Treatment modalities for genital warts

Carbon dioxide (CO2) laser therapy (Grade B). Carbon dioxide laser therapy relies upon the use of a concentrated beam of infrared light energy, which will heat and eventually vaporize the targeted areas. The intense light energy has the added benefit of providing immediate cauterization of any ligated vessels, ensuring a virtually bloodless procedure. The spatial confinement of the laser beam permits precise tissue ablation resulting in rapid healing with little or no scar formation.
The efficacy of CO2 therapy for CA remains contentious. Laser therapy is typically considered to be less effective than other forms of surgical treatment, with clearance rates ranging between 23 to 52 percent. Recurrence rates also tend to be elevated, reaching as high as 77 percent. Side effects are generally mild and limited to the burning of tissue surrounding the lesion. Despite these seemingly unfavorable results, the deep penetrating effect of the laser often allows for a greater and more complete viral attack than seen with other surgical treatment options. This renders it the treatment of choice for immunosuppressed individuals as well as for pregnant women with extensive lesions who remain unresponsive to TCA or cryotherapy.
Unfortunately, laser therapy is also a rather expensive and complicated treatment option. Specialized laser equipment must be purchased and subjected to continual upkeep, while physicians themselves are required to undergo additional training in order to utilize the equipment effectively. Furthermore, vaporization of viral lesions can lead to the release of HPV DNA into the surrounding environment. Appropriate measures must therefore be undertaken in order to ensure physicians and assisting personnel are protected from infection. This necessitates the use of specific, virus-resistant masks as well as a vacuum ventilation system in the examination room. Additional risk factors for the transmission of genital warts through vaporization include treatment of malignant HPV subtypes, thinness of skin, and the degree of viral burden.

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