HUMAN PAPILLOMA VIRUS INFECTION (VENEREAL WARTS) – MANAGEMENT
Personal hygiene is important. Affected parts should be kept clean, cool and dry. In females, any associated vaginal discharge should be investigated and treated.
Warts on the skin may be treated by the direct application of podophyllin
(10 to 25% solution in spirit or other solvent). When first used, the podophyllin should be washed away after 2 to 4 hours; if tolerated by the patient, the duration of subsequent applications can be increased. The area surrounding the wart can be protected by applying petroleum jelly before podophyllin is applied. Podophyllin is neurotoxic and large areas should not be treated at one time. Podophyllin should be avoided during pregnancy and must not be applied to the cervix. Treatment can be repeated every 2 or 3 days if necessary. Cauterisation or cryosurgery can be used for small lesions, if necessary under general anaesthetic. Trichloroacetic acid can be used for small keratinised lesions. Larger warts may be excised surgically. Carbon dioxide laser surgery possibly offers the best treatment option for patients with extensive condylomas or condylomas which are resistant to simpler treatments.
Sexual partners of patients with HPV infection should be examined.
Patients and their partners should be counselled about the prevention of transmission of the virus, including the use of condoms.
Because of the association of carcinoma with cervical HPV infection,
annual cervical cytological examination is recommended. Colposcopy is advisable for women with abnormal cervical smears. Because of the possibility of concomitant syphilis, syphilis serology should be repeated after 3 to 6 months.
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