If possible, the health care provider should apply the initial treatment to demonstrate proper application technique and identify which warts should be treated. Mild to moderate pain or local irritation might develop after treatment. After each treatment, the gel or solution should be allowed to dry. Patients should wash their hands before and after each application. Podofilox is contraindicated during pregnancy Sinecatechins is a patient-applied, green-tea extract with an active product catechins.
The medication should not be washed off after use. Genital, anal, and oral sexual contact should be avoided while the ointment is on the skin.
The most common side effects of sinecatechins are erythema, pruritus or burning, pain, ulceration, edema, induration, and vesicular rash. This medication is not recommended for persons with HIV infection, other immunocompromised conditions, or genital herpes because the safety and efficacy of therapy has not been evaluated.
The safety of sinecatechins during pregnancy is unknown. Cryotherapy is a provider-administered therapy that destroys warts by thermal-induced cytolysis. Health care providers should be trained on the correct use of this therapy because overtreatment or undertreatment can result in complications or low efficacy.
Pain during and after application of the liquid nitrogen, followed by necrosis and sometimes blistering, is common. Local anesthesia topical or injected might facilitate therapy if warts are present in many areas or if the area of warts is large.
Surgical therapy has the advantage of eliminating the majority of warts at a single visit, although recurrence can occur. Surgical removal requires substantial clinical training, additional equipment, and sometimes a longer office visit.
After local anesthesia is applied, anogenital warts can be physically destroyed by electrocautery, in which case no additional hemostasis is required. Care should be taken to control the depth of electrocautery to prevent scarring. Alternatively, the warts can be removed either by tangential excision with a pair of fine scissors or a scalpel, by CO 2 laser, or by curettage.
Because most warts are exophytic, this procedure can be accomplished with a resulting wound that only extends into the upper dermis. Hemostasis can be achieved with an electrocautery unit or, in cases of minor bleeding, a chemical styptic e.
Suturing is neither required nor indicated in the majority of cases. For patients with large or extensive warts, surgical therapy, including CO 2 laser, might be most beneficial; such therapy might also be useful for intraurethral warts, particularly for those persons whose warts have not responded to other treatments.
Trichloroacetic acid TCA and bichloroacetic acid BCA are provider-administered caustic agents that destroy warts by chemical coagulation of proteins. Although these preparations are widely used, they have not been investigated thoroughly. TCA solution has a low viscosity, comparable with that of water, and can spread rapidly and damage adjacent tissues if applied excessively.
A small amount should be applied only to the warts and allowed to dry i. If pain is intense or an excess amount of acid is applied, the area can be covered with sodium bicarbonate i. Fewer data are available regarding the efficacy of alternative regimens for treating anogenital warts, which include podophyllin resin, intralesional interferon, photodynamic therapy, and topical cidofovir. Shared clinical decision-making between the patient and provider regarding benefits and risks of these regimens should be provided.
In addition, alternative regimens might be associated with more side effects. Podophyllin resin is no longer a recommended regimen because of the number of safer regimens available, and severe systemic toxicity has been reported when podophyllin resin was applied to large areas of friable tissue and was not washed off within 4 hours — Podophyllin should be applied to each wart and then allowed to air dry before the treated area comes into contact with clothing.
Overapplication or failure to air dry can result in local irritation caused by spread of the compound to adjacent areas and possible systemic toxicity. The treatment can be repeated weekly, if necessary.
Podophyllin resin preparations differ in the concentration of active components and contaminants. Shelf life and stability of podophyllin preparations are unknown.
The safety of podophyllin during pregnancy has not been established. Cryotherapy with liquid nitrogen. The use of a cryoprobe in the vagina is not recommended because of the risk for vaginal perforation and fistula formation. Management of cervical warts should include consultation with a specialist. For women who have exophytic cervical warts, a biopsy evaluation to exclude HSIL should be performed before treatment is initiated.
Management of intra-anal warts should include consultation with a colorectal specialist. Anogenital warts typically respond within 3 months of therapy. Factors that might affect response to therapy include immunosuppression and treatment compliance.
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 therapy course. Complications occur rarely when treatment is administered correctly.
Persistent hypopigmentation or hyperpigmentation can occur with ablative modalities e. Genital warts usually appear as a small bump or group of bumps in the genital area. They can be small or large, raised or flat, or shaped like a cauliflower.
A healthcare provider can usually diagnose warts by looking at the genital area. HPV can cause cervical and other cancers , including cancer of the vulva, vagina, penis, or anus. It can also cause cancer in the back of the throat called oropharyngeal cancer. This can include the base of the tongue and tonsils. Cancer often takes years, even decades, to develop after a person gets HPV.
Genital warts and cancers result from different types of HPV. There is no way to know who will develop cancer or other health problems from HPV. They may also be more likely to develop health problems from HPV. Get vaccinated. The HPV vaccine is safe and effective. It can protect against diseases including cancers caused by HPV when given in the recommended age groups. Get screened for cervical cancer.
Routine screening for women aged 21 to 65 years old can prevent cervical cancer. Vaccination is not recommended for everyone older than age 26 years. However, some adults age 27 through 45 years who are not already vaccinated may decide to get the HPV vaccine after speaking with their healthcare provider about their risk for new HPV infections and the possible benefits of vaccination.
HPV vaccination in this age range provides less benefit. Most sexually active adults have already been exposed to HPV, although not necessarily all of the HPV types targeted by vaccination. At any age, having a new sex partner is a risk factor for getting a new HPV infection. People who are already in a long-term, mutually monogamous relationship are not likely to get a new HPV infection.
There are HPV tests that can screen for cervical cancer. These include:. All of these cancers come from HPV infections that did not go away. Cancer grows very slowly. The diagnosis may not be until years, or even decades, after a person gets HPV. Currently, there is no way to know who will get cancer after getting HPV. CDC also does not recommend routine testing for diseases from HPV before there are signs or symptoms in men. Some healthcare providers offer anal Pap tests to men who may be at greater risk for anal cancer.
This includes men with HIV or men who receive anal sex. If you have symptoms and have concerns about cancer, please see a healthcare provider. There is no specific treatment for HPV. But, there are treatments for health problems that develop from HPV. Your healthcare provider can treat genital warts with prescription medication.
Cancers from HPV are more treatable when found and treated early. For more information, visit www. Vaccination is not recommended for everyone older than age 26 years. However, some adults age 27 through 45 years who are not already vaccinated may decide to get the HPV vaccine after speaking with their healthcare provider about their risk for new HPV infections and the possible benefits of vaccination.
HPV vaccination for ages 27 through 45 provides less benefit. At any age, having a new sex partner is a risk factor for getting a new HPV infection. People who are already in a long-term, mutually monogamous relationship are not likely to get a new HPV infection.
Learn more about who should get an HPV vaccine. If you or your partner have genital warts, stop having sex until you no longer have warts.
0コメント