Position statement for the diagnosis and management of anogenital warts

Abstract

Background Anogenital warts ( AGW ) can cause economic burden on healthcare systems and are associated with emotional, psychological and physical issues. Objective To provide guidance to physicians on the diagnosis and management of AGW . Methods Fourteen global experts on AGW developed guidance on the diagnosis and management of AGW in an effort to unify international recommendations. Guidance was developed based on published international and national AGW guidelines and an evaluation of relevant literature published up to August 2016. Authors provided expert opinion based on their clinical experiences. Results A checklist for a patient's initial consultation is provided to help physicians when diagnosing AGW to get the relevant information from the patient in order to manage and treat the AGW effectively. A number of frequently asked questions are also provided to aid physicians when communicating with patients about AGW . Treatment of AGW should be individualized and selected based on the number, size, morphology, location, and keratinization of warts, and whether they are new or recurrent. Different techniques can be used to treat AGW including ablation, immunotherapy and other topical therapies. Combinations of these techniques are thought to be more effective at reducing AGW recurrence than monotherapy. A simplified algorithm was created suggesting patients with 1–5 warts should be treated with ablation followed by immunotherapy. Patients with >5 warts should use immunotherapy for 2 months followed by ablation and a second 2‐month course of immunotherapy. Guidance for daily practice situations and the subsequent action that can be taken, as well as an algorithm for treatment of large warts, were also created. Conclusion The guidance provided will help physicians with the diagnosis and management of AGW in order to improve the health and quality of life of patients with AGW .

A Multicentre, Randomised Clinical Trial to Compare a Topical Nitrizinc® Complex Solution Versus Cryotherapy for the Treatment of Anogenital Warts

“…Our study is innovative in that, to the best of our knowledge, it is the first randomised controlled study to assess the effectiveness of NZCS against another treatment in the treatment of AGW. In our study, the comparator treatment was CRYO, which is one of the reference treatments for AGW [5,21].…”

“…Patients affected with AGW often feel embarrassment, shame, anger, depression and guilt [4]. AGW place an important economic burden on public healthcare as patients have a high number of recurrences and no current therapy provides a satisfactory clearance rate [5,6].…”

Viral metagenomics updated the prevalence of human papillomavirus types in anogenital warts

“…AGWs treatment is expensive and often ineffective. Following AGW clearance with therapy, recurrence is common and is often seen within 3 months in 25% of cases, although rates of up to 67% have been observed [37,38]. Thus, developing effective strategies to prevent and control HPV infection is the most important way to lighten the burden of AGWs.…”

Dermatologists' Management Approach to Sexually Transmitted Disease

“…For small numbers of warts, destructive therapy is utilized first followed by several months of topical therapy; for larger numbers of warts, topical therapy is administered initially, followed by ablative intervention, followed by several additional months of topical therapy. 14 As to the precise modality used in each phase of management, that must be individualized and selected based on the number, size, morphology, location, and degree of keratinization of warts. Of course, prevention is optimal, and the nanovalent HPV vaccine is highly efficacious in this regard.…”