Genital Warts in Emergency Medicine Treatment & Management
- Author: Elizabeth Rubano, MD; Chief Editor: Rick Kulkarni, MD more...
Emergency Department Care
- Although an in-depth discussion of the treatment of genital warts (ie, type of workup, treatment regimens, necessary follow-up) is beyond the scope of ED practice, symptomatic treatment may be warranted.
- Use pressure to stop bleeding, if present.
- Relieve urethral obstruction (rare).
- Search for evidence of coexistent STDs; treat them if found and indicated.
- The following measures are beyond the scope of the ED and are presented for educational purposes only. Further treatment and screening guidelines from the American College of Obstetricians and Gynecologists and Centers for Disease Control and Prevention are available.[1, 2]
- Untreated: If visible genital warts are left untreated, they can undergo spontaneous resolution, increase in size, increase in number, or remain unchanged. Complete resolution of lesions after 2 years occurs in 75% of individuals without intervention.
- Ablative therapy
- Cryotherapy[2] : Use an open spray or cotton-tipped applicator for 10-15 seconds and repeat as needed. Lift away mobile skin from the underlying normal tissue before freezing. Response rates are high, clearance occurs about 75% of the time with few adverse sequelae. Adverse reactions include pain during treatment, erosion, ulceration, and postinflammatory hypopigmentation of skin. Cryotherapy is safe for use during pregnancy.
- Electrodesiccation (smoke plume may be infective)
- Curettage
- Surgical excision[2] : Excision has the highest success rate and lowest recurrence rate. Initial cure rates are 63-91%.
- Carbon dioxide laser treatment: This treatment is used for extensive or recurrent genital warts. The procedure requires local, regional, or general anesthesia. (A eutectic mixture of local anesthetics [EMLA] cream may be used as an alternative anesthetic.) Clearance rates are more than 90%, but reoccurrence can be up to 40%. HPV-6 DNA has been detected in the carbon dioxide laser plume; therefore, the laser operator is at risk of developing mucosal warts.
- Infrared coagulation: A beam of infrared light is delivered to the affected lesions, causing tissue coagulation and necrosis. Treatment is successful in about 80% of cases.
- Immune-based therapy
- Physician administered treatments include acid applications (bichloroacetic acid or trichloroacetic acid) and interferon injections with antiviral mechanisms.
- Medications for home use include imiquimod 5% cream, podofilox gel or solution, and antiproliferative compounds (5-fluorouracil).
- Two HPV vaccine candidates have proven to be highly effective in clinical trials: Gardasil and Cervarix. Gardasil, Merck's HPV vaccine, was licensed by the Food and Drug Administration (FDA) in June 2006 for the prevention of cervical cancers and other diseases caused by HPV in females. It is composed of a viruslike particle consisting of recombinant L1 proteins from HPV types 6, 11, 16, and 18. It has been recommended by the Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices to be routinely given to girls at age 11-12 years.[3] It can be administered starting at age 9 years, with catch-up vaccinations recommended for females aged 13-26 years. The vaccine is not established as CDC policy until it is accepted by the director of the CDC.
- Cervarix is GlaxoSmithKline's HPV vaccine candidate and focuses on cancer prevention with L1 proteins from HPV types 16 and 18 only.[4] The vaccines do not eliminate the need for other prevention strategies and screening.
Consultations
- No emergent consultation is indicated.
- Outpatient follow-up with a dermatologist, an OB/GYN, or a urologist is indicated.
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