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HPV-Associated Warts

for Health Care Providers

HPV-Associated Warts

Back to Dermatologic Conditions Chapter

EtiologyFindings/ DistributionDiagnostic CluesManagement
Human papillomavirus; most common subtypes 6, 11; also associated with dysplastic subtypes 16, 18, 31, 33, 35

Worse and more difficult to treat in patients with low CD4 nadirs

Condyloma acuminata: soft, skin-colored fleshy warts

Perianal lesions can be rough and cauliflower-like

In and around genitalia and anus, around mouth, palmar surface of hands, on feet

Can recur despite effective ARTCan recede on their own in 3 months with or without ART

Start with liquid nitrogen (10-second bursts with 30-second thaw), podophyllin (for genital warts), or paring (for large lesions) every 3 weeks for 12 sessions

Patients can be instructed to use duct tape and other exfoliative techniques at home between office treatment sessions (eg, for lesions on the extremities, apply duct tape nightly and pull off during the day; use pumice stone daily to sand down lesions)

For genital warts, may add imiquimod if initial treatment is not effective

Consider laser treatment, surgical excision (and send for pathology)

Repeat treatments are usually required

Can recur after any of the treatment modalities; none is 100% effective

For anal lesions, see Anal Dysplasia

From Dermatologic Conditions
Primary Care of Veterans with HIV
Office of Clinical Public Health Programs
Veterans Health Administration, 2009