Genitoanal papillomavirus infection--a diagnostic and therapeutic dilemma

There are now known to be many genotypes of human papillomavirus (HPV). Types 6 and 11 are closely associated with benign lesions of genitoanal epithelia; the classical forms are condylomata acuminata and papular warts, collectively known as genitoanal or "venereal" warts, but it is now known that subclinical infections are much more common. These were first identified on the cervix uteri by colposcopy after the application of acetic acid, but they can also be found on penile and vulval epithelia by the same technique. Genitoanal HPV infection is an increasingly common disease; because it is usually sexually transmitted, it is important that before a patient is treated appropriate laboratory tests are used to identify or exclude other infections. It is also important that female patients have cervical cytology, because cervical intraepithelial neoplasia is often associated with genital HPV infection. Treatment of anogenital warts is often difficult, and no one form of therapy is effective. Treatment modalities used include cytotoxic agents (podophyllin, podophyllotoxin, fluorouracil), and destructive procedures (scissor excision, cryotherapy, electrocautery, carbon dioxide laser). Recently, the possibility of using interferons either alone or in association with other forms of treatment has been investigated.