HPV Testing and Management of Anal Warts
Diagnosis and Management
- Visual examination is the primary and sufficient diagnostic method for genital/anal warts, which are predominantly caused by HPV types 6 and 11 (low-risk types) 2, 1
- Biopsy is indicated in specific circumstances, including uncertain diagnosis, lesions unresponsive to standard therapy, worsening during therapy, immunocompromised patients, and atypical lesions 3, 2, 1, 4
- The application of acetic acid is not a specific test for HPV infection and is not recommended as a screening procedure 2
- First-line treatments for anal warts include cryotherapy with liquid nitrogen, TCA or BCA 80-90% applied only to warts, and surgical removal 1, 4
Screening and Prevention
- Certain high-risk populations, such as men who have sex with men (MSM) with HIV infection, men with HIV infection, and women with HIV infection, may benefit from anal cancer screening due to increased risk 5
- The Centers for Disease Control and Prevention recommends HPV vaccination (Gardasil) for prevention, which protects against HPV types 6 and 11 (which cause 90% of genital warts) as well as types 16 and 18 (which cause most HPV-related cancers) 3
- An annual digital anorectal examination (DARE) might be useful to detect masses in persons with HIV infection and possibly in MSM without HIV with a history of receptive anal intercourse 5, 6
Patient Counseling
- The American College of Obstetricians and Gynecologists and the Centers for Disease Control and Prevention note that HPV infection is very common, with most sexually active adults acquiring HPV at some point 7
- Treatment targets visible warts but does not eliminate the virus itself, and recurrence is common (approximately 30%), regardless of treatment method 7, 1
- Correct and consistent condom use might reduce but does not eliminate transmission risk 7