Electrosurgery (Grade B). Electrosurgery involves the use of high frequency electrical currents in the form of thermal coagulation or electrocautery to burn and destroy warty lesions. The desiccated tissue is subsequently removed by curettage. This technique is particularly efficacious when used in the treatment of smaller warts located on the shaft of the penis, the rectum, or the vulva; however, it is not recommended for large lesions as it may lead to permanent scar formation. Electrosurgery is an extremely effective technique, with randomized, controlled trials yielding clearance rates as high as 94 percent measured six weeks post-treatment. These rates, however, tend to normalize after three months, suggesting that electrosurgery is comparable to cryotherapy with regard to its long-term effectiveness. Electrosurgery is also a fairly painful procedure and local or general anesthesia is usually required. Side effects tend to be relatively minimal and are typically limited to postprocedural pain, although the use of general anesthesia is always associated with a certain degree of elevated risk. It is important to note that electrosurgery is contraindicated in patients with cardiac pacemakers or other implanted cardiac devices due to the potentially fatal effects of current interference and the disruption of the pacemaker rhythms.