2019 IUSTI‐Europe guideline for the management of anogenital warts

Abstract

This guideline is an update of the 2011 European Guideline for the Management of Anogenital Warts. It is intended to support best practice in the care of patients with anogenital warts by including evidence-based recommendations on diagnosis, treatment, follow-up and advice to patients. It is intended for use by healthcare professionals in sexual healthcare or dermato-venereology clinics in Europe but may be adapted for use in other settings where the management of anogenital warts is undertaken. As a European guideline, recommendations should be adapted according to national circumstances and healthcare systems. Despite the availability of vaccine to prevent HPV types 6 and 11, the cause of >95% anogenital warts, they remain an important and frequent health problem. The previous systematic review of randomized controlled trials for anogenital warts was updated. The changes in the present guideline include the following: Updated background information on the prevalence, natural history and transmission of human papillomavirus (HPV) infection and anogenital warts. Key recommendations for diagnosis and treatment have been graded according to the strength of the recommendation and the quality of supporting evidence. 5-fluorouracil, local interferon and photodynamic therapy have been evaluated and included as potential second-line treatment options. Evidence of the impact of HPV vaccination on the incidence of anogenital warts has been updated.

Correlation of the ALA-PDT Treatment Efficacy and the HPV Genotype Profile of Genital Warts after Cryotherapy Failure and Podophyllotoxin Therapy in Male Patients

“…However, the available treatment options are difficult to rank in terms of efficacy due to the lack of comparative head-tohead studies. The literature data indicate that more than 90% of cases of genital warts are caused by HPV type 6 [1,3,23,25]. This finding was also confirmed by 80.95% (17/21) of patients in our study.…”

“…Various treatment techniques are used to treat genital warts including ablation, immunotherapy, PDT, or a combination of all of the above [23][24][25]. The choice of therapeutic option should be individually adjusted for each patient based on clinical factors such as number, size, morphology, location, keratosis of warts, and infection's course (new or recurrent) [5,8,[23][24][25]. Patient preferences, such as the desire to be treated at home or in a clinic, and the convenience of the treatment regimen in terms of frequency and time, should also be considered.…”

“…Patient preferences, such as the desire to be treated at home or in a clinic, and the convenience of the treatment regimen in terms of frequency and time, should also be considered. When planning treatment, the methods with the lowest risk of failure should be selected first [1,8,[23][24][25]. However, the available treatment options are difficult to rank in terms of efficacy due to the lack of comparative head-tohead studies.…”

“…Cryotherapy is commonly used to remove warts in everyday practice. The clearance rate of cryotherapy used in cycles is estimated at 46-96% and the recurrence rate is estimated at 18-39% [3,8,25]. The main disadvantage of cryotherapy is the high recurrence rate and the need to repeat therapeutic interventions.…”

Dermato‐venereology in the year of coronavirus – Hot topics in research and patient care

“…Management of lichen planus 28 Management of anogenital warts 29 Management of pemphigus vulgaris and foliaceus 30 …”