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Human Papillomavirus (HPV) | Questions & Answers | 2010 Treatment Guidelines

Question 1: Is sineatechins ointment by prescription only or is it available over the counter?

Answer: Sinecatechins ointment is available by prescription only. See 2010 STD Treatment Guidelines, page 70-74 for more information about genital warts recommended and alternative treatment regimens

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Question 2: Would you address anal cancer screening and human papillomavirus (HPV) vaccination? What are recommendations for practice?

Answer: No national guidelines currently exist for anal cancer screening. "Because of the increased incidence of anal cancer in HIV-infected men who have sex with men (MSM), screening for anal cytologic abnormalities can be considered; however, evidence is limited concerning the natural history of anal intraepithelial neoplasias, the reliability of screening methods, the safety and response to treatments, and the programmatic support needed for such a screening activity." (2010 STD Treatment Guidelines, page 13). Regarding HPV vaccination, please consult CDC Advisory Committee on Immunization Practices for the latest recommendations (http://www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/hpv.html).

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Question 3: What is the accepted effectiveness/recommendation of providing human papillomavirus (HPV) vaccine to women who already have HPV?

Answer: Although women should be advised that vaccination will have no therapeutic effect on an existing HPV infection or abnormal Pap test or genital warts, HPV vaccination will effectively provide protection against HPV infection types not already acquired. All women aged of 9–26 are recommended to receive HPV vaccination, regardless of prior history of HPV infection. Prevaccination assessments, such as Pap testing, or screening for high-risk HPV deoxyribonucleic acid (DNA), or type-specific HPV tests, or HPV antibody tests to establish the appropriateness of HPV vaccination are not recommended at any age. Please consult CDC Advisory Committee on Immunization Practices recommendations for further details (http://www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/hpv.html).

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Question 4: How would you choose which medication to use in the treatment of genital warts?

Answer: The choice of recommended regimen to use for external genital warts (if any) should be based upon a discussion between the provider and the patient. This discussion should include counseling messages for human papillomavirus (HPV) infection (2010 STD Treatment Guidelines, page 73), and include the provider’s preference and the patient’s preference, as well as cost, Choices for treatment of cervical, vaginal, urethral meatus, and anal warts are far more limited, but again should be made following a discussion with a provider who can present the risks and benefits of each recommended treatment regimen to help a patient make an informed decision about which regimen to use.

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Question 5: What is currently the best treatment for anal human papillomavirus (HPV) and the chances of reinfection?

Answer: The recommended regimens for anal warts are listed on page 72 of the 2010 STD Treatment Guidelines, together with recommendations for treating other mucosal warts. All three regimens are provider-administered. They are 1) cryotherapy with liquid nitrogen, 2) trichloroacetic acid (TCA) or bichloroacetic acid (BCA) 80% to 90%, or 3) surgical removal. Although chances of reinfection are not clear, chances of recurrence following treatment are common, especially in the first three months following treatment.

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