How is HPV treated?

The only treatments available are those to remove or destroy irregular cells, such as those that make up genital warts or cervical/anal dysplasia or cancer. Treatments aimed at the underlying cause of these problems—HPV—are still being studied.

As discussed above, therapy for genital warts and low-grade dysplasia are not required, but are often recommended to prevent them from advancing. Intermediate and high-grade dysplasia, as well as cervical or anal cancer, almost always require therapy to prevent them from becoming life-threatening problems.

Treating warts, dysplasia, and cancers depends on the location and severity of disease. Here's an overview of the currently available treatments and when they're usually used:

	Topical medications: Topical gels and creams—such as podofilox, podophyllum, trichloroacetic acid, and imiquimod—are used only for the treatment of genital warts. In general, they have shown to be 30% to 80% effective in reducing wart size, sometimes dramatically. All topical treatments, with the exception of imiquimod, can be used to treat warts inside the anus or vagina. They are not effective for the treatment of anal or cervical dysplasia or cancer.
	Cryotherapy uses liquid nitrogen to freeze warts or other abnormal cell patches (lesions; dysplasia) inside or near the genitals. This is one of the easiest treatments and can often be performed in a doctor's office. It is commonly used to treat genital warts and low-grade dysplasia It is not usually recommended for patients with intermediate or high-grade dysplasia
	Laser treatment is more aggressive than cryotherapy and uses a high-powered light beam to burn and remove abnormal anal or cervical tissue. This is usually done in a hospital. Laser treatment is effective for intermediate and high-grades of dysplasia, provided that the entire lesion can be seen using either a colposcope or anoscope.
	LEEP (loop electrical excision procedure) is a type of surgery and is almost always performed in a hospital. Like laser treatment, LEEP should not be used lesions that are too deep to see with either a colposcope or anoscope.
	Surgery/cold-knife cone biopsy are still widely used. Cutting away the abnormal cervical or anal tissue allows for both an accurate diagnosis and effective treatment of dysplasia.
	Radical surgery/radiation/chemotherapy: Cervical and anal cancer (carcinoma) are treated like other forms of cancer. Radiation and/or surgery are often necessary to either destroy or remove the cancer and the surrounding tissue. If the cancer spreads, chemotherapy is often used to kill cancer cells in other parts of the body.

An immune-based therapy called HspE7 is being developed as a way to prevent anal dysplasia from recurring in HIV-positive people. See the next section of this lesson regarding vaccines active against HPV.

Because the aim of treating intraepithelial lesions is to guard against the development of cervical, vaginal, vulvar and anal cancer, people who have had been diagnosed with AIN, VAIN, VIN or CIN stage II or III should continue to be monitored closely even after successful treatment of lesions. Monitoring should include colposcopy or anoscopy. Though men who have sex with men are at highest risk of anal lesions and anal cancer, HIV-positive women with cervical dysplasia have also been found to have anal lesions at higher rates than in HIV-negative women. Experts recommend an rectal digital exam once yearly as a screening tool against anal cancer, particularly in HIV-positive men who have sex with men.

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