Therapeutic Approaches to Genital Warts

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Abstract

Although many treatments are available for genital warts caused by human papillomavirus (HPV), none are uniformly successful in the treatment of this disease. Most current treatment options work by destroying affected tissue, either by a cytotoxic or a physically ablative mode of action. Interferons have antiviral, antiproliferative, and immunomodulatory activities, but these have not translated into a high level of cure rates against warts. With all current treatments, recurrent warts are common. Therapies currently being investigated include a 5-fluorouracil/epinephrine collagen gel that achieves high concentrations of 5-fluorouracil at the site of injection. Other new treatment modalities focus on activating the host's immune system or improving the delivery of therapeutic compounds to the affected site. Imiquimod, a novel immune-response modifier, induces interferon and a number of other endogenous cytokines. A cream formulation containing 5% imiquimod resulted in good total clearance rates and generally tolerable side effects in controlled clinical trials of patients with external genital warts. Perhaps the most effective means for managing HPV disease would be a vaccine that prevents the occurrence of genital warts. Although it is unlikely that such a vaccine will be introduced in the near future, preliminary studies indicate that it may be possible to develop suitable prophylactic and therapeutic vaccines.

Section snippets

Current Therapies for Genital Warts

Many of the therapies used to treat genital warts have been available for decades. In many cases, the safety and effectiveness of these treatments have not been assessed in well-controlled, prospective clinical trials. Comparative trials of therapies are also relatively rare. The dearth of such information can make it difficult to evaluate the efficacy of different treatment modalities.

Table 1 summarizes selected published data on current genital wart therapies. It should be noted that a number

New Therapies for the Treatment of External Genital Warts

New therapies for genital warts focus on improving delivery of therapeutic agents to genital lesions and stimulating the immune system to combat the virus. These treatments offer exciting options to conventional treatments and may play an important role in future therapeutic decisions.

Prospects for a Vaccine

As a viral disease, HPV infection is a candidate for preventative vaccination.[54]A successful vaccine could potentially reduce the number of cases of HPV-associated genital cancers, particularly cervical malignancies. Current efforts are targeted at the development of prophylactic vaccines to prevent HPV disease and therapeutic vaccines that help boost the host's immune response to HPV-infected cells.

Because HPV cannot be cultured, most attention to date has been focused on the possibility of

Conclusions

A variety of therapies are available for the treatment of genital warts. The best choice of treatment for a given patient depends on the extent and location of disease and the preferences of the clinician and patient.

Current therapies for the treatment of genital warts probably do not eradicate the viral reservoir present in adjacent tissue. Thus, in many cases these treatments are destined to fail, as indicated by the high rate of recurrent infections. Despite the high recurrence rates

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