What are genital warts?
It is a sexually transmitted disease caused by the human papillomavirus (HPV) in which exophytic keratotic papules (“warts”) appear in the genital, perineal, perianal and/or oral area. Detailed information can be found here.
Laser treatment of genital warts or condylomas. How are they treated?
Although different therapeutic methods are available, destructive methods are generally used in the first phase, and in a second phase those with an immunological action. In reference to destructive methods, which eliminate the visible lesions caused by HPV, podophyllin resin, cryotherapy, electrocoagulant and CO2 laser stand out. As for immunological methods, imiquimod, synatequins and photodynamic therapy stand out.
Condyloma acuminata should be treated by a dermatologist in the case of men and women with external lesions. Women should always be evaluated by a gynecologist to study if there is involvement of the cervix, in which case control or treatment will be offered.
What are destructive treatments of condylomas?
As the word indicates, they are aimed at removing genital warts, which are the visible part of the infection. If the lesions are few, either option is valid.
Podophyllin resin is applied at home by the patient himself and is a comfortable and effective treatment.
Cryotherapy consists of the application of liquid nitrogen in the dermatologist’s office: the low temperature of the nitrogen (-196ºC) burns the lesion and induces inflammation of the lesion that, in most cases, manages to make genital warts fall. It is probably the most frequently used method, due to its simplicity, speed and because it produces a certain inflammation that will favor the formation of an immune response against HPV. The only drawback is that it is a painful therapy (although tolerable) at the same time of application.
Electrocoagulation of warts consists of applying local anesthesia and burning the lesions with an electrode. It is an effective therapy, although it requires the injection of anesthesia, which is painful, and it is possible to leave scars in the treated areas since it is difficult to adjust the power of the burn with this instrument.
The CO2 laser is another tool that allows the removal of any protruding lesion on the skin, as it impacts the water of the redundant tissue and removes it quickly and accurately without causing intense pain in most cases.
How does the CO2 laser work for the treatment of genital warts?
The CO2 laser is a beam of light that specifically impacts the water that makes up the tissues. The sudden evaporation of this water allows the tissue to be removed in a very precise way.
In general, with a single session it is possible to remove all the warts. An anaesthetic cream is applied to the area, left on for a few minutes, and then the lesions are removed one by one. If any of these are bulky or settle in a particularly sensitive area, it is possible to use local anaesthesia. The wart tissue is removed immediately during the process. Depending on the number of genital warts, the procedure lasts approximately 5 – 30 minutes.
As advantages over other therapeutic options, it is worth noting that it can be performed only with topical anaesthesia cream (little discomfort during treatment), that it allows the energy emitted to the tissue to be graded very precisely (so the risk of scarring is minimal) and that the removal of the wart is immediate: you do not have to wait a few days for it to come off as in the case of cryotherapy or podophyllin resin.
A key aspect of CO2 laser compared to cryotherapy is that the former, according to scientific literature, is clearly more effective. According to the prospective study by Azizjalali et al., the whitening rate of CO2 laser-treated condylomas is 95% compared to 46% achieved by cryotherapy (liquid nitrogen) in a single session. Up to 12% of the patients present in this study needed 3 sessions of cryotherapy to achieve complete removal. Likewise, the recurrence rate of lesions was 0.05% in the case of CO2 laser and 0.18% with cryotherapy.
There are no drawbacks of CO2 laser treatment for the patient, since they are for the professional who practices the therapy. This procedure forces the dermatologist who practices it to use a surgical mask and an air aspiration system during the procedure, so he must have a certain structure in his center and experience in the practice of the treatment.
What is the best treatment for genital warts?
In the author’s opinion, the optimal treatment is one that achieves two objectives: the destruction of visible HPV lesions (warts) and the production of an immune response that allows the infection to be controlled or definitively eliminated.
In this sense, although it is possible to achieve both objectives with a destructive treatment, the chances increase if a destructive method is used in a first phase and in a second an immunological therapy (for example, with imiquimod).
Depending on the patient’s personal history, the number of lesions, their location and the patient’s sex life, an individualized treatment plan should be developed that provides the maximum chance of resolving or limiting HPV infection.
REFERENCES
Azizjalali et al. CO2 laser therapy versus cryotherapy in treatment of genital warts; a randomized controlled trial. Iranian Journal of Microbiology, 2012; 4(4):187-190.