Anogenital warts: an update on human papilloma virus, clinical manifestations and treatment strategies

Arzu Kilic; Ulku Mete Ural

doi:10.33204/mucosa.580103

Review

Anogenital warts: an update on human papilloma virus, clinical manifestations and treatment strategies

Year 2019, , 30 - 40, 29.06.2019

Arzu Kilic , Ulku Mete Ural

https://doi.org/10.33204/mucosa.580103

Abstract

Anogenital warts is a major health problem caused by human papillomavirus (HPV). To date, more than 200 subtypes of HPV exist.  Depending on the type of HPV and the immune status of the patient, various clinical forms may appear. The most detected types are HPV 6 and 11 which are responsible for approximately 90% of anogenital warts. High oncogenic strains HPV types 16 and 18 are responsible not only for servical cancer but also other cancers such as vagina, vulva, penis, anus, head and neck.   Besides, anogenital warts impact the individual’s quality of life leading significant psychosocial problems.  Treatment options for anogenital warts include cytodestructive,  immune-mediated and surgical therapies.  Treatment choice depends on the location, number, and size of the warts; patient situation (eg, pregnancy, ability to comply with therapy, immunsuppression); availability of clinical expertise; and patient preferences, cost, and convenience.   This article updates the epidemiological, etiological, clinical features and therapeutic choices in anogenital warts.

Özet

Keywords

anogenital warts, hpv

References

1. Yanofsky VR, Patel RV, Goldenberg G. Genital warts: a comprehensive review. J Clin Aesthet Dermatol. 2012;5:25-36.
2. Bhatia N, Lynde C, Vender R, Bourcier M. Understanding genital warts: epidemiology, pathogenesis, and burden of disease of human papillomavirus. J Cutan Med Surg 2013;17 Suppl 2:47-54.
3. Kirnbauer R, Lenz P. Human papillomaviruses. In: Dermatology (Bolognia JL, Jorizzo JL, Schaffer JV, eds.), 3rd ed. Elsevier Saunders, 2012;1383-99.
4. Leszczyszyn J, Lebski I, Lysenko L, Hirnle L, Gerber H. Anal warts (condylomata acuminata) - current issues and treatment modalities. Adv Clin Exp Med 2014;23:307-11.
5. Steben M, Duarte-Franco E. Human papillomavirus infection: epidemiology and pathophysiology. Gynecol Oncol 2007;107:2-5.
6. Tchernev G. Sexually transmitted papillomavirus infections: epidemiology pathogenesis, clinic, morphology, important differential diagnostic aspects, current diagnostic and treatment options. An Bras Dermatol 2009;84:377-89.
7. Patel H, Wagner M, Singhal P, Kothari S. Systematic review of the incidence and prevalence of genital warts. BMC Infect Dis 2013;13:39.
8. Leung AK, Barankin B, Leong KF, Hon KL. Penile warts: an update on their evaluation and management. Drugs Context 2018;7:212563.
9. Berman TA, Schiller JT. Human papillomavirus in cervical cancer and oropharyngeal cancer: One cause, two diseases. Cancer 2017;123:2219-29.
10. Costa-Silva M, Fernandes I, Rodrigues AG, Lisboa C. Anogenital warts in pediatric population. An Bras Dermatol 2017;92:675-81.
11. Harden ME, Munger K. Human papillomavirus molecular biology. Mutat Res Rev Mutat Res 2017;772:3-12.
12. Graham SV. The human papillomavirus replication cycle, and its links to cancer progression: a comprehensive review. Clin Sci 2017;131:2201-21.
13. Woappi Y, Hosseinipour M, Creek KE, Pirisi L. Stem cell properties of normal human keratinocytes determine transformation responses to human papillomavirus 16 DNA. J Virol 2018;92:e00331-18.
14. Maglennon GA, McIntosh P, Doorbar J. Persistence of viral DNA in the epithelial basal layer suggests a model for papillomavirus latency following immune regression. Virology 2011;414:153-63.
15. Gravitt PE, Winer RL. Natural History of HPV Infection across the Lifespan: Role of Viral Latency. Viruses 2017;9:267.
16. Sporkert M, Rubben A. Buschke-Lowenstein tumors. Hautarzt 2017;68:199-203.
17. Hornor G. Ano-genital warts in children: Sexual abuse or not?. J Pediatr Health Care 2004;18:165-70.
18. Ambuhl LM, Baandrup U, Dybkær K, et al. Human papillomavirus infection as a possible cause of spontaneous abortion and spontaneous preterm delivery. Infect Dis Obstet Gynecol 2016;2016:3086036.
19. Mammas IN, Dalianis T, Doukas SG, et al. Paediatric virology and human papillomaviruses: An update. Exp Ther Med 2019;17:4337-43.
20. Gormley RH, Kovarik CL. Human papillomavirus- related genital disease in the immunocompromised host: Part I.J Am Acad Dermatol 2012;66:867.
21. Maw RD, Reitano M, Roy M. An international survey of patients with genital warts: perceptions regarding treatment and impact on lifestyle. Int J STD AIDS 1998;9:571-8.
22. Mortensen GL, Larsen HK. The quality of life of patients with genital warts: a qualitative study. BMC Public Health 2010;10:113.
23. Sturgiss EA, Jin F, Martin SJ, Grulich A, Bowden FJ. Prevalence of other sexually transmissible infections in patients with newly diagnosed anogenital warts in a sexual health clinic. Sex Health 2010;7:55-9.
24. de Sanjose S, Quint WG, Alemany L, et al; Retrospective International Survey and HPV Time Trends Study Group. Human papillomavirus genotype attribution in invasive cervical cancer: a retrospective cross-sectional worldwide study. Lancet Oncol 2010;11:1048-56.
25. Chan PK, Picconi MA, Cheung TH, Giovannelli L, Park JS. Laboratory and clinical aspects of human papillomavirus testing. Crit Rev Clin Lab Sci 2012;49:117-36.
26. Gross G. Genitoanal human papillomavirus infection and associated neoplasias. Curr Probl Dermatol 2014;45:98-122.
27. Serrano B, Brotons M, Bosch FX, Bruni L. Epidemiology and burden of HPV-related disease. Best Pract Res Clin Obstet Gynaecol 2018;47:14-26.
28. Shimizu A, Kuriyama Y, Hasegawa M, Tamura A, Ishikawa O. Nail Squamous Cell Carcinoma: A hidden high-risk HPV reservoir for sexually transmitted infections. J Am Acad Dermatol 2019. pii: S0190-9622(19)30514-6.
29. Cho CY, Lo YC, Hung MC, et al. Risk of cancer in patients with genital warts: A nationwide, population- based cohort study in Taiwan. PLoS One 2017;12:e0183183.
30. Blomberg M, Friis S, Munk C, Bautz A, Kjaer SK. Genital warts and risk of cancer: a Danish study of nearly 50 000 patients with genital warts. J Infect Dis 2012;205:1544-53.
31. Chae JY, Bae JH, Yoon CY, et al.Female urethral condyloma causing bladder outlet obstruction. Int Neurourol J 2014;18:42-4.
32. Steben M, LaBelle D. Genital warts: Canadians’ perception, health-related behaviors, and treatment preferences. J Low Genit Tract Dis 2012;16:409-15.
33. Workowski KA, Bolan GA, Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep 2015;64:1-137.
34. Lacey CJ, Woodhall SC, Wikstrom A, Ross J. 2012 European guideline for the management of anogenital warts. J Eur Acad Dermatol Venereol 2013;27:263-70.
35. Schoenfeld A, Ziv E, Levavi H, et al. Laser versus loop electrosurgical excision in vulvar condyloma for eradication of subclinical reservoir demonstrated by assay for 2’5’ oligosynthetase human papillomavirus. Gynecol Obstet Invest 1995;40:46-51.
36. Ferenczy A, Mitao M, Nagai N, et al. Latent papillomavirus and recurring genital warts. N Engl J Med 1985;313:784-8.
37. Stern PL, van der Burg SH, Hampson IN, et al. Therapy of human papillomavirus-related disease. Vaccine 2012;5:71-82.
38. Sycuro LK, Xi LF, Hughes JP, et al. Persistence of genital human papillomavirus infection in a longterm follow-up study of female university students. J Infect Dis 2008;198:971-8.
39. American College of Obstetricians and Gynecologists. ACOG Practice Bulletin. Clinical management guidelines for obstetrician-gynecologists. Number 61, April 2005. Human papillomavirus. Obstet Gynecol 2005;105:905-18.
40. Vance JC, Davis D. Interferon alpha-2b injections used as an adjuvant therapy to carbon dioxide laser vaporization of recalcitrant ano-genital condylomata acuminata. J Invest Dermatol 1990;95:146-8.
41. Beutner KR, Reitano MV, Richwald GA, Wiley DJ. External genital warts: report of the American Medical Association Consensus Conference. AMA Expert Panel on External Genital Warts. Clin Infect Dis 1998;27:796-806.
42. Gunter J. Genital and perianal warts: new treatment opportunities for human papillomavirus infection. Am J Obstet Gynecol 2003;189:3-11.
43. Bonnez W, Elswick RK Jr, Bailey-Farchione A, et al. Efficacy and safety of 0.5% podofilox solution in the treatment and suppression of anogenital warts. Am J Med 1994;96:420-5.
44. Abdullah AN, Walzman M, Wade A. Treatment of external genital warts comparing cryotherapy (liquid nitrogen) and trichloroacetic acid. Sex Transm Dis 1993;20:344-5.
45. Swinehart JM, Skinner RB, McCarty JM, et al. Development of intralesional therapy with fluorouracil/ adrenaline injectable gel for management of condylomata acuminata: two phase II clinical studies. Genitourin Med 1997;73:481-7.
46. Heaton CL. Clinical manifestations and modern management of condylomata acuminata: a dermatologic perspective. Am J Obstet Gynecol 1995;172:1344-50.
47. Pride GL. Treatment of large lower genital tract condylomata acuminata with topical 5-fluorouracil. J Reprod Med 1990;35:384-7.
48. Krebs HB. Treatment of genital condylomata with topical 5-fluorouracil. Dermatol Clin 1991;9:333-41.
49. Gotovtseva EP, Kapadia AS, Smolensky MH, Lairson DR. Optimal frequency of imiquimod (aldara) 5% cream for the treatment of external genital warts in immunocompetent adults: a meta-analysis. Sex Transm Dis 2008;35:346-51.
50. Garland SM, Waddell R, Mindel A, et al. 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 2006;17:448-52.
51. Meltzer SM, Monk BJ, Tewari KS. Green tea catechins for treatment of external genital warts. Am J Obstet Gynecol 2009;200:233.
52. Dinsmore W, Jordan J, O’Mahony C, et al. Recombinant human interferon-beta in the treatment of condylomata acuminata. Int J STD AIDS 1997;8:622-8.
53. Recurrent condylomata acuminata treated with recombinant interferon alfa-2a. A multicenter double- blind placebo-controlled clinical trial. Condylomata international collaborative study group. JAMA 1991;265:2684-7.
54. Reichman RC, Oakes D, Bonnez W, et al. Treatment of condyloma acuminatum with three different interferon- alpha preparations administered parenterally: a double-blind, placebo-controlled trial. J Infect Dis 1990;162:1270-6.
55. Olmos L, Vilata J, Rodriguez Pichardo A, et al. Double- blind, randomized clinical trial on the effect of interferon-beta in the treatment of condylomata acuminata. Int J STD AIDS 1994;5:182-5.
56. Syed TA, Khayyami M, Kriz D, et al. Management of genital warts in women with human leukocyte interferon- alpha vs. podophyllotoxin in cream: a placebo- controlled, double-blind, comparative study. J Mol Med (Berl) 1995;73:255-8.
57. Wiley DJ, Douglas J, Beutner K, et al. External genital warts: diagnosis, treatment, and prevention. Clin Infect Dis 2002;35:210-24.
58. Cook K, Brownell I. Treatments for genital warts. J Drugs Dermatol 2008;7:801-7.
59. Bohle A, Buttner H, Jocham D. Primary treatment of condylomata acuminata with viable bacillus Calmette-Guerin. J Urol 2001;165:834-6.
60. Metawea B, El-Nashar AR, Kamel I, et al. Application of viable bacille Calmette-Guerin topically as a potential therapeutic modality in condylomata acuminata: a placebo-controlled study. Urology 2005;65:247-50.
61. Ting PT, Dytoc MT. Therapy of external anogenital warts and molluscum contagiosum: a literature review. Dermatol Ther 2004;17:68-101.
62. Bellina JH. The use of the carbon dioxide laser in the management of condyloma acuminatum with eightyear follow-up. Am J Obstet Gynecol 1983;147:375-8.
63. Baggish MS. Improved laser techniques for the elimination of genital and extragenital warts. Am J Obstet Gynecol 1985;153:545-50.
64. Ferenczy A. Laser therapy of genital condylomata acuminata. Obstet Gynecol 1984;63:703-7.
65. Ferenczy A, Bergeron C, Richart RM. Carbon dioxide laser energy disperses human papillomavirus deoxyribonucleic acid onto treatment fields. Am J Obstet Gynecol 1990;163:1271-4.
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Anogenital siğiller: İnsan papilloma virüsü, klinik bulguları ve tedavi stratejileri üzerine bir güncelleme

Year 2019, , 30 - 40, 29.06.2019

Arzu Kilic , Ulku Mete Ural

https://doi.org/10.33204/mucosa.580103

Abstract

Anogenital siğiller insan papilloma virüsünün (HPV) neden olduğu önemli bir sağlık sorunudur. Bugüne kadar, 200’den fazla İPV saptanmıştır. HPV tipine ve hastanın bağışıklık durumuna bağlı olarak, anogenital siğillerde çeşitli klinik formlar gözlenebilir. En çok tespit edilen tipler HPV-6 ve HPV 11 olup anogenital siğillerin yaklaşık% 90'ından sorumludur. Yüksek onkojenik suşlar HPV tip 16 ve 18 sadece servikal kanserden değil, vajina, vulva, penis, anüs, baş ve boyun gibi diğer kanserlerden de sorumludur. Ayrıca, anogenital siğiller, bireyin yaşam kalitesini etkileyerek önemli psikososyal sorunlara neden olur. Anogenital siğiller için tedavi seçenekleri arasında desktrüktif, immün modülatör ve cerrahi tedaviler bulunmaktadır. Tedavi seçimi siğillerin yeri, sayısı ve büyüklüğüne; hastanın durumuna (örneğin, hamilelik, tedaviye uyma yeteneği, immün baskılama); klinisyenin tecrübesine; ve hastanın tercihleri ve rahatlığına bağlıdır. Bu makale anogenital siğillerdeki epidemiyolojik, etiyolojik, klinik özellikleri ve tedavi seçeneklerini güncellemektedir.

Keywords

anogenital siğil, human papillomavirüs

References

1. Yanofsky VR, Patel RV, Goldenberg G. Genital warts: a comprehensive review. J Clin Aesthet Dermatol. 2012;5:25-36.
2. Bhatia N, Lynde C, Vender R, Bourcier M. Understanding genital warts: epidemiology, pathogenesis, and burden of disease of human papillomavirus. J Cutan Med Surg 2013;17 Suppl 2:47-54.
3. Kirnbauer R, Lenz P. Human papillomaviruses. In: Dermatology (Bolognia JL, Jorizzo JL, Schaffer JV, eds.), 3rd ed. Elsevier Saunders, 2012;1383-99.
4. Leszczyszyn J, Lebski I, Lysenko L, Hirnle L, Gerber H. Anal warts (condylomata acuminata) - current issues and treatment modalities. Adv Clin Exp Med 2014;23:307-11.
5. Steben M, Duarte-Franco E. Human papillomavirus infection: epidemiology and pathophysiology. Gynecol Oncol 2007;107:2-5.
6. Tchernev G. Sexually transmitted papillomavirus infections: epidemiology pathogenesis, clinic, morphology, important differential diagnostic aspects, current diagnostic and treatment options. An Bras Dermatol 2009;84:377-89.
7. Patel H, Wagner M, Singhal P, Kothari S. Systematic review of the incidence and prevalence of genital warts. BMC Infect Dis 2013;13:39.
8. Leung AK, Barankin B, Leong KF, Hon KL. Penile warts: an update on their evaluation and management. Drugs Context 2018;7:212563.
9. Berman TA, Schiller JT. Human papillomavirus in cervical cancer and oropharyngeal cancer: One cause, two diseases. Cancer 2017;123:2219-29.
10. Costa-Silva M, Fernandes I, Rodrigues AG, Lisboa C. Anogenital warts in pediatric population. An Bras Dermatol 2017;92:675-81.
11. Harden ME, Munger K. Human papillomavirus molecular biology. Mutat Res Rev Mutat Res 2017;772:3-12.
12. Graham SV. The human papillomavirus replication cycle, and its links to cancer progression: a comprehensive review. Clin Sci 2017;131:2201-21.
13. Woappi Y, Hosseinipour M, Creek KE, Pirisi L. Stem cell properties of normal human keratinocytes determine transformation responses to human papillomavirus 16 DNA. J Virol 2018;92:e00331-18.
14. Maglennon GA, McIntosh P, Doorbar J. Persistence of viral DNA in the epithelial basal layer suggests a model for papillomavirus latency following immune regression. Virology 2011;414:153-63.
15. Gravitt PE, Winer RL. Natural History of HPV Infection across the Lifespan: Role of Viral Latency. Viruses 2017;9:267.
16. Sporkert M, Rubben A. Buschke-Lowenstein tumors. Hautarzt 2017;68:199-203.
17. Hornor G. Ano-genital warts in children: Sexual abuse or not?. J Pediatr Health Care 2004;18:165-70.
18. Ambuhl LM, Baandrup U, Dybkær K, et al. Human papillomavirus infection as a possible cause of spontaneous abortion and spontaneous preterm delivery. Infect Dis Obstet Gynecol 2016;2016:3086036.
19. Mammas IN, Dalianis T, Doukas SG, et al. Paediatric virology and human papillomaviruses: An update. Exp Ther Med 2019;17:4337-43.
20. Gormley RH, Kovarik CL. Human papillomavirus- related genital disease in the immunocompromised host: Part I.J Am Acad Dermatol 2012;66:867.
21. Maw RD, Reitano M, Roy M. An international survey of patients with genital warts: perceptions regarding treatment and impact on lifestyle. Int J STD AIDS 1998;9:571-8.
22. Mortensen GL, Larsen HK. The quality of life of patients with genital warts: a qualitative study. BMC Public Health 2010;10:113.
23. Sturgiss EA, Jin F, Martin SJ, Grulich A, Bowden FJ. Prevalence of other sexually transmissible infections in patients with newly diagnosed anogenital warts in a sexual health clinic. Sex Health 2010;7:55-9.
24. de Sanjose S, Quint WG, Alemany L, et al; Retrospective International Survey and HPV Time Trends Study Group. Human papillomavirus genotype attribution in invasive cervical cancer: a retrospective cross-sectional worldwide study. Lancet Oncol 2010;11:1048-56.
25. Chan PK, Picconi MA, Cheung TH, Giovannelli L, Park JS. Laboratory and clinical aspects of human papillomavirus testing. Crit Rev Clin Lab Sci 2012;49:117-36.
26. Gross G. Genitoanal human papillomavirus infection and associated neoplasias. Curr Probl Dermatol 2014;45:98-122.
27. Serrano B, Brotons M, Bosch FX, Bruni L. Epidemiology and burden of HPV-related disease. Best Pract Res Clin Obstet Gynaecol 2018;47:14-26.
28. Shimizu A, Kuriyama Y, Hasegawa M, Tamura A, Ishikawa O. Nail Squamous Cell Carcinoma: A hidden high-risk HPV reservoir for sexually transmitted infections. J Am Acad Dermatol 2019. pii: S0190-9622(19)30514-6.
29. Cho CY, Lo YC, Hung MC, et al. Risk of cancer in patients with genital warts: A nationwide, population- based cohort study in Taiwan. PLoS One 2017;12:e0183183.
30. Blomberg M, Friis S, Munk C, Bautz A, Kjaer SK. Genital warts and risk of cancer: a Danish study of nearly 50 000 patients with genital warts. J Infect Dis 2012;205:1544-53.
31. Chae JY, Bae JH, Yoon CY, et al.Female urethral condyloma causing bladder outlet obstruction. Int Neurourol J 2014;18:42-4.
32. Steben M, LaBelle D. Genital warts: Canadians’ perception, health-related behaviors, and treatment preferences. J Low Genit Tract Dis 2012;16:409-15.
33. Workowski KA, Bolan GA, Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep 2015;64:1-137.
34. Lacey CJ, Woodhall SC, Wikstrom A, Ross J. 2012 European guideline for the management of anogenital warts. J Eur Acad Dermatol Venereol 2013;27:263-70.
35. Schoenfeld A, Ziv E, Levavi H, et al. Laser versus loop electrosurgical excision in vulvar condyloma for eradication of subclinical reservoir demonstrated by assay for 2’5’ oligosynthetase human papillomavirus. Gynecol Obstet Invest 1995;40:46-51.
36. Ferenczy A, Mitao M, Nagai N, et al. Latent papillomavirus and recurring genital warts. N Engl J Med 1985;313:784-8.
37. Stern PL, van der Burg SH, Hampson IN, et al. Therapy of human papillomavirus-related disease. Vaccine 2012;5:71-82.
38. Sycuro LK, Xi LF, Hughes JP, et al. Persistence of genital human papillomavirus infection in a longterm follow-up study of female university students. J Infect Dis 2008;198:971-8.
39. American College of Obstetricians and Gynecologists. ACOG Practice Bulletin. Clinical management guidelines for obstetrician-gynecologists. Number 61, April 2005. Human papillomavirus. Obstet Gynecol 2005;105:905-18.
40. Vance JC, Davis D. Interferon alpha-2b injections used as an adjuvant therapy to carbon dioxide laser vaporization of recalcitrant ano-genital condylomata acuminata. J Invest Dermatol 1990;95:146-8.
41. Beutner KR, Reitano MV, Richwald GA, Wiley DJ. External genital warts: report of the American Medical Association Consensus Conference. AMA Expert Panel on External Genital Warts. Clin Infect Dis 1998;27:796-806.
42. Gunter J. Genital and perianal warts: new treatment opportunities for human papillomavirus infection. Am J Obstet Gynecol 2003;189:3-11.
43. Bonnez W, Elswick RK Jr, Bailey-Farchione A, et al. Efficacy and safety of 0.5% podofilox solution in the treatment and suppression of anogenital warts. Am J Med 1994;96:420-5.
44. Abdullah AN, Walzman M, Wade A. Treatment of external genital warts comparing cryotherapy (liquid nitrogen) and trichloroacetic acid. Sex Transm Dis 1993;20:344-5.
45. Swinehart JM, Skinner RB, McCarty JM, et al. Development of intralesional therapy with fluorouracil/ adrenaline injectable gel for management of condylomata acuminata: two phase II clinical studies. Genitourin Med 1997;73:481-7.
46. Heaton CL. Clinical manifestations and modern management of condylomata acuminata: a dermatologic perspective. Am J Obstet Gynecol 1995;172:1344-50.
47. Pride GL. Treatment of large lower genital tract condylomata acuminata with topical 5-fluorouracil. J Reprod Med 1990;35:384-7.
48. Krebs HB. Treatment of genital condylomata with topical 5-fluorouracil. Dermatol Clin 1991;9:333-41.
49. Gotovtseva EP, Kapadia AS, Smolensky MH, Lairson DR. Optimal frequency of imiquimod (aldara) 5% cream for the treatment of external genital warts in immunocompetent adults: a meta-analysis. Sex Transm Dis 2008;35:346-51.
50. Garland SM, Waddell R, Mindel A, et al. 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 2006;17:448-52.
51. Meltzer SM, Monk BJ, Tewari KS. Green tea catechins for treatment of external genital warts. Am J Obstet Gynecol 2009;200:233.
52. Dinsmore W, Jordan J, O’Mahony C, et al. Recombinant human interferon-beta in the treatment of condylomata acuminata. Int J STD AIDS 1997;8:622-8.
53. Recurrent condylomata acuminata treated with recombinant interferon alfa-2a. A multicenter double- blind placebo-controlled clinical trial. Condylomata international collaborative study group. JAMA 1991;265:2684-7.
54. Reichman RC, Oakes D, Bonnez W, et al. Treatment of condyloma acuminatum with three different interferon- alpha preparations administered parenterally: a double-blind, placebo-controlled trial. J Infect Dis 1990;162:1270-6.
55. Olmos L, Vilata J, Rodriguez Pichardo A, et al. Double- blind, randomized clinical trial on the effect of interferon-beta in the treatment of condylomata acuminata. Int J STD AIDS 1994;5:182-5.
56. Syed TA, Khayyami M, Kriz D, et al. Management of genital warts in women with human leukocyte interferon- alpha vs. podophyllotoxin in cream: a placebo- controlled, double-blind, comparative study. J Mol Med (Berl) 1995;73:255-8.
57. Wiley DJ, Douglas J, Beutner K, et al. External genital warts: diagnosis, treatment, and prevention. Clin Infect Dis 2002;35:210-24.
58. Cook K, Brownell I. Treatments for genital warts. J Drugs Dermatol 2008;7:801-7.
59. Bohle A, Buttner H, Jocham D. Primary treatment of condylomata acuminata with viable bacillus Calmette-Guerin. J Urol 2001;165:834-6.
60. Metawea B, El-Nashar AR, Kamel I, et al. Application of viable bacille Calmette-Guerin topically as a potential therapeutic modality in condylomata acuminata: a placebo-controlled study. Urology 2005;65:247-50.
61. Ting PT, Dytoc MT. Therapy of external anogenital warts and molluscum contagiosum: a literature review. Dermatol Ther 2004;17:68-101.
62. Bellina JH. The use of the carbon dioxide laser in the management of condyloma acuminatum with eightyear follow-up. Am J Obstet Gynecol 1983;147:375-8.
63. Baggish MS. Improved laser techniques for the elimination of genital and extragenital warts. Am J Obstet Gynecol 1985;153:545-50.
64. Ferenczy A. Laser therapy of genital condylomata acuminata. Obstet Gynecol 1984;63:703-7.
65. Ferenczy A, Bergeron C, Richart RM. Carbon dioxide laser energy disperses human papillomavirus deoxyribonucleic acid onto treatment fields. Am J Obstet Gynecol 1990;163:1271-4.
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Details

Primary Language	English
Subjects	Clinical Sciences
Journal Section	Review Articles
Authors	Arzu Kilic Ulku Mete Ural This is me 0000-0001-6163-6756
Publication Date	June 29, 2019
Published in Issue	Year 2019

Cite

Vancouver	Kilic A, Mete Ural U. Anogenital warts: an update on human papilloma virus, clinical manifestations and treatment strategies. Mucosa. 2019;2(2):30-4.

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