Warts (genital)

Overview

General background | Focus of the review | Comments on evidence | Search and appraisal summary | Substantive changes at this update | Abstract | Cite as

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General background

External genital warts (EGWs) are benign epidermal growths on the anogenital regions, as well as, occasionally, in other locations, which can occur in both women and men. There are four morphological types: condylomatous, keratotic, papular, and flat warts. EGWs are caused by the human papillomavirus (HPV).

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Focus of the review

The ultimate goal in management of disease is its prevention. For EGWs, there is extensive evidence that vaccination is more than 90% effective. It is important to use either the quadrivalent or new nonavalent vaccine, both containing HPVs 6 and 11. The bivalent vaccine contains neither. Therefore, this overview has focused on treatments where there is greater uncertainty. For people, external genital warts are very disturbing. Even though they are only rarely related to atypia or malignancy, they are not taken lightly. To the clinician, they present perplexing management problems in the frequency of persistence and recurrence. This has resulted in multiple types of treatment with results often described only anecdotally.

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Comments on evidence

For what is a relatively common condition, we found few RCTs that met our quality criteria. The quantity and quality of trials are disappointing.

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Search and appraisal summary

The literature search for this update was conducted in June 2014. For more information on the databases searched and methods used for critical appraisal, please see the Methods section. After deduplication and removal of conference abstracts, 98 potentially relevant abstracts and titles were appraised. We obtained full text papers for 43 articles and eventually added two studies.

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Additional information

It is important to include the vagina and external cervix in the term 'anogenital', and to include the skin and the mouth near the lips, when managing external genital warts.

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Substantive changes at this update

Ablative procedure (cryotherapy, laser therapy, electrosurgery, surgical excision) plus imiquimod in people with external genital warts New option. One RCT added.[12] Categorised as 'unknown effectiveness'.

Podophyllotoxin for external genital warts in pregnancy New option. Categorised as 'unknown effectiveness'.

Podophyllin for external genital warts in pregnancy New option. Categorised as 'unknown effectiveness'.

Bi- and tricholoroacetic acid for external genital warts in pregnancy New option. Categorised as 'unknown effectiveness'.

Cryotherapy for external genital warts in pregnancy New option. Categorised as 'unknown effectiveness'.

Electrosurgery for external genital warts in pregnancy New option. Categorised as 'unknown effectiveness'.

Laser surgery for external genital warts in pregnancy New option. Categorised as 'unknown effectiveness'.

Surgical excision for external genital warts in pregnancy New option. Categorised as 'unknown effectiveness'.

Imiquimod for external genital warts in pregnancy New option. Categorised as 'unknown effectiveness'.

Abstract

INTRODUCTION: External genital warts (EGWs) are sexually transmitted benign epidermal growths caused by the human papillomavirus (HPV), on the anogenital areas of both women and men, as well as, occasionally, in other locations. In the US, about 50% to 60% of sexually active women aged 18 to 25 years have been exposed to HPV infection, but only 10% to 15% will have genital warts. METHODS AND OUTCOMES: We conducted a systematic overview, aiming to answer the following clinical questions: What are the effects of ablative procedure (cryotherapy, laser therapy, electrosurgery, surgical excision) plus imiquimod in people with external genital warts? What are the effects of treatments for external genital warts in pregnancy? We searched: Medline, Embase, The Cochrane Library, and other important databases up to June 2014 (BMJ Clinical Evidence overviews are updated periodically; please check our website for the most up-to-date version of this overview). RESULTS: At this update, searching of electronic databases retrieved 170 studies. After deduplication and removal of conference abstracts, 98 records were screened for inclusion in the overview. Appraisal of titles and abstracts led to the exclusion of 55 studies and the further review of 43 full publications. Of the 43 full articles evaluated, one systematic review and one RCT were added at this update. We performed a GRADE evaluation for two PICO combinations. CONCLUSIONS: In this systematic overview we present information relating to the effectiveness and safety of the following interventions: ablative procedure plus imiquimod; bi- and trichloroacetic acid; cryotherapy; electrosurgery; imiquimod alone; laser surgery; podophyllin; podophyllotoxin; and surgical excision.

Cite as

Jr HWB. Warts (genital). Systematic review 1602. BMJ Clinical Evidence. . 2015 July. Accessed [date].

Latest citations

5-FU for genital warts in non-immunocompromised individuals. ( 02 September 2015 )

Male circumcision and human papillomavirus infection in men: a systematic review and meta-analysis. ( 02 September 2015 )