Papillomavirus Treatment & Management

Author: John D Shanley, MD, MPH; Chief Editor: Burke A Cunha, MD more...

Updated: Dec 29, 2011

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Medical Care
Surgical Care
Consultations
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Medical Care

Both provider-applied treatments and patient-applied treatments are available. Medical treatments (eg, interferon injection) have been tried, with mixed success. Lesions often recur after treatment, requiring recurrent treatment. Many lesions spontaneously regress. No effective antiviral agents are currently available to treat human papillomavirus (HPV) infections. The US Food and Drug Administration (FDA) has recently approved an HPV vaccine (Gardasil; Merck and Co.) for HPV types 6, 11, 16, and 18. Its efficacy in preventing infection exceeds 90%, but it has no role in treatment.

Surgical Care

Surgical ablation methods include cryotherapy, electrocautery, curettage, and tangential excision. Cryosurgery is the local application of liquid nitrogen to freeze the lesion. The area blisters and sloughs. Monitor for secondary cellulitis.

The location, size, or extent of the lesion and the potential for malignant transformation largely dictate treatment. Uncomplicated lesions can be treated with chemical ablation, cryoablation, surgical excision, or laser treatment. Because the virus is present in the basal layer of the epidermis in a latent state, recurrences are common and retreatment may be necessary.

Treatment options for cervical neoplasia depend on the stage of the disease.

Consultations

Consultation with a dermatologist may be indicated in some situations. For potentially malignant papilloma infections that involve the genital tract, consultation with a gynecologist or urologist is indicated. A proctologist may be consulted for individuals with perianal or anal warts or in whom anal dysplasia is suspected. This is especially true for individuals infected with HIV. An otolaryngologist (ENT) should be consulted for patients with papilloma infections involving the larynx.

Proceed to Medication

Contributor Information and Disclosures

Author

John D Shanley, MD, MPH Professor Emeritus, University of Connecticut; Professor of Preventive Medicine, Stony Brook Medical Center

John D Shanley, MD, MPH is a member of the following medical societies: American Association for the Advancement of Science, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Specialty Editor Board

Jeffrey D Band, MD Professor of Medicine, Oakland University William Beaumont School of Medicine; Director, Division of Infectious Diseases and International Medicine, Corporate Epidemiologist, William Beaumont Hospital; Clinical Professor of Medicine, Wayne State University School of Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Charles V Sanders, MD Edgar Hull Professor and Chairman, Department of Internal Medicine, Professor of Microbiology, Immunology and Parasitology, Louisiana State University School of Medicine at New Orleans; Medical Director, Medicine Hospital Center, Charity Hospital and Medical Center of Louisiana at New Orleans; Consulting Staff, Ochsner Medical Center

Charles V Sanders, MD is a member of the following medical societies: Alliance for the Prudent Use of Antibiotics, Alpha Omega Alpha, American Association for the Advancement of Science, American Association of University Professors, American Clinical and Climatological Association, American College of Physician Executives, American College of Physicians, American Federation for Medical Research, American Foundation for AIDS Research, American Geriatrics Society, American Lung Association, American Medical Association, American Society for Microbiology, American Thoracic Society, American Venereal Disease Association, Association for Professionals in Infection Control and Epidemiology, Association of American Medical Colleges, Association of American Physicians, Association of Professors of Medicine, Infectious Disease Society for Obstetrics and Gynecology, Infectious Diseases Society of America, Louisiana State Medical Society, Orleans Parish Medical Society, Royal Society of Medicine, Sigma Xi, Society of General Internal Medicine, Southeastern Clinical Club, Southern Medical Association, Southern Society for Clinical Investigation, and Southwestern Association of Clinical Microbiology

Disclosure: Nothing to disclose.

Eleftherios Mylonakis, MD Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital

Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital

Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

References

Hariri S, Unger ER, Sternberg M, Dunne EF, Swan D, Patel S, et al. Prevalence of genital human papillomavirus among females in the United States, the national health and nutrition examination survey, 2003-2006. J Infect Dis. Aug 2011;204(4):566-73. [Medline].
[Guideline] FDA licensure of bivalent human papillomavirus vaccine (HPV2, Cervarix) for use in females and updated HPV vaccination recommendations from the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep. May 28 2010;59(20):626-9. [Medline]. [Full Text].
Recommendations on the Use of Quadrivalent Human Papillomavirus Vaccine in Males - Advisory Committee on Immunization Practices (ACIP), 2011. MMWR Morb Mortal Wkly Rep. Dec 23 2011;60:1705-8. [Medline].
FDA. FDA licensure of bivalent human papillomavirus vaccine (HPV2, Cervarix) for use in females and updated HPV vaccination recommendations from the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep. May 28 2010;59(20):626-9. [Medline].
FDA. FDA licensure of quadrivalent human papillomavirus vaccine (HPV4, Gardasil) for use in males and guidance from the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep. May 28 2010;59(20):630-2. [Medline].
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Burd EM. Human papillomavirus and cervical cancer. Clin Microbiol Rev. Jan 2003;16(1):1-17. [Medline].
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Cox JT. History of the use of HPV testing in cervical screening and in the management of abnormal cervical screening results. J Clin Virol. Jul 2009;45 Suppl 1:S3-S12. [Medline].
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Huang CM. Human papillomavirus and vaccination. Mayo Clin Proc. Jun 2008;83(6):701-6; quiz 706-7. [Medline].
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Koutsky L. Epidemiology of genital human papillomavirus infection. Am J Med. May 5 1997;102(5A):3-8. [Medline].
Sedlacek TV. Advances in the diagnosis and treatment of human papillomavirus infections. Clin Obstet Gynecol. Jun 1999;42(2):206-20. [Medline].
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Tjalma WA, Arbyn M, Paavonen J, van Waes TR, Bogers JJ. Prophylactic human papillomavirus vaccines: the beginning of the end of cervical cancer. Int J Gynecol Cancer. Sep-Oct 2004;14(5):751-61. [Medline].
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Verrucous warts in a patient with HIV infection.

Plantar warts.

Flat wart.

Table 1. Association of HPV Types With Morphology and Site of Skin Lesions

Lesion	Location	HPV Genotype
Common wart	Mostly hands	2, 4
Plantar wart	Bottom of feet	1
Mosaic wart	Hands and feet	2
Flat wart	Arms, face, knees	3, 10, 28, 41
Butcher wart	Hand	7
Extragenital Bowen disease	Upper and lower extremities, head	2, 3, 5, 16, 18, 20, 31, 33, 34, 54, 56, 58, 61, 62, 73
Macular plaques of epidermodysplasia verruciformis	Light-exposed areas	5, 8, 9, 12, 14, 15, 17, 19, 20, 21, 22, 23, 24, 25, 36, 47, 50

Table 2. HPV Types Associated With Anogenital Lesions

Lesions	HPV Genotype
Genital warts	6, 11
Flat condylomata	6, 11, 16, 18, 31
Cervical intraepithelial neoplasia	16, 18, 31, 33, 35, 39, 42, 43, 44, 45, 51, 52, 56
Bowen disease	6, 11
Buschke-Löwenstein tumors	6, 11
Vulvar intraepithelial neoplasia	16 (occasionally 6, 11)
Cervical cancer	16, 18 (strong association)
	31, 33, 35, 45, 51, 52, 56 (moderate association)
	6, 11, 42, 43, 44 (weak association)
Penile intraepithelial neoplasia	16, 18
Anal intraepithelial neoplasia	16 (rarely 6, 11, 18, 33)

View Table List

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