Treatment of human papillomavirus infection in men: a review of effective remedies, surgical treatment, possible complications

A unified scheme for the treatment of human papillomavirus infection does not exist. The main goals of therapy is the destruction of formations, reduction of symptoms and the number of viral particles.

Men with papillomatosis should receive treatment as long as the immune system begins to control the replication of the virus.

Therapy is not recommended for the treatment of human papillomavirus infection in men the subclinical stage, in the absence of coexistent dysplasia (precancerous disease).

Synonyms human papillomavirus infection:

  • condylomata acuminata,
  • warts,
  • papillomatosis;
  • viral papilloma,
  • genital warts,
  • genital/genital warts, etc.

It is important

Currently, there is no evidence that treatment eliminates HPV infection completely. After removal of the growth with new lesions can appear again due to activation of latent virus.

Papillomavirus in men: General information, principles of therapy

HPV infection is common, depending on the pathogenic HPV types the clinical manifestations are different, but the basis – papilloma, which can develop anywhere, including on the genitals.

The greatest difficulty causes getting rid of internal entities associated with HPV.

Genital warts (genital warts) in men can be removed in different ways, and the universal impact does not exist.

How to remove papilloma, depends on the following factors:

  • size;
  • localization;
  • morphology;
  • number;
  • the area of damage;
  • financial capabilities;
  • previous experience of therapy.

The treatment is connected with activities aimed at removing tumors by surgery, chemical destruction, cryo – and laser therapy. Incorrect application of the methods of treatment of human papillomavirus infection in men can cause extensive and unnecessary tissue damage.

Most patients with genital warts requires a series of treatments over several weeks or months. If after 3 sessions, significant improvements are not observed, or after 6 treatments did not happen a full cleansing, you should use a different method of treatment.

Patients with HIV or those taking immunosuppressive drugs require long-term combination therapy; of these men, HPV infection is treatable with great difficulty. In addition to HIV infection, immunodeficiency observed, for example, when maintenance immunosuppressive therapy for transplantation of the organ.

Please note

Regardless of the method, the recurrence rate is quite high for a patient with condyloma acuminata.

Men non-traditional sexual orientation from perianal warts on the background of HIV-infection are at risk for the development of invasive cancer of the rectum.

The main difference between the papillomatous infection in men – the duration of the latent (latent) period.

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Treatment of condyloma in men

Giant condyloma Buske-Levenshtein is a locally invasive squamous cell carcinoma associated with HPV types 6 and 11 and should be considered in the differential diagnosis of formations, with a diameter more than 1 see the Only appropriate treatment is radical surgical removal.

Drug therapy

Veganically papillomatosis men have special difficulties in treatment is not.

Most drugs used for the treatment of HPV infection in men, are applied topically on cutaneous surfaces. Side effects include local allergic reactions and pain.

It is important

Unacceptable use of the mucous membranes and for the treatment of dysplastic lesions.

These include:

  • squamous cell carcinoma;
  • warty carcinoma;
  • boveney papulez.

What are the current medications from papillomatous infection in men

In the treatment of HPV disease use following medications:

  • Modifiers of the immune response these include Imiqimod and interferon alpha. These drugs are used in therapy of anogenital wart or condyloma acuminata.
  • Cytotoxic agents In this group include antiproliferative drugs Podofilox, Podophyllin and 5 — Fluorouracil, and destructive or keratolytic remedies: Salicylic acid, Trichloroacetic acid, Dichlorooctane acid.

None of these drugs has no direct antiviral effect.

Please note

For treatment of papillomatous veganically forms of infection it is recommended to use keratolytic.

Imiqimod

Although Imiqimod has no direct antiviral activity, it is a potent inducer of cytokines, which stimulates the formation of interferon alpha, tumor necrosis factor, interleukins (IL — 1, IL-6 and IL-8). In several randomized studies have shown that the use of Imiqimod as a 5% cream can result in complete resolution of genital warts in 50% of patients. The recurrence rate ranges from 19% to 23% after 6 months.

Imiqimod cream applied 3 times a week before bedtime, the treatment is continued until, until the skin is fully cleared, up to a maximum of 16 weeks. Imiqimod should be washed 8 hours after application; local skin reactions are common, especially after contact with the mucosa. Primary side effects include erythema, itching and burning.

Interferon Alfa

Interferons used in the world practice for the treatment of genital warts in various doses. Currently there is no convincing evidence that local or systemic therapy is better than placebo.

Alpha interferon is a natural cytokine, which is produced either by using recombinant DNA technology, or allocated from a pool of human leukocytes. It possesses powerful immunomodulatory and direct antiviral effects.

Interferon alfa is used for intrauterine treatment of external anogenital warts and condyloma acuminatum. It is injected into the base of each wart in a dosage of 3 million IU 3 times weekly for 3 weeks. For large warts it can be introduced at several points along the periphery in a total dose of 250,000 IU per wart.

Some experts believe that a local injection of interferon is more effective than systemic injection.

A meta-analysis of controlled trials comparing interferon versus placebo for the treatment of genital warts showed a complete response rate of 45% and 16% respectively. The recurrence rate was 21% for interferon and 34% for patients in the placebo group. Side effects included flu-like symptoms, fatigue and local pain.

It is important

The maximum response usually occurs 4-8 weeks after the start of the first course of treatment.

If the results in 12-16 weeks after initiation of therapy with interferon Alfa-2b are not satisfactory, may be subjected to repeated treatment using the same dosage.

An important role is withdrawn and the modulation of the immune response. Systemic use of interferon alpha is indicated for resistant or recurrent external genital warts, even if other ways (podophyllin, surgical removal, laser therapy or cryotherapy) was ineffective.

Podofilox (Podofilox)

In men with papilloma infection drug of choice is gel or solution Podofilox, which is used to treat genital warts or condyloma acuminatum. Method of application 2 times a day for 3 days, repeat every 4 weeks. The application develops visible necrosis of the wart tissue. Side effects are minimal.

It is important

A day is not recommended to use more than 0.5 g of product. Surrounding the wart tissue in need of protection.

Podophyllum (Podophyllin)

Podophyllin, a resin obtained from the may Apple (Podophyllum peltatum Linné) and contains the active ingredient podophyllotoxin, which have a cytotoxic effect.

Podophyllum is used in the treatment of external genital warts and condyloma acuminatum. Rate – weekly application of substances to 6 weeks. Warts that are visible after 6 treatments, usually do not respond to further therapy.

Podophyllin is applied directly to HPV tumors, but do not use more than 0.5 ml per treatment.

Before use, thoroughly clean the affected area, when applied to try not to traumatize the surrounding tissue. Caused medication must be allowed to dry. Initial exposure — 30 — 40 minutes later — from 60 minutes to 4 hours. Dried Podophyllin is removed by an alcohol solution or use soap with water.

Unacceptable simultaneous treatment of multiple warts, due to the toxicity.

Side effects — the formation of ulcerations and pain.

Please note that the drug has neurological toxicity, and a vast area of application increases the absorption of the drug.

Please note

Most practitioners prefer Podofilox Podophyllin, as its toxicity is less, and the active substance can be displayed independently.

Podofilox has the best efficiency (68 -88%, the recurrence rate – 16 – 34%).

5-fluorouracil

Another drug for topical treatment cream is 5-Fluorouracil which prevents the synthesis of DNA and RNA, thereby creating a thymine deficiency that causes unbalanced growth of the cells. There are limited data about the effectiveness of this treatment in patients with genital warts.

Recurrence of papillomatous infection occurs in 10 — 50% of patients after the use of this drug.

5-FU causes a chemical desquamation warts.

5% cream of 5 — fluorouracil can also be useful in the treatment of human papillomavirus infection in men.

5-FU is applied 1-3 times a week for several weeks may repeat the course as necessary.

Apply the medication on clean skin. The dried layer is removed after 3 to 10 hours after application. Mandatory protection of the surrounding tissue.

Note that the treatment of genital warts with 5 — fluorouracil is a painful procedure, as the side effects (pain, ulceration, burning) often develop and are considerably.

Keratolytic

Trichloroacetic acid and Dichlorooctane acid – are extremely powerful keratolytic remedies that rapidly penetrate and chemically cauterize skin, and other tissues. The cauterizing effect is comparable to effect of cryotherapy or electrogastrogram. These prescribed funds may be used for all types of skin warts, except genital. Salicylic acid is more gentle keratolytic substance.

In addition, keratolytic agents used to remove giperkineticeskih formations of the skin: corn, ihtioze, benign warts.

Sinecatechin

Relatively recently, the treatment of human papillomavirus infection in men for the destruction of genital warts began to use the ointment on the basis of sinecatechins.

This drug based on the extract from green tea leaves.

Method of action is unknown, confirmation has anti-oxidant properties.

Research was carried out that demonstrated good results from the application of the 15% ointment (method of application – applying 3 times a week for 4 months). Complete cleansing of the skin was recorded in 57% of patients with anogenital warts. Of the side effects were more likely to be pain, erythema and itching. It is believed that the recurrence rate after application of only 5%.

Indications – local treatment of external genital and perianal warts.

The above drugs normally used to treat human papillomavirus infection in men in developed countries. In Russia HPV diseases can be similar to buy drugs:

  • Viferon;
  • Genferon®;
  • Acyclovir;
  • Laferon;
  • Cycloferon;
  • Oxolinic ointment;
  • Panavir;
  • Veregen;
  • Polyphenon E;
  • 5-fluorouracil;
  • Podophyllum;
  • Podofilox;
  • Of aldara;
  • Bonafton, etc.

It is important

The treatment must appoint a physician.

If medical therapy fails, consider surgical removal of the growths associated with HPV infection.

What operations are applied for removal of warts in men

Laser therapy for HPV

Ongoing research has shown that greater effect is achieved by simultaneous use of alpha-interferon or 5 – fluorouracil with ablation by carbon dioxide laser or the influence ofNd:YAG. The likelihood of recurrence with this method of treatment of papillomatous infection in men reduced.

Nd: YAG laser is preferable to carbon dioxide as the risk of damage to surrounding tissue less. Moreover, the Nd: YAG laser can be used to remove vnutriuretralnami formations if urethrocystoscopy. Carbon dioxide is not suitable for use with the cystoscope.

In modern urology vnutriuretralnami lesions detected with the use of 5 – aminolevulinic acid and subsequent fluorescent diagnostics, which increases the effect of laser removal Nd: YAG. The destruction of warts, which are not visualized during a routine examination, allows to ensure the absence of recurrence of papillomatous infection in men.

A comparable result can be achieved by using a Thulium laser for removal of warts on the external genitals or in the urethra.

The disadvantages include pain after the intervention, which require the appointment of analgesics.

Laser treatment is suitable for removing large anogenital warts.

Cryotherapy

Cryotherapy with liquid nitrogen and solid carbon dioxide is preferable to use for superficial lesions. Treatment can be long, up to 6 cycles of exposure. Internal education difficult to treat.

Photodynamic therapy

Photodynamic treatment is more effective than treatment with carbon dioxide. The performance reaches 95%.

Circumcision, diathermy, and surgical excision

Circumcision is a good way to get rid of prepucialna warts.

Transurethral resection (TUR) of entities using a loop allows you to remove lesions in the prostatic portion of the urethra or for single warts in the anterior urethra.

It is important

If the affected area is extensive, due to the possible development of stricture of the urethra, the method does not apply.

Surgical excision is necessary to remove the papillomatous masses in the urethra, when the endoscopic methods do not produce the desired results or have observed frequent relapses. In some cases, you may need a urethroplasty.

What can be complications

Complications after removal of HPV-formations are rare. They are usually limited to the exposure area and include coarse scarring and giperstesia. Each treatment method has its negative effects. Thus, cryotherapy may be complicated by the appearance of vesicles, recruitasia, pain, swelling. The risk of bleeding, papillomatous proliferation of infection, pigmentation and minor paresthesias.

After the laser exposure can be pigmentation, rough scarring and infection.

Victoria Mishina, urologist, medical columnist