HPV Treatment Options

Yes, you can manage HPV warts...

There is an important concept which every discussion covering the available treatment options for HPV should make.  Human papillomavirus (HPV) infection can not be treated.  We do not have any treatment modalities which would treat the infection.  However, we do know how to treat some of the symptoms of an HPV infection, such as skin warts.  There is an important distinction between an “infection” and the “warts” that were caused by the infection. So, for the time being, we can only treat the symptoms of the infection.

This concept is not all that unusual, especially in cases of viral infections.  One of the most common examples are upper respiratory infections (or the common cold)  frequently caused by a virus.  In these cases, patients presenting with a fever, receive acetaminophen or ibuprofen to decrease the fever.  These medications don’t “treat” the infection.  They only help minimize the symptoms.  The same analogy applies to HPV treatment.  All of the available treatment modalities, do nothing to the HPV infection, but only treat the symptoms (skin warts).

 

Medications available over-the-counter (OTC)

 

Salicylic acid

Available as a solution, gel or a disc soaked with solution.  It should be applied over the affected skin directly on the wart.  Research has shown a modest effectiveness of 0-80% cure rate (1). 

Despite its modest cure rate, salicylic acid continues to be one of the first-line treatment options for HPV warts because of its low cost and widespread availability.  SA can be purchased, without a prescription, at most if not all drug stores.  Learn more.

 

Prescription medications

 

Imiquimod

Approved by the FDA in 1997, imiquimod is a viable option for the management of HPV warts, especially perianal warts.  It’s mechanism of action involves stimulation of tumor necrosis factor leading to regression of warts. 

Imiquimod preparations are available in 2.5%, 3.75% and 5% concentrations.  The 3.75% solution is the preferred option as it has been shown to have fewer side effects with relatively good treatment rate.  The strongest concentration of imiquimod (5% solution) has been shown to provide a 69.7% cure rate (2) and 17% relapse rate.  Most therapies last 8-12 weeks. Learn more.

  

 

Podophyllotoxin

Derivative of podophyllin, a resin naturally found in the roots of Podophyllum peltatum, podophyllotoxin interferes with replication of HPV virus leading to cellular death.

One of its main uses is the treatment of anogenital warts (condyloma acuminata)  (3), achieving a complete cure rate in 72% cases (4).  Unfortunately, one study reported a 79% relapse rate (5).

Compared to other treatment options, Podophyllotoxin is relatively expensive.  But it can be easily administered by the patient, making it a feasible option for some.  A 0.5% cream or solution is applied on the wart two times a day for 3 consecutive days.  It is then discontinued for the next 4 days.  The same cycle is then repeated every week, until warts are no longer visible.  Maximum duration of therapy is 4 weeks.

 

Cidofovir

The exact mechanism of action of cidofovir is not known.  We know that it competitively inhibits DNA polymerase and leads to cellular destruction or apoptosis (6).  The medication should only be used on the skin.  Intravenous administration is contraindicated due to severe adverse drug reactions.  It should also be noted that codofovir is currently only approved by the FDA for the treatment of CMV retinitis.  However, one of its off-label uses is the treatment of HPV warts.

When used for the management of HPV warts, Cidofovir concentration 1-3% is applied to the skin wart 1-2 times daily for a maximum of 10 weeks (7). 

Due to the fact that cidofovir use for HPV warts has not been extensively studied, it is recommended that other treatment options be tried first, before considering cidofovir.

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