Genital Warts Laser Removal NYC New York NY

Wart Treatment
Will Find You The Best Remedy To Cure Your Warts

While there may not be one single, best treatment for warts, there are hundreds of remedies that can react differently on each individual. Warts can often go away without treatment, especially true in children, but adults may not have the same luck. Our immune system is responsible for a wart’s disappearance or persistence. Many wart treatments result in some degree of inflammation, or irritation of the affected tissues, prompting the immune system to activate, and cure the wart. The spontaneous disappearance of a wart is likely a sign of the immune system at work.
Understanding Warts

Warts are benign (not cancerous) skin growths that appear when a virus infects the top layer of skin. Viruses that cause warts are called human papillomavirus (HPV). You are more likely to get one of these viruses if you cut or damage your skin in some way.

Wart viruses are contagious and can spread by contact with the wart or something that touched the wart. Shaving may cause them to spread in the beard area or legs. Biting or picking may also cause them to spread.

Warts are often skin colored and rough. But they can be dark (brown or gray-black), flat, and smooth.
Types of Warts
Common Warts
Common warts, also called verruca vulgaris, can grow on any part of the body.

Genital warts
Genital warts, also known as condyloma acuminata, are sexually transmitted, and occur on the genitals, groin, and anal area.

Plantar warts
Plantar warts are common warts, which are found on the soles of the feet.

Flat warts
Flat warts are commonly found on the face and the extremities.

HPV and Cancer

Some types of sexually transmitted human papillomavirus (HPV) can cause genital warts. Other types, called high-risk or oncogenic HPVs, can cause cancer.
High-risk HPVs cause virtually all cervical cancers. They also cause most anal cancers, and some vaginal, penile, and oropharyngeal (mouth) cancers.
Most infections with high-risk HPVs do not cause cancer. Many HPV infections go away on their own in 1 to 2 years. However, infections that last for many years increase a person’s risk of developing cancer.
For a more in-depth discussion of warts and cancer, see the National Cancer Institute website:

Warts & Cancer Information
Types of Wart Treatments

Dermatologist  may use one or a combination of the following treatments:
Cryotherapy
Cryotherapy
Liquid nitrogen is applied, causing the wart to freeze. There is some discomfort, but anesthesia is typically unnecessary. It is common to need repeated treatments.
Electrosurgery and Curettage
Electrosurgery and Curettage
Basically, scraping and burning of the wart where local anesthesia is necessary.
Laser
Laser
For stubborn warts, a pulsed-dye laser is sometimes used.
Chemotherapy
Chemotherapy
Bleomycin, an anti-cancer medicine, is injected into the wart. This can be painful afterward, and is used infrequently. It is used only for the most stubborn warts. 5 percent of 5-fluorouracil cream is a topical anti-cancer cream, which can kill the wart virus, and has the ability to soak into surrounding infected skin, thus eliminating dormant wart particles.
Imiquimod (Aldara)
Imiquimod (Aldara)
A topical cream which activates certain cells in the skin to attack the viral particles. It is primarily used for genital warts. It doesn’t work well on thicker skin, where most common warts are found.
Salicylic Acid
Salicylic Acid
Dissolves away the surface layers of skin, so a wart may be rubbed off. It is safe for children, but may take weeks or months to cure a wart. There are several over-the-counter preparations.
Duct Tape
Duct Tape
May work by keeping the wart soft so it can be rubbed off. It may also be used to occlude medications, such as salicylic acid or 5 percent 5-fluoruracil, improving their effectiveness.
Folk Remedies
Folk Remedies
There are hundreds (if not thousands) of these that many people swear by. They may work, in part, because some of them may cause some degree of inflammation, prompting the immune system to do the cleanup. Some may work because they mentally enlist the immune system to act (in a similar way to a placebo). My old professor said that hypnosis works 60 percent of the time, probably for the same reasons.

What is Genital Warts NYC New York NY

A small bump on the genitals caused by a common sexually transmitted infection.
Very common
More than 3 million US cases per year
Spreads by sexual contact
Can't be cured, but treatment may help
Usually self-diagnosable
Lab tests or imaging rarely required
Genital warts are a common sexually transmitted infection caused by the human papillomavirus (HPV).
Vaccines can protect against many genital-wart-causing strains of HPV.
Genital warts can be treated with prescription medication applied directly to the warts or can be surgically removed.

Could the HPV vaccine treat warts? NYC New York NY

The human papillomavirus (HPV) vaccine is intended to prevent people from getting infected with the virus, but in some cases, it may actually work as a treatment, clearing warts in people who are already infected, a new report suggests. 

The report describes several cases of people who had persistent oral warts that went away soon after they received the HPV vaccine. While it's too early to say for certain whether the HPV vaccine treated the warts, the researchers said formal studies should look at this question.

"There remains a critical need for randomized clinical trials to assess efficacy of quadrivalent HPV vaccination for treatment" of oral warts, the researchers said.

The report highlights the case of a man in his 60s who had recurrent warts on his lips, tongue and cheeks for 18 months. The man tried to have the warts removed, but they kept coming back. Doctors diagnosed the man with an HPV infection. There are more than 150 strains of HPV, and although most infections go away on their own, some can linger and lead to health problems, such as genital warts, oral warts, cervical cancer or oral cancer. [Quiz: Test Your STD Smarts]

Dr. John Stern, of the Division of Infectious Diseases at the University of Pennsylvania Health System, who treated the man and co-authored the new report, said he told the patient that there wasn't anything more the doctors could do for his warts. But Stern suggested that the man get the HPV vaccine because he thought it would protect the patient from becoming infected with other HPV strains that are linked with cancer.

The man received the quadrivalent HPV vaccine, which protects against four HPV strains. "We immunized him — not with any therapeutic benefit in mind," Stern said. The vaccine is typically given to children before they become sexually active — it is not thought to help with existing HPV infections.

But a month after the patient received the first dose of the HPV vaccine, he showed significant improvement, and within three months, the warts went away.

"They were all gone; they just disappeared," Stern told Live Science. Stern told a colleague. "We both sort of said, 'Wow,'" Stern said.

Now, two years later, the patient is still free of oral warts.

To see if this had happened in any other patients, the researchers scoured the literature, and found that since 2010, there have been eight other reports of people whose warts disappeared after they received the HPV vaccine. Some of these patients experienced an improvement just two to three weeks after vaccination.

In one case, a 41-year-old woman with widespread warts had not received treatment for her warts for 10 years, but many of her warts cleared about six months after she received the HPV vaccine.

However, it's possible for warts caused by HPV to just go away on their own, so more research is needed to confirm that the vaccine is indeed responsible for these cases, Stern said.

And not all people who receive the HPV vaccine have their warts disappear. A 2013 study of six people with genital warts found that all of the patients had their warts come back after they received the HPV vaccine. Moreover, a 2007 study of more than 2,000 women with genital HPV infections found that the HPV vaccine did not accelerate the speed at which the women's bodies cleared the infection.

"These case report shouldn't prompt every person with HPV to then go and demand to be vaccinated," said Dr. Amesh Adalja, an infectious-disease specialist and a senior associate at the University of Pittsburgh Medical Center's Center for Health Security, who was not involved with the new report. "This isn't something that happens to every person that has the vaccine," Adalja said.

However, the report should prompt researchers to try to understand why some people appear to benefit from getting the vaccine even after they have an HPV infection, while others don't, Adalja said.

It may be that the warts cleared in the 60-year-old man because the HPV vaccine boosted his immune response to all HPV strains, even though the strain that the man had was not in the vaccine, Adalja said.

If it turns out that the HPV vaccine does help with some cases of HPV-related warts, it would be one of the few examples of a vaccine that treats, rather than prevents, disease. There are some experi

Strategies to Prevent Genital HPV Infection nyc new york ny

According to the Center of Disease Control

Based on currently available science, the following recommendations summarize the strategies most likely to be effective in preventing

future infections with genital HPV infection and cervical cancer.

• The surest way to eliminate the risk for future genital HPV infections is to refrain from any genital contact with another individual.



• For those who choose to be sexually active, a long-term, mutually monogamous relationship with an uninfected partner is the strategy

most likely to prevent future genital HPV infections. However, it is difficult to determine whether a partner who has been sexually active

 in the past is currently infected.



• For those choosing to be sexually active and who are not in long-term mutually monogamous relationships, reducing the number of

 sexual partners and choosing a partner less likely to be infected may reduce the risk of genital HPV infection. Partners less likely to

be infected include those who have had no or few prior sex partners.



• While available scientific evidence suggests that the effect of condoms in preventing HPV infection is unknown, condom use has

been associated with lower rates of the HPV-associated diseases of genital warts and cervical cancer. The available scientific evidence

is not sufficient to recommend condoms as a primary prevention strategy for the prevention of genital HPV infection, but it does indicate

 that the use of condoms may reduce the risk of cervical cancer.



• Regular cervical cancer screening for all sexually active women and treatment of pre cancerous lesions remains the key strategy to prevent

cervical cancer.





• In the future, receiving a safe and effective HPV vaccine to help prevent genital HPV infection as well as the HPV-associated diseases

 of genital warts and cervical cancer would be an important prevention measure. However, an effective HPV vaccine would not replace

other prevention strategies.

Overseas and out of state patient accommodation NYC NEW YORK NY

We have many patients that come to us from long distances. Please find the following nearby hotel for your accommodation.
Please call us in advance in order to expedite treatment and diagnostic services before you arrive.

High risk HPV Causing Cancer NYC New York, NY

Of greatest importance, persistent infection with certain types of HPV is a leading cause of cervical cancer. Progression from cervical cancer precursor lesions to invasive cancer is a slow process, estimated to take 10–15 years. Cervical cancer is an uncommon consequence of HPV infection in women, especially if they are screened for cancer regularly with Pap tests and have appropriate follow-up of abnormalities. The purpose of screening with the Pap test is to detect cervical abnormalities that can be treated, thereby preventing progression to invasive cervical cancer, and also to detect invasive cervical cancer at a very early stage. If detected early and managed promptly, survival rates for cervical cancer are over 90%. In the past 40 years, widespread cervical cancer screening using the Pap test and treatment of pre cancerous cervical abnormalities have resulted in a dramatic decrease in the incidents and mortality rates due to cervical cancer in the United States. However, each year in the United States, an estimated 12,200 women develop cervical cancer and 4,100 women die from it. Of women in the United States who develop cervical cancer, about half have never had a Pap test. Because genital HPV infection is most common in men and women who have had multiple sexual partners, abstaining from sexual activity (i.e. refraining from any genital contact with another individual) is the surest way to prevent infection. For those who choose to be sexually active, a monogamous relationship with an uninfected partner is the strategy most likely to prevent future genital HPV infections. For those who choose to be sexually active but who are not in a monogamous relationship, reducing the number of sexual partners and choosing a partner less likely to be infected may reduce the risk of genital HPV infection."

Reconstructive Genital Warts Treatment nyc new york ny

The majority of our patients come to our center after having had a variety of different treatments in the past with relapses and scar development. We primarily approach these cases with micro-scissor excision
and in some cases partial scar revision. Our minor micro-surgical procedure approach is completely painless.

Laser Treatment with high relapse rate genital warts nyc new york

Laser is a device that has recently been used by different health providers for treatment of genital warts. Laser intensity and depth has of penetration is pre set. This is the reason that many patients with laser therapy have high relapse rate of recurrence of genital warts. The depth of the genital wart is not even and equal, so laser will not completely destroy the wart. Once again destruction of genital wart is very challenging and each individual wart needs different attention. There is no unique routine procedure for all.

What would happen if you do not treat your genital warts nyc new york ny

There are many possible complications and we only mention few of them below:
1) Possible extension to urethra causing urinary obstruction
2) Possible extension to anus causing anal bleeding, fecal incontinence
3) Disfiguring genital
4) Loosing elasticity of genital skin, this is very important as the penis needs elasticity of skin for erection and vaginal entry needs
to be stretched for penetration
5) Decrease sexual sensation of genital skin
6) Itching, bleeding, sloughing
7) Pregnancy complication (always treat them before planning for pregnancy)

Persistent warts what do I need to do now? NYC New York, NY

Life is filled with beauty and darkness. We fight to win, sometimes victorious and sometimes not, but the point is that we get up and fight again learn a life time experience and put it behind us. However, as human we go to fight to win and not to lose and that is why we stop fighting if there is no chance of wining at all. If you want to win then you need to have the right tools and preparation. You need all your strength and you must have excellent knowledge of your enemy's behavior. Genital warts are product of the virus which work from your own body cells. First, you need your immune system as strong as it can be. If you are worried or depressed then your immune system may weaken. Get educated and read about your condition. I have tried to cover all the aspect of genital warts and give you detailed information from my clinical experience. The more you read, the more prepared you are. Do not scratch or manipulate your warts. Do not smoke. Do not
use any over the counter remedies such as non-prescription creams, gels, sprays which could stimulate the viral shedding and worsening of your condition. Do not shave the area with blade. Try hair clipper with protective shield instead. Do not use over the counter anti itching medicine such as hydrocortisone. Keep a close eye on the effected areas. If your previous removal techniques have failed over and over then you might need to give it a second thought and a different approach, but do not lose hope. Ask your doctor all the question that you may have. Ask about the pathophysiology of HPV wart, treatment outcome, success rates, cosmetics, before and after pictures, healing time, possible adverse effect of treatment, doctor's experience of treating genital warts and what do you need to do to protect yourself etc.

STD Test and Genital Warts / HPV NYC New York, NY

Whenever you get one STD then you might be at risk of others. Lets say you get genital warts, we know you have got that through sexual contact. It is visible and that is how you found out, at this point you must think about other STD, then what about STD which might not always have symptom (such as HIV). Once you have one STD, then you have to be careful for others. You could ask your doctor to screen you for common STDs. We have capability to test you for various STDs on the same day of your visit with same day test result, [CaliforniaSTD.com]. As we do the surgery to remove your warts for you our lab works on your specimen for STD detection. The STD test result would be discussed by the time we have finished removing your genital warts. If there is any abnormal test we would provide you with the treatment on the same day. Remember Genital warts are red flag for possibility of other hidden STD

Transmission Genital Warts NYC - New York, NY

Double stranded Human Papilloma Virus enters the skin and passes its DNA to the proliferative
layer of the skin genome and as a result, undesirable proliferations will occur which appear as warts.
Inoculation without manifestation of warts may take from a week to 18 months or more. It means you
may have been infected with HPV but won't develop a visible wart until a much later time. This is the
reason why we ask our patients to return to the clinic for a re-evaluation after 6 months and 2 years to
make sure that they don't have a new wart. Some individuals are naturally resistant to HPV viruses and
don't become infected as easily as others. HPV warts are a contagious infection and spread easier by manipulation
such as scratching or shaving.

Warning against Laser treatment which could increase & worsen the patient condition by irritation & viral shedding and transmission by laser plume nyc new york ny

We have seen numerous cases of patients who were victims of genital warts laser treatment. Laser instrument might be effective and FDA approved for hair removal, acne, tattoo and skin tag removal, etc but might not as in HPV which is a highly infectious sexually transmitted disease. Consult your experienced physician before treating your genital warts. HPV genital warts and Molluscum are infectious medical conditions and they need to be treated by an experienced Physician only.

Management of Sex Partners NYC New York NY

Persons should inform current partner(s) about having genital warts because the types of HPV that cause warts can be passed on to partners. Partners should receive counseling messages that partners might already have HPV despite no visible signs of warts, so HPV testing of sex partners of persons with genital warts is not recommended. Partner(s) might benefit from a physical examination to detect genital warts and tests for other STDs. No recommendations can be made regarding informing future sex partners about a diagnosis of genital warts because the duration of viral persistence after warts have resolved is unknown.

Recommended Regimens for Intra-anal Warts NYC New York NY

Cryotherapy with liquid nitrogen
ORSurgical removal
ORTCA or BCA 80%–90% solution

Recommended Regimens for Vaginal Warts NYC New York, NY

Cryotherapy with liquid nitrogen. The use of a cryoprobe in the vagina is not recommended because of the risk for vaginal perforation and fistula formation.

Recommended Regimens for Urethral Meatus Warts NYC New York NY

Cryotherapy with liquid nitrogen

ORSurgical removal

Recommended Regimens for External Anogenital Warts (i.e., penis, groin, scrotum, vulva, perineum, external anus, and perianus nyc new york ny

Patient-Applied:

Imiquimod 3.75% or 5% cream†

ORPodofilox 0.5% solution or gel

ORSinecatechins 15% ointment†

Provider–Administered:

Cryotherapy with liquid nitrogen or cryoprobe

ORSurgical removal either by tangential scissor excision, tangential shave excision, curettage, laser, or electrosurgery

ORTrichloroacetic acid (TCA) or bichloroacetic acid (BCA) 80%–90% solution

*Many persons with external anal warts also have intra-anal warts. Thus, persons with external anal warts might benefit from an inspection of the anal canal by digital examination, standard anoscopy, or high-resolution anoscopy.

†Might weaken condoms and vaginal diaphragms.

Imiquimod is a patient-applied, topically active immune enhancer that stimulates production of interferon and other cytokines. Imiquimod 5% cream should be applied once at bedtime, three times a week for up to 16 weeks (768). Similarly, imiquimod 3.75% cream should be applied once at bedtime, but is applied every night (769). With either formulation, the treatment area should be washed with soap and water 6–10 hours after the application. Local inflammatory reactions, including redness, irritation, induration, ulceration/erosions, and vesicles might occur with the use of imiquimod, and hypopigmentation has also been described (770). A small number of case reports demonstrate an association between treatment with imiquimod cream and worsened inflammatory or autoimmune skin diseases (e.g., psoriasis, vitiligo, and lichenoid dermatoses) (771-773). Data from studies of human subjects are limited regarding use of imiquimod in pregnancy, but animal data suggest that this therapy poses low risk (317).

Podofilox (podophyllotoxin) is a patient-applied antimitotic drug that causes wart necrosis. Podofilox solution (using a cotton swab) or podofilox gel (using a finger) should be applied to anogenital warts twice a day for 3 days, followed by 4 days of no therapy. This cycle can be repeated, as necessary, for up to four cycles. The total wart area treated should not exceed 10 cm2, and the total volume of podofilox should be limited to 0.5 mL per day. If possible, the health-care provider should apply the initial treatment to demonstrate proper application technique and identify which warts should be treated. Mild to moderate pain or local irritation might develop after treatment. Podofilox is contraindicated in pregnancy (317).

Sinecatechins is a patient-applied, green-tea extract with an active product (catechins). Sinecatechins 15% ointment should be applied three times daily (0.5 cm strand of ointment to each wart) using a finger to ensure coverage with a thin layer of ointment until complete clearance of warts is achieved. This product should not be continued for longer than 16 weeks (774-776). The medication should not be washed off after use. Genital, anal, and oral sexual contact should be avoided while the ointment is on the skin. The most common side effects of sinecatechins are erythema, pruritus/burning, pain, ulceration, edema, induration, and vesicular rash. The medication is not recommended for persons with HIV infection, other immunocompromised conditions, or with genital herpes because the safety and efficacy of therapy has not been evaluated. The safety of sinecatechins during pregnancy is unknown.

Cryotherapy is a provider-applied therapy that destroys warts by thermal-induced cytolysis. Health-care providers must be trained on the proper use of this therapy because over- and under-treatment can result in complications or low efficacy. Pain during and after application of the liquid nitrogen, followed by necrosis and sometimes blistering, is common. Local anesthesia (topical or injected) might facilitate therapy if warts are present in many areas or if the area of warts is large.

Surgical therapy has the advantage of eliminating most warts at a single visit, although recurrence can occur. Surgical removal requires substantial clinical training, additional equipment, and sometimes a longer office visit. After local anesthesia is applied, anogenital warts can be physically destroyed by electrocautery, in which case no additional hemostasis is required. Care must be taken to control the depth of electrocautery to prevent scarring. Alternatively, the warts can be removed either by tangential excision with a pair of fine scissors or a scalpel, by carbon dioxide (CO2) laser, or by curettage. Because most warts are exophytic, this procedure can be accomplished with a resulting wound that only extends into the upper dermis. Hemostasis can be achieved with an electrocautery unit or, in cases of very minor bleeding, a chemical styptic (e.g., an aluminum chloride solution). Suturing is neither required nor indicated in most cases. In patients with large or extensive warts, surgical therapy, including CO2 laser, might be most beneficial; such therapy might also be useful for intraurethral warts, particularly for those persons who have not responded to other treatments. Treatment of anogenital and oral warts should be performed in an appropriately ventilated room using standard precautions (http://www.cdc.gov/hicpac/pdf/isolation/Isolation2007.pdf#page=2) and local exhaust ventilation (e.g., a smoke evacuator) (777) (http://www.cdc.gov/niosh/docs/hazardcontrol/hc11.html).

Trichloroacetic acid (TCA) and bichloroacetic acid (BCA) are provider-applied caustic agents that destroy warts by chemical coagulation of proteins. Although these preparations are widely used, they have not been investigated thoroughly. TCA solution has a low viscosity comparable with that of water and can spread rapidly and damage adjacent tissues if applied excessively. A small amount should be applied only to the warts and allowed to dry (i.e., develop white frost on tissue) before the patient sits or stands. If pain is intense or an excess amount of acid is applied, the area can be covered with sodium bicarbonate (i.e., baking soda), washed with liquid soap preparations, or be powdered with talc to neutralize the acid or remove unreacted acid. TCA/BCA treatment can be repeated weekly if necessary.

Alternative Regimens for External Genital Warts

Less data are available regarding the efficacy of alternative regimens for treating anogenital warts, which include podophyllin resin, intralesional interferon, photodynamic therapy, and topical cidofovir. Further, alternative regimens might be associated with more side effects. Podopyllin resin is no longer a recommended regimen because of the number of safer regimens available, and severe systemic toxicity has been reported when podophyllin resin was applied to large areas of friable tissue and was not washed off within 4 hours (778-780). Podophyllin resin 10%–25% in a compound tincture of benzoin might be considered for provider-administered treatment under conditions of strict adherence to recommendations. Podophyllin should be applied to each wart and then allowed to air-dry before the treated area comes into contact with clothing. Over-application or failure to air-dry can result in local irritation caused by spread of the compound to adjacent areas and possible systemic toxicity. The treatment can be repeated weekly, if necessary. To avoid the possibility of complications associated with systemic absorption and toxicity, 1) application should be limited to <0 .5="" 1="" 2="" 3="" active="" administered="" after="" an="" and="" any="" application.="" are="" area="" be="" been="" cm2="" components="" concentration="" contain="" contaminants.="" differ="" during="" established.="" font="" friable="" has="" hours="" in="" is="" lesions="" ml="" not="" of="" off="" open="" or="" per="" podophyllin="" pregnancy="" preparation="" preparations="" resin="" safety="" session="" shelf-life="" should="" stability="" the="" thoroughly="" tissue="" to="" treatment="" unknown.="" warts="" washed="" which="" wounds="">

Anogenital Warts NYC New York, NY

Of anogenital warts, 90% are caused by nononcogenic HPV types 6 or 11; these types can be commonly identified before or at the same time anogenital warts are detected (767). HPV types 16, 18, 31, 33, and 35 are also occasionally found in anogenital warts (usually as co-infections with HPV 6 or 11) and can be associated with foci of high-grade squamous intraepithelial lesions (HSIL), particularly in persons who have HIV infection. In addition to anogenital warts, HPV types 6 and 11 have been associated with conjunctival, nasal, oral, and laryngeal warts.

Anogenital warts are usually asymptomatic, but depending on the size and anatomic location, they can be painful or pruritic. They are usually flat, papular, or pedunculated growths on the genital mucosa. Anogenital warts occur commonly at certain anatomic sites, including around the vaginal introitus, under the foreskin of the uncircumcised penis, and on the shaft of the circumcised penis. Warts can also occur at multiple sites in the anogenital epithelium or within the anogenital tract (e.g., cervix, vagina, urethra, perineum, perianal skin, anus, and scrotum). Intra-anal warts are observed predominantly in persons who have had receptive anal intercourse, but they also can occur in men and women who have not had a history of anal sexual contact.

Diagnostic Considerations

Diagnosis of anogenital warts is usually made by visual inspection. The diagnosis of anogenital warts can be confirmed by biopsy, which is indicated if lesions are atypical (e.g., pigmented, indurated, affixed to underlying tissue, bleeding, or ulcerated lesions). Biopsy might also be indicated in the following circumstances, particularly if the patient is immunocompromised (including those infected with HIV): 1) the diagnosis is uncertain; 2) the lesions do not respond to standard therapy; or 3) the disease worsens during therapy. HPV testing is not recommended for anogenital wart diagnosis, because test results are not confirmatory and do not guide genital wart management.

Treatment

The aim of treatment is removal of the wart and amelioration of symptoms, if present. The appearance of warts also can result in significant psychosocial distress, and removal can relieve cosmetic concerns. In most patients, treatment results in resolution of the wart(s). If left untreated, anogenital warts can resolve spontaneously, remain unchanged, or increase in size or number. Because warts might spontaneously resolve within 1 year, an acceptable alternative for some persons is to forego treatment and wait for spontaneous resolution. Available therapies for anogenital warts might reduce, but probably do not eradicate, HPV infectivity. Whether the reduction in HPV viral DNA resulting from treatment reduces future transmission remains unknown.

Recommended Regimens

Treatment of anogenital warts should be guided by wart size, number, and anatomic site; patient preference; cost of treatment; convenience; adverse effects; and provider experience. No definitive evidence suggests that any one recommended treatment is superior to another, and no single treatment is ideal for all patients or all warts. The use of locally developed and monitored treatment algorithms has been associated with improved clinical outcomes and should be encouraged. Because all available treatments have shortcomings, some clinicians employ combination therapy (e.g., provider-administered cryotherapy with patient-applied topical therapy between visits to the provider). However, limited data exist regarding the efficacy or risk for complications associated with combination therapy. Treatment regimens are classified as either patient-applied or provider-administered modalities. Patient-applied modalities are preferred by some persons because they can be administered in the privacy of their home. To ensure that patient-applied modalities are effective, instructions should be provided to patients while in the clinic, and all anogenital warts should be accessible and identified during the clinic visit. Follow-up visits after several weeks of therapy enable providers to answer any questions about the use of the medication and address any side effects experienced; follow-up visits also facilitate the assessment of the response to treatment.

2015 Sexually Transmitted Diseases Treatment Guidelines NYC New York NY

These guidelines for the treatment of persons who have or are at risk for sexually transmitted diseases (STDs) were updated by CDC after consultation with a group of professionals knowledgeable in the field of STDs who met in Atlanta on April 30–May 2, 2013. The information in this report updates the Sexually Transmitted Diseases Treatment Guidelines, 2010 (MMWR Recomm Rep 2010;59 [No. RR–12]). These updated guidelines discuss 1) alternative treatment regimens for Neisseria gonorrhoeae; 2) the use of nucleic acid amplification tests for the diagnosis of trichomoniasis; 3) alternative treatment options for genital warts; 4) the role of Mycoplasma genitalium in urethritis/cervicitis and treatment-related implications; 5) updated HPV vaccine recommendations and counseling messages; 6) the management of persons who are transgender; 7) annual testing for hepatitis C in persons with HIV infection; 8) updated recommendations for diagnostic evaluation of urethritis; and 9) retesting to detect repeat infection. Physicians and other health-care providers can use these guidelines to assist in the prevention and treatment of STDs.