7 | pmid=18720702 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18720702 }} </ref><ref name="pmid11176481">{{cite journal| author=Böhle A, Büttner H, Jocham D| title=Primary treatment of condylomata acuminata with viable bacillus Calmette-Guerin. | journal=J Urol | year= 2001 | volume= 165 | issue= 3 | pages= 834-6 | pmid=11176481 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11176481 }} </ref><ref name="pmid15708031">{{cite journal| author=Metawea B, El-Nashar AR, Kamel I, Kassem W, Shamloul R| title=Application of viable bacille Calmette-Guérin topically as a potential therapeutic modality in condylomata acuminata: a placebo-controlled study. | journal=Urology | year= 2005 | volume= 65 | issue= 2 | pages= 247-50 | pmid=15708031 | doi=10.1016/j.urology.2004.09.025 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15708031 }} </ref> | ||
:::* 1.2 '''Provider-administered''': Cryotherapy with liquid nitrogen or cryoprobe {{or}} [[Trichloroacetic acid]] (TCA) {{or}} Bichloroacetic acid (BCA) 80%-90% solution | :::* 1.2 '''Provider-administered''': Cryotherapy with liquid nitrogen or cryoprobe {{or}} [[Trichloroacetic acid]] (TCA) {{or}} Bichloroacetic acid (BCA) 80%-90% solution | ||
:::* Note (1): Many persons with external anal warts also have intra-anal warts. Thus, persons with external anal warts might benefit from an inspection of the anal canal by digital examination, standard anoscopy, or high-resolution anoscopy. | :::* Note (1): Many persons with external anal warts also have intra-anal warts. Thus, persons with external anal warts might benefit from an inspection of the anal canal by digital examination, standard anoscopy, or high-resolution anoscopy. | ||
| Line 28: | Line 28: | ||
::* 2.'''Alternative regimens for external genital warts'''<ref name=CDC>{{Cite journal| issn = 1545-8601| volume = 64| issue = RR-03| pages = 1–137| last1 = Workowski| first1 = Kimberly A.| last2 = Bolan| first2 = Gail A.| title = Sexually transmitted diseases treatment guidelines, 2015| journal = MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control| date = 2015-06-05| pmid = 26042815}}</ref><ref name="pmid9798036">{{cite journal| author=Beutner KR, Reitano MV, Richwald GA, Wiley DJ| title=External genital warts: report of the American Medical Association Consensus Conference. AMA Expert Panel on External Genital Warts. | journal=Clin Infect Dis | year= 1998 | volume= 27 | issue= 4 | pages= 796-806 | pmid=9798036 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9798036 }} </ref> | ::* 2.'''Alternative regimens for external genital warts'''<ref name=CDC>{{Cite journal| issn = 1545-8601| volume = 64| issue = RR-03| pages = 1–137| last1 = Workowski| first1 = Kimberly A.| last2 = Bolan| first2 = Gail A.| title = Sexually transmitted diseases treatment guidelines, 2015| journal = MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control| date = 2015-06-05| pmid = 26042815}}</ref><ref name="pmid9798036">{{cite journal| author=Beutner KR, Reitano MV, Richwald GA, Wiley DJ| title=External genital warts: report of the American Medical Association Consensus Conference. AMA Expert Panel on External Genital Warts. | journal=Clin Infect Dis | year= 1998 | volume= 27 | issue= 4 | pages= 796-806 | pmid=9798036 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9798036 }} </ref> | ||
:::* 2.1 '''Urethral meatus warts''' | :::* 2.1 '''Urethral meatus warts''' | ||
::::* Preferred regimen: Cryotherapy with liquid nitrogen | ::::* Preferred regimen: Cryotherapy with liquid nitrogen<ref name="pmid14756893">{{cite journal| author=Ting PT, Dytoc MT| title=Therapy of external anogenital warts and molluscum contagiosum: a literature review. | journal=Dermatol Ther | year= 2004 | volume= 17 | issue= 1 | pages= 68-101 | pmid=14756893 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14756893 }} </ref> | ||
:::* 2.2 '''Vaginal warts''' | :::* 2.2 '''Vaginal warts''' | ||
::::* Preferred regimen: Cryotherapy with liquid nitrogen {{or}} TCA {{or}} BCA 80%–90% solution | ::::* Preferred regimen: Cryotherapy with liquid nitrogen<ref name="pmid14756893">{{cite journal| author=Ting PT, Dytoc MT| title=Therapy of external anogenital warts and molluscum contagiosum: a literature review. | journal=Dermatol Ther | year= 2004 | volume= 17 | issue= 1 | pages= 68-101 | pmid=14756893 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14756893 }} </ref> {{or}} TCA {{or}} BCA 80%–90% solution | ||
::::* Note: The use of a cryoprobe in the vagina is not recommended because of the risk for vaginal perforation and fistula formation | ::::* Note: The use of a cryoprobe in the vagina is not recommended because of the risk for vaginal perforation and fistula formation | ||
:::* 2.3 '''Cervical warts''' | :::* 2.3 '''Cervical warts''' | ||
Revision as of 14:25, 14 October 2016
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Maliha Shakil, M.D. [2] Aysha Anwar, M.B.B.S[3]
Overview
There is no definitve medical treatment of HPV infection. However, treatment is mainly aimed to treat warts or precancerous lesions. Two types of medical therapy which may be considered are cytodestructive therapy and immunotherapy. No treatment is considered superior to the other. However, selection of the treatment may depend on the wart size, number of warts, anatomic site of wart, wart morphology, patient preference, cost of treatment, convenience, adverse effects. Medical therapies for human papillomavirus infection include either imiquimod, sinecatechins, or podofilox.[1]
Medical Therapy
There is no definitve medical treatment of HPV infection. However, treatment is mainly aimed to treat warts or precancerous lesions. Two types of medical therapy may be considered:
- Cytodestructive therapy: aimed to destroy warty lesion
- Immunotherapy: acts by enhancing patient's immune system to clear infection (imiquimod, sinecatechins, interferons, bacillus calmette-Guerin, HPV vaccine)[2][3][4][5][6]
- No treatment is considered superior to the other. However, selection of the treatment may depend on the following factors:
- Wart size
- Number of warts
- Anatomic site of wart
- Wart morphology
- Patient preference
- Cost of treatment
- Convenience
- Adverse effects
Medical Therapy
- Human papillomavirus therapy[1]
-
- 1.Preferred regimen for External Anogenital Warts(i.e., penis, groin, scrotum, vulva, perineum, external anus, and perianus)
- 1.1 Patient-applied: Imiquimod 3.75% or 5% cream OR Podofilox 0.5% solution or gel OR Sinecatechins 15% ointment[8][9][10][5][11][12][13][14][15][16]
- 1.2 Provider-administered: Cryotherapy with liquid nitrogen or cryoprobe OR Trichloroacetic acid (TCA) OR Bichloroacetic acid (BCA) 80%-90% solution
- Note (1): Many persons with external anal warts also have intra-anal warts. Thus, persons with external anal warts might benefit from an inspection of the anal canal by digital examination, standard anoscopy, or high-resolution anoscopy.
- Note (2): Might weaken condoms and vaginal diaphragms.
- 2.1 Urethral meatus warts
- Preferred regimen: Cryotherapy with liquid nitrogen[17]
- 2.2 Vaginal warts
- Preferred regimen: Cryotherapy with liquid nitrogen[17] OR TCA OR BCA 80%–90% solution
- Note: The use of a cryoprobe in the vagina is not recommended because of the risk for vaginal perforation and fistula formation
- 2.3 Cervical warts
- Preferred regimen: Cryotherapy with liquid nitrogen OR TCA OR BCA 80%–90% solution
- Note: Management of cervical warts should include consultation with a specialist.For women who have exophytic cervical warts, a biopsy evaluation to exclude high-grade SIL must be performed before treatment is initiated.
- 2.4 Intra-anal warts
- Preferred regimen: Cryotherapy with liquid nitrogen OR TCA OR BCA 80%–90% solution
- Note: Management of intra-anal warts should include consultation with a specialist.
- 3. Specific considerations[1]
- 3.1 Management of sex partners
- Persons should inform current partner(s) about having genital warts because the types of HPV that cause warts can be passed on to partners. Partners should receive counseling messages that partners might already have HPV despite no visible signs of warts, so HPV testing of sex partners of persons with genital warts is not recommended.
- 3.2 Pregnancy
- Podofilox (podophyllotoxin), Podophyllin, and Sinecatechins should not be used during pregnancy. Imiquimod appears to pose low risk but should be avoided until more data are available.
- Cesarean delivery is indicated for women with anogenital warts if the pelvic outlet is obstructed or if vaginal delivery would result in excessive bleeding.
- Pregnant women with anogenital warts should be counseled concerning the low risk for warts on the larynx of their infants or children (recurrent respiratory papillomatosis).
- Trichloroacetic acid may be used during pregnancy as it has no known fetal side effects.
- 3.3 HIV infection
- Data do not support altered approaches to treatment for persons with HIV infection.
- Squamous cell carcinomas arising in or resembling anogenital warts might occur more frequently among immunosuppressed persons, therefore requiring biopsy for confirmation of diagnosis for suspicious cases
- 3.4 High-grade squamous intraepithelial lesions
- Biopsy of an atypical wart might reveal HSIL or cancer of the anogenital tract. In this instance, referral to a specialist for treatment is recommended.
Follow-up
- Most anogenital warts respond within 3 months of therapy.
- Factors that might affect response to therapy include immunosuppression and treatment compliance.
- In general, warts located on moist surfaces or in intertriginous areas respond best to topical treatment.
- A new treatment modality should be selected when no substantial improvement is observed after a complete course of treatment or in the event of severe side effects; treatment response and therapy-associated side effects should be evaluated throughout the course of therapy.
References
- ↑ 1.0 1.1 1.2 1.3 1.4 Workowski, Kimberly A.; Bolan, Gail A. (2015-06-05). "Sexually transmitted diseases treatment guidelines, 2015". MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control. 64 (RR-03): 1–137. ISSN 1545-8601. PMID 26042815.
- ↑ Gotovtseva EP, Kapadia AS, Smolensky MH, Lairson DR (2008). "Optimal frequency of imiquimod (aldara) 5% cream for the treatment of external genital warts in immunocompetent adults: a meta-analysis". Sex Transm Dis. 35 (4): 346–51. doi:10.1097/OLQ.0b013e31815ea8d1. PMID 18360317.
- ↑ Garland SM, Waddell R, Mindel A, Denham IM, McCloskey JC (2006). "An open-label phase II pilot study investigating the optimal duration of imiquimod 5% cream for the treatment of external genital warts in women". Int J STD AIDS. 17 (7): 448–52. doi:10.1258/095646206777689161. PMID 16820073.
- ↑ Edwards L, Ferenczy A, Eron L, Baker D, Owens ML, Fox TL; et al. (1998). "Self-administered topical 5% imiquimod cream for external anogenital warts. HPV Study Group. Human PapillomaVirus". Arch Dermatol. 134 (1): 25–30. PMID 9449906.
- ↑ 5.0 5.1 "Veregen: a botanical for treatment of genital warts". Med Lett Drugs Ther. 50 (1280): 15–6. 2008. PMID 18292715.
- ↑ Eron LJ, Judson F, Tucker S, Prawer S, Mills J, Murphy K; et al. (1986). "Interferon therapy for condylomata acuminata". N Engl J Med. 315 (17): 1059–64. doi:10.1056/NEJM198610233151704. PMID 3531860.
- ↑ Bonnez W, Elswick RK, Bailey-Farchione A, Hallahan D, Bell R, Isenberg R; et al. (1994). "Efficacy and safety of 0.5% podofilox solution in the treatment and suppression of anogenital warts". Am J Med. 96 (5): 420–5. PMID 8192173.
- ↑ Brodell LA, Mercurio MG, Brodell RT (2007). "The diagnosis and treatment of human papillomavirus-mediated genital lesions". Cutis. 79 (4 Suppl): 5–10. PMID 17508490.
- ↑ 9.0 9.1 Beutner KR, Reitano MV, Richwald GA, Wiley DJ (1998). "External genital warts: report of the American Medical Association Consensus Conference. AMA Expert Panel on External Genital Warts". Clin Infect Dis. 27 (4): 796–806. PMID 9798036.
- ↑ Beutner KR, Spruance SL, Hougham AJ, Fox TL, Owens ML, Douglas JM (1998). "Treatment of genital warts with an immune-response modifier (imiquimod)". J Am Acad Dermatol. 38 (2 Pt 1): 230–9. PMID 9486679.
- ↑ Tatti S, Swinehart JM, Thielert C, Tawfik H, Mescheder A, Beutner KR (2008). "Sinecatechins, a defined green tea extract, in the treatment of external anogenital warts: a randomized controlled trial". Obstet Gynecol. 111 (6): 1371–9. doi:10.1097/AOG.0b013e3181719b60. PMID 18515521.
- ↑ Friedman-Kien AE, Eron LJ, Conant M, Growdon W, Badiak H, Bradstreet PW; et al. (1988). "Natural interferon alfa for treatment of condylomata acuminata". JAMA. 259 (4): 533–8. PMID 3336177.
- ↑ Dinsmore W, Jordan J, O'Mahony C, Harris JR, McMillan A, Radcliffe KW; et al. (1997). "Recombinant human interferon-beta in the treatment of condylomata acuminata". Int J STD AIDS. 8 (10): 622–8. PMID 9310221.
- ↑ Cook K, Brownell I (2008). "Treatments for genital warts". J Drugs Dermatol. 7 (8): 801–7. PMID 18720702.
- ↑ Böhle A, Büttner H, Jocham D (2001). "Primary treatment of condylomata acuminata with viable bacillus Calmette-Guerin". J Urol. 165 (3): 834–6. PMID 11176481.
- ↑ Metawea B, El-Nashar AR, Kamel I, Kassem W, Shamloul R (2005). "Application of viable bacille Calmette-Guérin topically as a potential therapeutic modality in condylomata acuminata: a placebo-controlled study". Urology. 65 (2): 247–50. doi:10.1016/j.urology.2004.09.025. PMID 15708031.
- ↑ 17.0 17.1 Ting PT, Dytoc MT (2004). "Therapy of external anogenital warts and molluscum contagiosum: a literature review". Dermatol Ther. 17 (1): 68–101. PMID 14756893.