Papillomavirus Medication

The medications used to treat human papillomavirus (HPV) infections primarily are designed to ablate the lesion because of their corrosive properties.

Class Summary

Treatment of anogenital warts results in necrosis of visible wart tissue. The exact mechanism of action is unknown. Genital warts are epidemiologically associated with cervical carcinoma.

Podofilox (Condylox, Podophyllotoxin)

Topical antimitotic that can be synthesized chemically or purified from plant families Coniferae and Berberidaceae (eg, species of Juniperus and Podophyllum).

Limit treatment to < 10 cm² of wart tissue and to < 0.5 mL of solution per day. This is a patient-applied therapy.

Podophyllum resin (Pod-Ben-25, Podofin)

Cytotoxic agent that results in necrosis when applied to anogenital warts. Arrests mitosis in metaphase; active agent is podophyllotoxin. It is a powdered mixture of resins removed from Mayapple or Mandrake (Podophyllum peltatum Linne). American podophyllum contains one fourth of the amount of the Indian source.

Only a trained medical professional can apply it, and it cannot be dispensed to a patient.

Class Summary

These are topical preparations that contain the fluorinated pyrimidine 5-fluorouracil. These are antineoplastic and antimetabolite agents.

Fluorouracil topical (Efudex)

Primary indication of 5-fluorouracil is topical treatment of actinic keratoses. Not FDA-approved for treatment of warts; however, has been used in adults.

Solution contains either 2% or 5% fluorouracil in propylene glycol, tris (hydroxymethyl) aminomethane, hydroxypropyl cellulose, paraben, and disodium edetate. Cream is 5% in white petrolatum, stearyl alcohol, propylene glycol, polysorbate 60, and paraben.

When applied to lesion, the area undergoes a sequence of erythema, vesiculation, desquamation, erosion, and reepithelialization.

Class Summary

Trichloroacetic acid is a highly corrosive desiccating agent that is used to burn lesions.

Trichloroacetic acid 85% (Tri-Chlor)

Cauterizes skin, keratin, and other tissues. Although caustic, causes less local irritation and systemic toxicity than other agents in the same class. However, response often is incomplete, and reoccurrence is frequent.

Class Summary

These agents are naturally produced proteins with antiviral, antitumor, and immunomodulatory actions. Alfa, beta, and gamma interferons may be administered topically, systemically, and intralesionally.

Interferon alfa-n3 (Alferon N)

Protein product manufactured by recombinant DNA technology that uses a genetically engineered Escherichia coli bacterium. Mechanisms by which it exerts antiviral activity are not clearly understood. However, modulation of the host immune response may play an important role.

Class Summary

These agents stimulate key factors of the immune system.

Imiquimod (Aldara)

Imidazoquinolinamine derivative with no in vitro antiviral activity but does induce macrophages to secrete cytokines (eg, IL-2, IFN-γ). Imiquimod has been studied extensively and is a new therapy relative to other external genital wart (EGW) treatments.

Imiquimod has been studied extensively and is a new therapy relative to other EGW treatments.

Dispensed as an individual dose. Patients are advised to wash affected area with mild soap and water upon awakening and to remove residual drug.

Class Summary

Two human papillomavirus (HPV) vaccines are now available for the prevention of HPV-associated dysplasias and neoplasia, including cervical cancer, genital warts (condyloma acuminata), and precancerous genital lesions.^[2] Girls and women aged 9-26 years should receive the complete immunization series of 3 doses at 0, 2, and 6 months. Vaccination is also recommended for all boys aged 11 or 12 years and males aged 13 through 21 years who have not been vaccinated previously.^[3]

Papillomavirus vaccine (Gardasil)

Quadrivalent HPV recombinant vaccine. First vaccine indicated to prevent cervical cancer, genital warts (condyloma acuminata), and precancerous genital lesions (eg, cervical adenocarcinoma in situ; cervical intraepithelial neoplasia grades 1, 2, and 3; vulvar intraepithelial neoplasia grades 2 and 3; vaginal intraepithelial neoplasia grades 2 and 3) due to HPV types 6, 11, 16, and 18. It contains HPV L1 protein of the virus that self-assembles into empty capsids. Vaccine efficacy, mediated by humoral immune responses following immunization series, is >90%. Indicated for prevention of condyloma acuminata caused by HPV types 6 and 11 in boys, men, girls, and women aged 9-26 years. Also indicated for prevention of anal cancer and associated precancerous lesions in people aged 9-26 years.

Papillomavirus vaccine, bivalent (Cervarix)

Recombinant HPV vaccine prepared from L1 protein of HPV types 16 and 18. Indicated in girls and women (aged 10-25 y) for prevention of diseases caused by oncogenic HPV types 16 and 18 (ie, cervical cancer, cervical intraepithelial neoplasia grade 2 or higher, adenocarcinoma in situ, cervical intraepithelial grade 1).

Class Summary

Kunecatechins is another FDA-approved topical product for genital warts.

Kunecatechins (Veregen)

Botanical drug product for topical use that consists of extract from green tea leaves. Mode of action unknown but does elicit antioxidant activity in vitro. Indicated for topical treatment of external genital and perianal warts (condylomata acuminatum) in immunocompetent patients.