Treatment

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There is no cure for HPV. Many researchers believe eliminating the virus will require a vaccine, currently under development and showing good potential. Until science delivers more answers, however, such as how much protection condoms truly provide, your best defense against HPV is to learn as much as possible about the disease and try to minimize your risk.

For instance, having multiple or many sexual partners puts you at a higher risk of contracting the HPV virus, as well as other sexually transmitted infections.

Most people with HPV infections don't require treatment. Your body simply gets rid of the virus on its own. Less than one percent develop problems, ranging from warts to cervical cancer, that require treatment.

Most genital warts are treated because you may not like the way they look -- not because treatment prevents them from reforming or from you transmitting the infection to someone else. In fact, even with treatment, about one in four people will have a recurrence within three months. Studies also find that small warts of short duration (less than one year) respond better to therapy than large warts of long duration. All wart treatments may cause mild local irritation.

Experts reviewing current HPV practices find that no single treatment is ideal for all women. They recommend that you be involved in making any treatment decisions with your health care professional. So it's important that you understand your options.

You may not even need treatment. The U.S. Centers for Disease Control (CDC) do not recommend treatment for subclinical genital HPV infection (i.e., no visible warts diagnosed by colposcopy, biopsy, acetic acid application or HPV laboratory tests. That's because there's no certain way to diagnosis subclinical genital HPV infection, and no effective therapy.

In the past, treatments for genital warts were administered by health care professionals and often caused more damage than the disease itself. Traditional treatments ranged from cryotherapy, which froze the wart with liquid nitrogen, to electrocautery, which burned off the wart. Today, there are a wide variety of treatments that can be administered by you or your health care professional.

The goal of treatment should be to remove visible genital warts and relieve annoying symptoms. No available treatment is any better than another, and no single treatment is ideal for all cases. Thus, the CDC has developed the following guidelines:

Self-applied treatments:

• Podofilox (Condylox). This 0.5 percent solution or gel is a relatively cheap, safe, easy-to-use treatment. It is applied directly to the warts and should not be used on warts that occur inside the rectum, vagina, or urine passageways inside the penis (male) or the vulva (female). It must be applied twice a day for three days, followed by four days of no therapy. This cycle is repeated up to four times. Studies find that podofilox clears warts in 45 to 82 percent of patients within four to six weeks of treatment, and that up to 91 percent have recurrences.

• Imiquimod (Aldara). This 5 percent cream is used to treat external genital warts and perianal warts, which appear around the anus. It is safe, effective and easy to use and, unlike podofilox, does not destroy the underlying tissue, or skin. Instead, the cream stimulates the immune system to target the warts. Apply three times a week for up to 16 weeks. Studies of imiquimod find that 37 to 85 percent of patients become wart-free after treatment, and that 13 to 19 percent have recurrences. Studies also find that 5 percent preparation creams are twice as effective as 1 percent creams.

Although comparative studies of the two drugs have not been conducted, it appears that podofilox works faster and is less expensive. However, imiquimod may be more effective and less irritating. Regardless of which you choose, both treatments take several weeks to work and require that you be able to identify and reach the warts.

Side effects may include tenderness, irritation and localized burning. Neither has been deemed safe to use during pregnancy.

Treatments applied by health care professionals:

• Cryotherapy (freezing off the wart with liquid nitrogen). This treatment is relatively inexpensive. It is usually performed without an anesthesia, and you may experience some discomfort. You may require several treatments a week for up to six weeks to remove all warts.

• Podophyllin resin 10 to 25 percent. This solution must be washed off one to four hours after application to reduce local irritation and is more likely to cause side effects than the less-toxic, over-the-counter podofilox. There's no evidence it's safe for use during pregnancy.

• Trichloracetic acid (TCA) or bichloracetic acid (BCA) 80 to 90 percent. These are two other chemicals that are applied to the surface of the wart. These chemicals are stronger forms of the over-the-counter acids used to remove external warts. Because the procedure can be painful, most health care professionals use a topical anesthetic.

• Laser therapy (using an intense light to destroy the warts) or surgery (cutting off the warts) gets rid of warts in a single office visit. However, treatment can be expensive and the health care provider must be well trained in these methods. A local anesthetic may be used. If not performed correctly, laser therapy can cause burning and scarring.

• Interferon, a naturally occurring human protein known for its anti-viral and immunostimulating effects, can be injected directly into the warts. This treatment is about as effective as other methods, but isn't usually provided because it requires a painful shot, frequent office visits and has a greater risk of side effects such as fever, chills, muscle aches and pain at the injection site.

Because HPV is a virus, your immune system plays a role in whether your warts return or not. The virus travels to the lower level of tissue where it can remain indefinitely. You should watch for recurrences, which occur most frequently during the first three months after treatment.

Eating a balanced diet, exercising regularly and avoiding illegal drugs, tobacco and alcohol are simple ways to help maintain a strong immune system.