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Laser, electrosurgery justified when other anogenital wart treatments fail

In treatment for anogenital warts, the complete clearance rate was higher in provider-administered therapies than patient-administered therapies; however, researchers found a lower recurrence rate in patient-administered therapies.

The 2018 European guideline for the management of anogenital warts lacks a clear treatment grading system, though several options exist, according to Antoine Bertolotti, MD, of the department of infectious diseases at Reunion University Hospital, Saint-Pierre, La Réunion, France, and colleagues. In a pooled analysis of randomized controlled trials of anogenital wart treatments, the researchers analyzed 70 trials involving 9,931 patients.

The complete clearance rate of 92% was higher in provider-administered therapies than patient-administered therapies at 56%.

Similarly, the recurrence rate of 6% was lower for patient-administered therapies than 29% in provider-administered therapies.

Researchers noted that surgery was painful in 48% of cases, and CO₂ laser was associated with a 31% recurrence rate.

The recurrence rate was high in electrosurgery, adverse effects were low, and the clearance rate was low because of the high number of patients lost to follow-up, according to Bertolotti and colleagues.

Compared with cryotherapy, trichloroacetic acid was associated with a high clearance rate, a low recurrence rate and few adverse effects.

Additionally, they found a high clearance rate and a low recurrence rate for 5-fluorouracil cream and potassium hydroxide.

“Although the risk of bias was high in many of the included studies (unpublished data), our results can complement the latest guidelines,” Bertolotti and colleagues wrote. “Therapy could be selected according to anogenital wart duration and to previous recurrence.”

They concluded that surgery, CO₂ laser and electrosurgery seem justified when other treatments have failed. – by Abigail Sutton

Disclosures: The authors report no relevant financial disclosures.