Improved laser techniques for the elimination of genital and extragenital warts

Two series of patients with genital warts were compared for effectiveness of treatment by means of the carbon dioxide laser. In the earlier series (1977 to 1981) laser vaporization was used to remove overt warts while surrounding normal skin was spared. Examination of anal, urethral, and other extragenital sites for possible involvement was done only when warts persisted or recurred. In the later series (1983 to 1985), patients were similarly treated by carbon dioxide laser techniques; however, two additional measures supplemented laser vaporization of gross condyloma acuminatum. The brush technique superficially coagulated skin and mucosal surfaces contiguous to warts. This methodology was hypothesized to eliminate subclinical human papillomavirus infection within normal-appearing epithelium. Compulsive examination and treatment of extragenital sites at the time of the initial laser surgical procedure eliminated the most likely locations for persistence or recurrence. The primary cure rate for the earlier series was 65.8% compared to 91% for the later series. This difference was highly significant (p less than 0.005).