2024 recommendations for the therapeutic management of anogenital warts

M Boyer1, M Boyer1, E Joly2

  • 1CHU La Réunion, Department of Infectious Diseases - Dermatology, Saint Pierre, La Réunion, France; UFR Santé (Health Training and Research Unit), University of La Réunion, France.

Abstract

Insights

This study provides treatment recommendations for anogenital warts (AGW) by establishing a hierarchy of therapies based on a systematic literature review. It addresses various patient groups and specific treatment sites, promoting combination therapy.

Area of Science:

  • Dermatology
  • Infectious Diseases
  • Public Health

Background:

  • Anogenital warts (AGW) are common skin lesions caused by human papillomavirus (HPV).
  • AGW frequently recur after treatment, and existing guidelines lack treatment prioritization.
  • Therapies for AGW are categorized as self-administered or clinician-applied.

Purpose of the Study:

  • To develop evidence-based recommendations for managing anogenital warts (AGW).
  • To establish a prioritized hierarchy of treatments for AGW.
  • To provide guidance for diverse patient populations and specific anatomical sites.

Main Methods:

  • A systematic literature review was conducted by a working group with no conflicts of interest.
  • Databases searched included PubMed and Embase up to June 1, 2024.
  • Study quality was assessed using multiple standardized tools (PRISMA, ROBIS, AMSTAR 2, AGREE II, RIGHT, ROB grids) and expert review (GRaAL method).

Main Results:

  • 204 studies were selected from 1446, encompassing RCTs, SRs, non-randomized trials, MAs, and guidelines.
  • Methodological quality of the included studies varied significantly.
  • A treatment hierarchy algorithm was developed, considering general populations, pregnant women, children, immunocompromised individuals, and specific sites (urethral, vaginal, anal). Combination therapy is frequently recommended.

Conclusions:

  • These recommendations offer a structured approach to AGW management.
  • The hierarchy is based on a comprehensive systematic review of available literature.
  • Acknowledges limitations due to data gaps in specific populations and study quality variations.

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