Asian guidelines for condyloma acuminatum.

ABSTRACT

The present guidelines aim to provide comprehensive information on genital condyloma acuminata, including the epidemiology, clinical features, diagnosis and management. The guidelines provide evidence-based recommendations on the diagnosis, prevention and treatment of genital condyloma acuminata in adults in Asia, including patients with HIV co-infection. METHODOLOGY: A PubMed search was performed, using the keywords "condyloma acuminata", "anal wart", "anogenital wart", "genital wart" and "genital HPV". A total of 3031 results were found in publications during last six years. A careful review of the titles and abstracts was done to find all the studies pertaining to epidemiology, clinical features, diagnosis, treatment and prevention of condyloma acuminata. DIAGNOSIS Various diagnostic procedures described are 1. PCR (LE 2b). 2. Serology (LE 2b). 3. In-situ hybridization (LE 3). PREVENTION 1. Vaccination (LE 1a) Quadrivalent vaccine reduced the frequency of anogenital warts in both vaccinated and unvaccinated contacts. According to the update Advisory Committee on Immunization Practices (ACIP) recommendations, the following protocol is recommended (a). HPV vaccination at age 11 or 12 years for both males and females. (b). Catch-up vaccination for all persons through age 26 years. (c). Shared clinical decision-making regarding potential HPV vaccination for persons aged 27-45 years, who are at risk of new HPV infection. 2. Male circumcision (LE 2a) conflicting evidence. HIV AND CONDYLOMA ACUMINATA In HIV-affected individuals, the course of HPV is more aggressive, with a greater risk of treatment resistance, increased chances of intraepithelial neoplasia as well as cancers. TREATMENT Physician administered. 1. Photodynamic therapy (LE 1a). 2. Laser (LE 2b). 3. Surgery (LE 1a). 4. Electrosurgery (LE 2c). 5. Cryotherapy (LE 1b). 6. Immunotherapy (LE 1b). 7. Podophyllin (LE 1b). Provider administered. 1. Imiquimod 5%(LE 1a). 2. Podophyllotoxin (LE 1b). 3. Sinecatechins (LE 1a). 4. Cidofovir (LE 3). 5. 5- Fluorouracil (LE 1a). 6. Interferon (LE 1a).