Issues in the management of human papillomavirus genital disease

Human papillomavirus (HPV) infects epithelial cells at a variety of anatomic sites. Of the more than 80 types of this virus, approximately one third infect genital tissue. Genital infection can be clinical (warts), subclinical (abnormal Papanicolaou [Pap] smears or lesions visible only with magnification and application of acetic acid) or latent (infection with apparently normal tissue). Recent research has revealed a clear association between genital warts and HPV types 6 and 11, and between cervical cancer and HPV types 16, 18 and others. Women with genital warts who have normal Pap smears do not need colposcopy. All available therapies are suboptimal because HPV is not eradicated by treatment. However, the active disease expression can be eliminated by treatment. The approach to treatment will depend on each patient's personal characteristics and preferences.