{ "slug": "do-anal-warts-go-away", "question": "Do anal warts go away on their own?", "shortTitle": "Do Anal Warts Go Away on Their Own?", "clinicalQuestion": "In patients with anogenital (anal) warts caused by HPV, what proportion experience spontaneous resolution without treatment, and over what time frame, compared with those who receive treatment?", "pico": { "population": "Adults and adolescents with anal warts (condylomata acuminata)", "intervention": "No treatment / watchful waiting (spontaneous regression)", "comparator": "Active treatment (topical therapy, cryotherapy, surgical removal) or no comparator", "outcomes": [ "Proportion with spontaneous clearance of warts", "Time to spontaneous resolution", "Recurrence rate after spontaneous clearance", "Progression or persistence of lesions", "Rate of clearance with treatment vs no treatment" ] }, "category": "anorectal", "relatedConditions": [ "anal-warts", "hpv-infection", "genital-warts" ], "relatedTreatments": [], "relatedEvidence": [], "bottomLine": { "verdict": "In the best-designed trial, most anal and genital warts did not clear up on their own within six months.", "detail": "In a randomised trial of 203 people with widespread anogenital warts left untreated as a control group, only 8% cleared their warts within six months, compared with about 70% who received active treatment such as interferon or heat treatment (diathermocoagulation). A second small trial found that none of its untreated control patients cleared warts within six weeks. Lower-quality reviews and small case series report much higher spontaneous clearance, sometimes over several years, but these studies did not have proper untreated comparison groups.", "studyIds": [ "pmid:2761917", "pmid:8652714" ] }, "strength": { "level": "moderate", "why": "One well-conducted randomised trial addresses this question directly.", "override": null }, "direction": { "level": "no-meaningful-benefit", "why": "Most of the evidence found no meaningful difference.", "override": null }, "counts": { "recordsRetrieved": 208, "recordsScreened": 200, "included": 75, "rcts": 4, "systematicReviews": 3, "observational": 19, "participants": 85368, "yearFrom": 1979, "yearTo": 2026, "registeredTrialsWithoutResults": 0 }, "excluded": [], "outcomes": [ { "name": "Proportion with spontaneous clearance", "status": "no-improvement", "note": "In the one randomised trial with an untreated control group, only 8% of people cleared their warts within six months without treatment [68]. Another small trial found none of its untreated controls had natural remission within six weeks [52]. Smaller, lower-quality studies and case series report a wide range, from about 1 in 5 up to more than half, usually over much longer follow-up [44,56,58,18,62].", "studyIds": [ "pmid:2761917", "pmid:8652714", "pmid:9843007", "pmid:7801889", "pmid:8218514", "pmid:24026888", "pmid:1543764" ] }, { "name": "Time to spontaneous resolution", "status": "insufficient", "note": "No well-controlled study tracked exactly how long it takes untreated anal warts to clear. A review mentions a time frame of two to five years, but gives no original data or patient numbers to back this up [18].", "studyIds": [ "pmid:24026888" ] }, { "name": "Recurrence rate after spontaneous clearance", "status": "not-studied", "note": "One small trial followed 15 people with anal warts left untreated for about a year; none of them had their warts clear on their own, so there is no evidence from these studies on how often warts come back after spontaneous clearance.", "studyIds": [ "pmid:8652714" ] }, { "name": "Progression or persistence of lesions", "status": "insufficient", "note": "Case reports describe rare, severe warts (giant Buschke-Löwenstein tumours) that grew instead of resolving and occasionally became cancerous, but these are extreme, atypical cases rather than ordinary anal warts [10].", "studyIds": [ "pmid:29644039" ] }, { "name": "Rate of clearance with treatment vs no treatment", "status": "improvement", "note": "In the randomised trial, about 70% of people given active treatment (interferon or heat treatment) cleared their warts within six months, compared with 8% of untreated controls [68].", "studyIds": [ "pmid:2761917" ] } ], "benefits": [ { "text": "A minority of anal and genital warts do clear up without any treatment, so spontaneous resolution does happen, just not for most people in the short term studied.", "studyIds": [ "pmid:2761917", "pmid:7801889" ] } ], "limitations": [ { "text": "The main trial's abstract does not report how long patients were followed after the initial outcome assessment, so it cannot say what happens to warts that are still present afterward, including whether they ever clear later on their own.", "studyIds": [ "pmid:2761917" ] }, { "text": "Most studies reporting higher rates of spontaneous clearance are small case series or narrative reviews without an untreated comparison group, so they cannot reliably tell true spontaneous resolution apart from treatment effects, misdiagnosis, or recall.", "studyIds": [ "pmid:9843007", "pmid:7801889", "pmid:8218514", "pmid:24026888", "pmid:9217658" ] }, { "text": "Several of the available studies looked at children, pregnant women, or people with HIV, whose immune status or circumstances may differ from most adults with anal warts, limiting how well the findings generalise.", "studyIds": [ "pmid:9843007", "pmid:8218514", "pmid:21934446", "pmid:21251265" ] } ], "risks": [ { "text": "Choosing to wait means living with visible warts that may grow or stay the same while you wait to see if they clear on their own, since reviewing the evidence shows untreated warts can grow, stay unchanged, or spontaneously regress, with no way to know in advance which will happen.", "studyIds": [ "pmid:24388560" ], "severity": "minor" }, { "text": "Very rarely, warts that are left untreated or do not respond to treatment can grow into large, locally invasive masses (Buschke-Löwenstein tumours) that are hard to treat and can become cancerous; this is not typical for ordinary anal warts.", "studyIds": [ "pmid:29644039" ], "severity": "serious" }, { "text": "In people living with HIV, anal warts have been linked to a higher chance of developing more advanced anal disease, including precancerous changes, though this study could not prove the warts themselves caused this.", "studyIds": [ "pmid:39099077" ], "severity": "serious" } ], "whyPeopleTryIt": [ { "text": "Anal warts are an embarrassing place to have an exam, so many people hope the problem will simply disappear on its own." }, { "text": "Wart treatments like freezing, creams, or minor surgery can be uncomfortable or costly, making 'just waiting' feel like the easier option." }, { "text": "People know that HPV infections and some skin growths elsewhere on the body often clear on their own, and assume anal warts behave the same way." }, { "text": "Online information repeats the idea that 'the immune system clears HPV naturally', which gets applied to visible warts even though that's a different thing." } ], "keyStudies": [ "pmid:2761917", "pmid:8652714", "pmid:9843007", "pmid:7801889", "pmid:8218514", "pmid:24026888", "pmid:1543764", "pmid:9217658" ], "studies": [ { "id": "pmid:42198950", "pmid": "42198950", "doi": "10.1002/rmv.70168", "nctId": null, "pmcid": null, "title": "The Natural History of Human Papillomavirus (HPV) Infection in Males: Global Evidence From a Systematic Review and Meta-Analysis", "firstAuthor": "Qi", "multipleAuthors": true, "journal": "Rev Med Virol", "year": 2026, "design": "meta-analysis", "n": 68477, "nField": "reported", "population": "males infected with HPV (various ages, including men who have sex with men and people living with HIV)", "intervention": "no treatment; natural course of HPV infection over time", "comparator": "different anatomical sites (oral, anal, genital) and risk groups (e.g., MSM vs heterosexual, HIV-positive vs HIV-negative)", "primaryOutcome": "rates of HPV clearance, persistence, recurrence, progression and transmission", "result": "Anal HPV cleared at 65.14 per 1000 person-months, but the recurrence rate of anogenital warts was 50%", "resultDirection": "mixed", "quality": "moderate", "qualityWhy": "It pools many observational studies with high heterogeneity and no control group, so it shows patterns but can't prove cause and effect.", "directness": "indirect", "limitations": "Considerable heterogeneity across behavioural, immunological, anatomical, and virological factors; abstract does not separate warts specifically from overall HPV infection clearance.", "followUp": "", "plainFinding": "Anal HPV often clears, but warts may return.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42198950/", "sourceText": "This systematic review provides a comprehensive global synthesis of male-specific infection patterns and determinants, aiming to inform targeted prevention and control strategies in public health. A systematic review and meta-analysis were conducted in accordance with the PRISMA 2020 statement. We systematically searched PubMed, Embase, Wanfang, and CNKI for studies on the natural history of HPV infection in males published between January 1, 2003, and March 10, 2025. Meta-analyses were conducted to estimate pooled rates of HPV clearance, persistence, recurrence, progression and transmission. A total of 89 studies involving 68,477 males were included. The overall pooled clearance rate of any HPV in males was 71.04 per 1000 person-months (95% CI: 56.55-87.17). Clearance rates varied by anatomical site, with the lowest rate observed in the oral region (38.79 per 1000 person-months, 95% CI: 10.43-85.13), followed by the anal (65.14 per 1000 person-months, 95% CI: 49.04-83.52) and genital sites (89.40 per 1000 person-months, 95% CI: 66.52-116.99). Clearance rates were lower among men who have sex with men and people living with HIV (PLWH) compared with heterosexual men and those living without HIV, respectively. The pooled progression rate within 12-24 months was 20.75% (95% CI: 6.44%-40.28%). Female-to-male HPV transmission rates were higher than male-to-female transmission rates. The overall recurrence rate of anogenital warts was 50.00% (95% CI: 39.00%-60.00%). Risk factors associated with persistent infection included age over 30 years, current smoking, having male sexual partners, and CD4+ cell counts below 200 cells/mm3. The natural history of HPV infection in males exhibits considerable heterogeneity across behavioural, immunological, anatomical, and virological factors. These findings highlight the importance of including males, particularly high-risk populations, in HPV vaccination, surveillance, and prevention strategies to better inform clinical practice and public health policy.", "provenance": [ { "field": "n", "quote": "A total of 89 studies involving 68,477 males were included." }, { "field": "population", "quote": "A total of 89 studies involving 68,477 males were included." }, { "field": "intervention", "quote": "A systematic review and meta-analysis were conducted in accordance with the PRISMA 2020 statement." }, { "field": "comparator", "quote": "followed by the anal (65.14 per 1000 person-months, 95% CI: 49.04-83.52) and genital sites (89.40 per 1000 person-months, 95% CI: 66.52-116.99)." }, { "field": "primaryOutcome", "quote": "Meta-analyses were conducted to estimate pooled rates of HPV clearance, persistence, recurrence, progression and transmission." }, { "field": "result", "quote": "The overall recurrence rate of anogenital warts was 50.00% (95% CI: 39.00%-60.00%)." } ] }, { "id": "pmid:39099077", "pmid": "39099077", "doi": "10.1111/codi.17099", "nctId": null, "pmcid": "PMC11511645", "title": "Risk of developing high-grade squamous intraepithelial lesions or anal cancer after anal condylomata treatment in people living with HIV", "firstAuthor": "Hewitt", "multipleAuthors": true, "journal": "Colorectal Dis", "year": 2024, "design": "retrospective", "n": 118, "nField": "reported", "population": "people living with HIV who had anal warts (condyloma)", "intervention": "anal condyloma treatment (various treatment modalities)", "comparator": "patients who did not progress to advanced anal disease (non-AAD)", "primaryOutcome": "developing advanced anal disease (high-grade lesions or anal cancer) after condyloma diagnosis", "result": "31% of patients developed advanced anal disease, with risk linked to perianal location, longer time since diagnosis, and lower CD4/CD8 ratio; recurrence and treatment type were not linked to this risk", "resultDirection": "harm", "quality": "low", "qualityWhy": "This is a single-centre retrospective study without a comparison group of untreated patients, so it cannot show whether warts resolve on their own.", "directness": "indirect", "limitations": "Retrospective, single-centre design; no untreated comparison group; studies only HIV-positive patients who received treatment for condyloma.", "followUp": "9.3 years", "plainFinding": "Disease can progress even after treatment.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39099077/", "sourceText": "AIM: To assess the risk and natural history of developing advanced anal disease after diagnosis of anal condyloma in people living with HIV (PLWH). METHODS: This was a single-centre retrospective cohort study of PLWH and anal condyloma from 2001 to 2021. Patients who developed advanced anal disease (AAD; anal high-grade squamous intraepithelial lesions and/or anal cancer) were compared to those who did not progress (non-AAD). We assessed the potential association between AAD and condyloma location, recurrence, and treatment modality. AAD-free survival was calculated utilizing Kaplan-Meier methods. RESULTS: A total of 118 PLWH and anal condyloma were included. Mean overall follow-up time was 9.3 years. A total of 31% of patients developed AAD (n = 37). Average time to AAD from condyloma diagnosis was 5.6 years. On multivariate analysis, risk for AAD development was associated with perianal location of condyloma (OR 4.39, p = 0.038) and increased time from initial condyloma diagnosis (OR 1.12, p = 0.008). Higher CD4/CD8 ratios were associated with lower risk of AAD (OR 0.15, p = 0.029). Condyloma recurrence and treatment type were not associated with development of AAD. AAD-free survival was longer in those with intra-anal only condyloma versus those with either perianal disease alone or combined intra-anal/perianal disease (mean survival times: 22.8 vs. 8.7 vs. 10.7 years, p = 0.017). CONCLUSION: Our study demonstrates the need for careful, long-term follow-up of PLWH and condyloma, particularly in the setting of perianal disease and low CD4/CD8 ratio. Risk of anal disease progression is present even in the setting of condyloma regression following treatment.", "provenance": [ { "field": "population", "quote": "This was a single-centre retrospective cohort study of PLWH and anal condyloma from 2001 to 2021." }, { "field": "intervention", "quote": "We assessed the potential association between AAD and condyloma location, recurrence, and treatment modality." }, { "field": "comparator", "quote": "Patients who developed advanced anal disease (AAD; anal high-grade squamous intraepithelial lesions and/or anal cancer) were compared to those who did not progress (non-AAD)." }, { "field": "primaryOutcome", "quote": "To assess the risk and natural history of developing advanced anal disease after diagnosis of anal condyloma in people living with HIV (PLWH)." }, { "field": "result", "quote": "A total of 31% of patients developed AAD (n = 37)." }, { "field": "result", "quote": "Condyloma recurrence and treatment type were not associated with development of AAD." }, { "field": "n", "quote": "A total of 118 PLWH and anal condyloma were included." }, { "field": "followUp", "quote": "Mean overall follow-up time was 9.3 years." } ] }, { "id": "pmid:38666757", "pmid": "38666757", "doi": "10.1002/rmv.2537", "nctId": null, "pmcid": null, "title": "Human papillomavirus infection: Epidemiology, biology, host interactions, cancer development, prevention, and therapeutics", "firstAuthor": "Wolf", "multipleAuthors": true, "journal": "Rev Med Virol", "year": 2024, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with HPV infection, including genital and anal warts", "intervention": "no specific intervention tested; general review of HPV disease", "comparator": "none reported", "primaryOutcome": "not a specific measured outcome; review covers epidemiology, biology, cancer risk, prevention and treatment of HPV", "result": "the abstract does not state whether anal/genital warts resolve on their own", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this is a broad narrative literature review that never actually studies or reports on whether warts clear without treatment, so it can't answer the question.", "directness": "indirect", "limitations": "abstract does not report any original data, follow-up, or specific findings about natural resolution of warts", "followUp": "", "plainFinding": "Doesn't answer this question.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38666757/", "sourceText": "Human papillomavirus (HPV) infection is one of the most common sexually transmitted infections worldwide. It is caused by the HPV, a DNA virus that infects epithelial cells in various mucous membranes and skin surfaces. HPV can be categorised into high-risk and low-risk types based on their association with the development of certain cancers. High-risk HPV types, such as HPV-16 and HPV-18, are known to be oncogenic and are strongly associated with the development of cervical, anal, vaginal, vulvar, penile, and oropharyngeal cancers. These types of HPV can persist in the body for an extended period and, in some cases, lead to the formation of precancerous lesions that may progress to cancer if left untreated. Low-risk HPV types, such as HPV-6 and HPV-11, are not typically associated with cancer but can cause benign conditions like genital warts. Genital warts are characterised by the growth of small, cauliflower-like bumps on the genital and anal areas. Although not life-threatening, they can cause discomfort and psychological distress. HPV is primarily transmitted through sexual contact, including vaginal, anal, and oral sex. It can also be transmitted through non-penetrative sexual activities that involve skin-to-skin contact. In addition to sexual transmission, vertical transmission from mother to child during childbirth is possible but relatively rare. Prevention of HPV infection includes vaccination and safe sexual practices. HPV vaccines, such as Gardasil and Cervarix, are highly effective in preventing infection with the most common high-risk HPV types. These vaccines are typically administered to adolescents and young adults before they become sexually active. Safe sexual practices, such as consistent and correct condom use and limiting the number of sexual partners, can also reduce the risk of HPV transmission. Diagnosis of HPV infection can be challenging because the infection is often asymptomatic, especially in men. In women, HPV testing can be done through cervical screening programs, which involve the collection of cervical cells for analysis. Abnormal results may lead to further diagnostic procedures, such as colposcopy or biopsy, to detect precancerous or cancerous changes. Overall, HPV infection is a prevalent sexually transmitted infection with significant implications for public health. Vaccination, regular screening, and early treatment of precancerous lesions are key strategies to reduce the burden of HPV-related diseases and their associated complications. Education and awareness about HPV and its prevention are crucial in promoting optimal sexual health. This study aimed to carry out a literature review considering several aspects involving HPV infection: Global distribution, prevalence, biology, host interactions, cancer development, prevention, therapeutics, coinfection with other viruses, coinfection with bacteria, association with head and neck squamous cell carcinomas, and association with anal cancer.", "provenance": [ { "field": "population", "quote": "Low-risk HPV types, such as HPV-6 and HPV-11, are not typically associated with cancer but can cause benign conditions like genital warts." }, { "field": "intervention", "quote": "This study aimed to carry out a literature review considering several aspects involving HPV infection" }, { "field": "primaryOutcome", "quote": "Global distribution, prevalence, biology, host interactions, cancer development, prevention, therapeutics, coinfection with other viruses, coinfection with bacteria, association with head and neck squamous cell carcinomas, and association with anal cancer." }, { "field": "result", "quote": "Genital warts are characterised by the growth of small, cauliflower-like bumps on the genital and anal areas. Although not life-threatening, they can cause discomfort and psychological distress." }, { "field": "comparator", "quote": "Prevention of HPV infection includes vaccination and safe sexual practices." } ] }, { "id": "pmid:38543517", "pmid": "38543517", "doi": "10.3390/microorganisms12030466", "nctId": null, "pmcid": "PMC10972135", "title": "Prospective Longitudinal Study of Dynamics of Human Papillomavirus 6 and 11 Infection in Anogenital Hairs and Eyebrows of Male Patients with Anogenital Warts and Age-Matched Controls", "firstAuthor": "Tlaker", "multipleAuthors": true, "journal": "Microorganisms", "year": 2024, "design": "prospective-cohort", "n": 64, "nField": "reported", "population": "men newly diagnosed with anogenital warts, compared to age-matched healthy men", "intervention": "standard treatment for anogenital warts, with tracking of HPV6/11 in anogenital and eyebrow hairs over time", "comparator": "age-matched healthy controls without warts", "primaryOutcome": "presence/clearance of HPV6/11 in hair samples and recurrence of visible anogenital warts over repeated follow-up visits", "result": "despite treatment, most patients had wart recurrences, and hair HPV positivity tracked with visible warts over time", "resultDirection": "unclear", "quality": "low", "qualityWhy": "this was a small, observational study of treated patients tracking HPV in hair follicles, not a trial comparing treatment to no treatment, so it cannot show whether warts clear on their own.", "directness": "indirect", "limitations": "all patients received standard treatment rather than being left untreated, small sample size (32 patients), and the focus was on HPV DNA dynamics in hair rather than spontaneous wart resolution.", "followUp": "six follow-up visits (every 2.6 months)", "plainFinding": "Warts often recurred despite treatment.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38543517/", "sourceText": "To better understand the natural history of anogenital warts (AGWs) and the dynamics of HPV6/11 infection in regional hairs, 32 newly diagnosed male patients with AGWs and 32 age-matched healthy controls were closely followed. During enrollment and six follow-up visits (every 2.6 months), 43 AGW tissues and 1232 anogenital and eyebrow hair samples were collected. This is the closest longitudinal monitoring of AGW patients to date. Patients were treated according to standards of care. The HPV6/11 prevalence was 19.9% in the patients' hair samples (HPV6 B1 in 53.1%) and 0% in the controls. The highest HPV6/11 prevalence was found in pubic hairs (29.0%) and the lowest in eyebrows (7.1%). The odds of having HPV6/11-positive hairs increased with smoking, shaving the anogenital region, and age. A close association between HPV6/11 presence in hairs and clinically visible AGWs was observed. The proportion of patients with visible AGWs and HPV6/11-positive hairs declined during follow-up with similar trends. No particular HPV6/11 variant was linked with an increased AGW recurrence, but the sublineage HPV6 B1 showed significantly higher clearance from hairs. Despite treatment, 78.1% and 62.5% of the AGW patients experienced one and two or more post-initial AGW episodes, respectively. The patients with HPV6/11-positive hairs or visible AGWs at a preceding visit demonstrated substantially higher odds of presenting with visible AGWs at a subsequent visit.", "provenance": [ { "field": "n", "quote": "32 newly diagnosed male patients with AGWs and 32 age-matched healthy controls were closely followed" }, { "field": "population", "quote": "32 newly diagnosed male patients with AGWs and 32 age-matched healthy controls" }, { "field": "intervention", "quote": "Patients were treated according to standards of care." }, { "field": "comparator", "quote": "32 age-matched healthy controls" }, { "field": "primaryOutcome", "quote": "The proportion of patients with visible AGWs and HPV6/11-positive hairs declined during follow-up with similar trends." }, { "field": "result", "quote": "Despite treatment, 78.1% and 62.5% of the AGW patients experienced one and two or more post-initial AGW episodes, respectively." }, { "field": "followUp", "quote": "six follow-up visits (every 2.6 months)" } ] }, { "id": "pmid:37787054", "pmid": "37787054", "doi": "10.1080/21645515.2023.2258569", "nctId": null, "pmcid": "PMC10549189", "title": "Public health impact of 2-, 4-, and 9-valent HPV vaccination in females on cervical and noncervical diseases in men and women under different coverage scenarios in China: A simulation study", "firstAuthor": "Diakite", "multipleAuthors": true, "journal": "Hum Vaccin Immunother", "year": 2023, "design": "lab", "n": null, "nField": "not-reported", "population": "men and women in China", "intervention": "HPV vaccination (2-, 4-, or 9-valent) in females", "comparator": "no vaccination", "primaryOutcome": "incidence of HPV-related diseases including cervical and noncervical cancers, genital warts, and recurrent respiratory papillomatosis", "result": "this is a simulation model predicting disease reduction from vaccination; it does not address whether anal warts resolve without treatment", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this is a mathematical simulation model about vaccination impact, not a clinical study of whether warts resolve untreated", "directness": "indirect", "limitations": "abstract does not address natural resolution of anal or genital warts; it is a projection model about vaccination coverage impact over 100 years", "followUp": "", "plainFinding": "Not relevant to question asked.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37787054/", "sourceText": "The high prevalence of human papillomavirus (HPV) infection in China suggests there would be a substantial positive health impact of widespread vaccination against HPV. We adapted a previously described dynamic transmission model of the natural history of HPV infection and related diseases to the Chinese setting to estimate the public health impact in China of 2-valent (with and without cross-protection), 4-valent, and 9-valent HPV vaccination strategies. The model predicted the incidence and mortality associated with HPV-related diseases, including cervical and noncervical cancers, genital warts, and recurrent respiratory papillomatosis (RRP), based on the various vaccination coverage rate (VCR) scenarios, over a 100-year time horizon. The public health impact of the 4 vaccination strategies was estimated in terms of cases and deaths averted compared to a scenario with no vaccination. Under the assumption of various primary and catch-up VCR scenarios, all 4 vaccination strategies reduced the incidence of cervical cancer in females and noncervical cancers in both sexes, and the 4-valent and 9-valent vaccines reduced the incidence of genital warts and RRP in both sexes. The 9-valent vaccination strategy was superior on all outcomes. The number of cervical cancer cases averted over 100 years ranged from ~ 1 million to ~ 5 million while the number of cervical cancer deaths averted was ~ 345,000 to ~ 1.9 million cases, depending on the VCR scenario. The VCR for primary vaccination was the major driver of cases averted.", "provenance": [ { "field": "population", "quote": "estimate the public health impact in China" }, { "field": "intervention", "quote": "2-valent (with and without cross-protection), 4-valent, and 9-valent HPV vaccination strategies" }, { "field": "comparator", "quote": "compared to a scenario with no vaccination" }, { "field": "primaryOutcome", "quote": "The model predicted the incidence and mortality associated with HPV-related diseases, including cervical and noncervical cancers, genital warts, and recurrent respiratory papillomatosis (RRP)" }, { "field": "result", "quote": "all 4 vaccination strategies reduced the incidence of cervical cancer in females and noncervical cancers in both sexes, and the 4-valent and 9-valent vaccines reduced the incidence of genital warts and RRP in both sexes" } ] }, { "id": "pmid:32684426", "pmid": "32684426", "doi": "10.1016/j.androl.2020.01.007", "nctId": null, "pmcid": null, "title": "[Consensus on HPV of the Portuguese Society of Andrology, Sexual Medicine and Reproduction: Treatment]", "firstAuthor": "Jorge Pereira", "multipleAuthors": true, "journal": "Rev Int Androl", "year": 2021, "design": "guideline", "n": null, "nField": "not-reported", "population": "people with genital/anal warts (condyloma)", "intervention": "various wart treatments (patient-applied, provider-applied, experimental)", "comparator": "no specific comparator; general treatment landscape discussed", "primaryOutcome": "clearance and recurrence of warts", "result": "not directly studied; abstract states spontaneous resolution rate is high but gives no specific figures or data on natural resolution", "resultDirection": "unclear", "quality": "low", "qualityWhy": "this is a consensus/expert opinion statement, not original research, and gives no data on natural resolution.", "directness": "indirect", "limitations": "This is a consensus statement summarizing treatment options and expert opinion rather than original data on natural history of warts; no numbers or study details are given for spontaneous resolution.", "followUp": "", "plainFinding": "Often clear up on their own.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/32684426/", "sourceText": "The treatment of condyloma is generally a challenge in clinical practice. Although the spontaneous resolution rate is high, a significant proportion of patients seek treatment, not because of symptomatology, but mainly for aesthetic issues and concerns related to the transmission or worsening of existing lesions. The available treatments should be applied only for clinically evident macroscopic lesions. Ideally, available therapies should have rapid action onset and clearance, resolve symptoms, reduce recurrence rate and viral load, be effective in treating small lesions, and be well tolerated. However, none of the currently available treatments is clearly more effective than the others and there is no ideal treatment for all patients or for all condyloma. Therefore, the therapeutic decision should be based on the clinician's experience, available resources, lesion morphology, size, number and location, primary or recurrent lesions, disease severity, patient preference and expectations, patient's immune competence, convenience, tolerance, cost of treatment and results of previous therapies. The available treatments are divided into three groups: applied by the patient himself (imiquimod 3.75 or 5%, podophyllotoxin .5%, synecatekines 10% or 15%), applied by the health care provider (bi- and tricloacetic acids 80%-90%, intralesional interferon alpha, cryotherapy, surgical removal, electrofulguration, laser ablation) and experimental or alternative therapies (topical cidofovir, intralesional bleomycin, photodynamic therapy). Treatment methodologies can be further divided into their action - ablative or destructive treatment (cryotherapy, electrofulguration, laser ablation, surgical excision), cytotoxic or proapoptotic treatments (podophyllotoxin .5%, 5-fluoruracil, bleomycin) and immunomodulatory treatments (imiquimod 3.75% or 5%, synecatekines 10% or 15%, intralesional interferon alpha). The overall success rate of the various treatments available ranges from 23% to 94%. Only treatments that include cryotherapy or surgical excision are suitable in condyloma with any anatomical location and that have the highest success rate in monotherapy. Recurrences are common regardless of the treatment received. In contrast, immunomodulatory therapies despite having lower initial clearance rates appear to have higher probabilities of cure in the medium term, with low recurrence rates. Some treatments may be combined with each other and the effectiveness of combined therapies appears to be superior to monotherapy (proactive sequential treatment). The consensuses for the treatment of HPV also consider special situations: immunocompromised patients, meatus and intraurethral lesions and treatment of the partner.", "provenance": [ { "field": "result", "quote": "Although the spontaneous resolution rate is high, a significant proportion of patients seek treatment" }, { "field": "population", "quote": "treatment of condyloma is generally a challenge in clinical practice" }, { "field": "intervention", "quote": "applied by the patient himself (imiquimod 3.75 or 5%, podophyllotoxin .5%, synecatekines 10% or 15%), applied by the health care provider (bi- and tricloacetic acids 80%-90%, intralesional interferon alpha, cryotherapy, surgical removal, electrofulguration, laser ablation) and experimental or alternative therapies (topical cidofovir, intralesional bleomycin, photodynamic therapy)" }, { "field": "comparator", "quote": "none of the currently available treatments is clearly more effective than the others" }, { "field": "primaryOutcome", "quote": "The overall success rate of the various treatments available ranges from 23% to 94%." } ] }, { "id": "pmid:30852604", "pmid": "30852604", "doi": "10.1093/cid/ciz168", "nctId": null, "pmcid": null, "title": "Sex Differences in the Incidence and Clearance of Anogenital Human Papillomavirus Infection in Liuzhou, China: An Observational Cohort Study", "firstAuthor": "Wei", "multipleAuthors": true, "journal": "Clin Infect Dis", "year": 2020, "design": "prospective-cohort", "n": 4687, "nField": "reported", "population": "men and women aged 18 to 55 in China", "intervention": "no treatment given; natural clearance of HPV infection observed over time", "comparator": "men compared with women", "primaryOutcome": "incidence and clearance of anogenital HPV infection, including the wart-causing types HPV-6/11", "result": "HPV-6/11 infection cleared at a rate of about 112 per 1000 person-months in men and 85 per 1000 person-months in women, with no significant difference between sexes", "resultDirection": "unclear", "quality": "moderate", "qualityWhy": "it is a large, well-designed cohort study, but it tracks HPV virus clearance rather than whether visible anal warts themselves go away, so it only indirectly answers the question.", "directness": "indirect", "limitations": "abstract does not report whether participants had visible warts or track resolution of warts specifically, only clearance of HPV genotypes detected by lab testing", "followUp": "~1 year", "plainFinding": "Wart-causing HPV virus often clears within a year", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/30852604/", "sourceText": "BACKGROUND: Human papillomavirus (HPV) causes anogenital warts and cancers in men and women. However, little is known about sex differences regarding the natural history of anogenital HPV infection. METHODS: Starting in May 2014, an observational cohort study including 2309 men and 2378 women aged 18-55 years was conducted in Liuzhou, China. Samples from anogenital sites were tested for HPV genotypes by multicolor real-time polymerase chain reaction and melting curve analysis biannually for ~1 year. RESULTS: The incidence of oncogenic HPV infection was similar in men and women (10.3 and 11.5/1000 person-months; P = .275), whereas the incidence of HPV-6/11 infection was higher in men than in women (2.0 vs 1.1; P = .018). The incidence of both oncogenic HPV and HPV-6/11 infections was significantly higher in women in the 18- to 25-year age group than in the older age groups (P = .006 and .011, respectively), whereas it did not vary by age among men (P = .552 and .425, respectively). Additionally, men were more likely than women to clear oncogenic infections (101.5 vs 58.6/1000 person-months; P < .001), but no significant difference was found in the clearance of HPV-6/11 by sex (111.7 vs 84.8; P = .266). The median time to clearance of oncogenic type and type 6/11 infections was not age dependent for either sex (all P > .05). CONCLUSIONS: The natural history of oncogenic and nononcogenic HPV infection differs by sex, which implies that sex-specific vaccination strategies should be considered for oncogenic and nononcogenic HPV. CLINICAL TRIALS REGISTRATION: NCT02188004.", "provenance": [ { "field": "n", "quote": "an observational cohort study including 2309 men and 2378 women aged 18-55 years was conducted in Liuzhou, China" }, { "field": "population", "quote": "2309 men and 2378 women aged 18-55 years" }, { "field": "intervention", "quote": "Samples from anogenital sites were tested for HPV genotypes by multicolor real-time polymerase chain reaction and melting curve analysis biannually for ~1 year" }, { "field": "comparator", "quote": "men were more likely than women to clear oncogenic infections" }, { "field": "primaryOutcome", "quote": "The incidence of oncogenic HPV infection was similar in men and women" }, { "field": "result", "quote": "no significant difference was found in the clearance of HPV-6/11 by sex (111.7 vs 84.8; P = .266)" }, { "field": "followUp", "quote": "biannually for ~1 year" } ] }, { "id": "pmid:30799416", "pmid": "30799416", "doi": "10.1159/000493737", "nctId": null, "pmcid": null, "title": "Human Papillomavirus and Genital Disease in Men: What We Have Learned from the HIM Study", "firstAuthor": "Sichero", "multipleAuthors": true, "journal": "Acta Cytol", "year": 2019, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "men enrolled in a multi-country study on HPV infection", "intervention": "natural history tracking of HPV infection in men", "comparator": "", "primaryOutcome": "development of HPV-related genital disease including warts and cancer", "result": "the abstract summarizes findings on HPV infection and risk factors but does not report whether anal warts resolve without treatment", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this is a general review summarizing a cohort study without specific data on wart regression or resolution rates.", "directness": "indirect", "limitations": "abstract does not describe methodology, statistics, or specific outcomes related to spontaneous wart clearance.", "followUp": "", "plainFinding": "No specific finding reported.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/30799416/", "sourceText": "It is currently recognized that in addition to the major impact of human papillomavirus (HPV) infection in females, HPV causes considerable disease in men at the genitals, anal canal, and oropharynx. Specifically, genital HPV infections may progress to genital warts and penile carcinoma. Although studies concerning the natural history of HPV infections and associated neoplasias have mainly focused on women, during the last 2 decades considerable attention has been given in further understanding these infections in men. The HIM (HPV infection in men) Study, the only prospective multicenter study of male HPV natural history, consisted of a large prospective international cohort study in which men from Brazil, the United States, and Mexico were enrolled. The design and protocols of this study allowed unraveling crucial information regarding the relationship between HPV infection and clinical consequences in men, and associated risk factors at each of the anatomic sites where HPV is known to cause cancer in men.", "provenance": [ { "field": "population", "quote": "men from Brazil, the United States, and Mexico were enrolled" }, { "field": "intervention", "quote": "The design and protocols of this study allowed unraveling crucial information regarding the relationship between HPV infection and clinical consequences in men, and associated risk factors at each of the anatomic sites where HPV is known to cause cancer in men." }, { "field": "primaryOutcome", "quote": "genital HPV infections may progress to genital warts and penile carcinoma" }, { "field": "result", "quote": "The design and protocols of this study allowed unraveling crucial information regarding the relationship between HPV infection and clinical consequences in men, and associated risk factors at each of the anatomic sites where HPV is known to cause cancer in men." } ] }, { "id": "pmid:30388232", "pmid": "30388232", "doi": "10.1093/infdis/jiy533", "nctId": null, "pmcid": "PMC6376908", "title": "Genital Wart Recurrence Among Men Residing in Brazil, Mexico, and the United States", "firstAuthor": "Giuliano", "multipleAuthors": true, "journal": "J Infect Dis", "year": 2019, "design": "prospective-cohort", "n": null, "nField": "not-reported", "population": "men aged 18-70 in the United States, Mexico, and Brazil who had a prior genital wart episode", "intervention": "none (observational follow-up of men over time)", "comparator": "none (no treatment comparison)", "primaryOutcome": "whether and when new genital wart episodes occurred after an initial one", "result": "44% of men had at least one more wart episode after the first, and the rate of new episodes rose with each additional episode", "resultDirection": "unclear", "quality": "low", "qualityWhy": "This is an observational recurrence study, not a test of whether untreated warts resolve on their own, so it only indirectly bears on the question.", "directness": "indirect", "limitations": "Abstract does not report total number of participants, does not describe whether warts were treated, and does not directly assess spontaneous resolution without treatment.", "followUp": "median follow-up of 50.4 months", "plainFinding": "Warts often recur after the first episode.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/30388232/", "sourceText": "BACKGROUND: Genital wart (GW) incidence is high among men. The percentage and rate at which subsequent GW events occur are understudied. The purpose of this study was to describe the rate of subsequent GWs, associated human papillomavirus (HPV) types, and time to subsequent GW event among unvaccinated men. METHODS: The study was nested within a multinational prospective HPV natural history study of men aged 18-70 years in the United States, Mexico, and Brazil, examined every 6 months for a median follow-up of 50.4 months. Subsequent GW events were defined as GWs detected after ≥16 weeks of the prior event. RESULTS: Forty-four percent of men experienced ≥1 GW following the initial episode. Men with ≥2 subsequent events were at highest risk of continued GW experiences, with as high as 10 postinitial GW events. The incidence rate of each subsequent GW increased with increasing events (incidence of first subsequent event was 13.1 vs 36.6/1000 person-months for the fourth event). The proportion of GWs among HPV-6 and/or -11-positive patients remained constant across events. Approximately 63%-69% were positive for ≥1 of the 9-valent HPV vaccine types. CONCLUSIONS: These data highlight the high burden of GWs among men across the lifespan and the need for vaccination to prevent multiple GW episodes.", "provenance": [ { "field": "population", "quote": "men aged 18-70 years in the United States, Mexico, and Brazil" }, { "field": "intervention", "quote": "examined every 6 months for a median follow-up of 50.4 months" }, { "field": "comparator", "quote": "unvaccinated men" }, { "field": "primaryOutcome", "quote": "describe the rate of subsequent GWs, associated human papillomavirus (HPV) types, and time to subsequent GW event" }, { "field": "result", "quote": "Forty-four percent of men experienced ≥1 GW following the initial episode." }, { "field": "result", "quote": "The incidence rate of each subsequent GW increased with increasing events (incidence of first subsequent event was 13.1 vs 36.6/1000 person-months for the fourth event)." }, { "field": "followUp", "quote": "median follow-up of 50.4 months" } ] }, { "id": "pmid:29644039", "pmid": "29644039", "doi": "10.1093/jscr/rjy058", "nctId": null, "pmcid": "PMC5888221", "title": "Giant anorectal condyloma acuminatum of Buschke-Löwenstein presents difficult management decisions", "firstAuthor": "Kim", "multipleAuthors": true, "journal": "J Surg Case Rep", "year": 2018, "design": "case-series", "n": 1, "nField": "reported", "population": "person with a BLT case reaching large dimensions in the anorectal region", "intervention": "treated with neoadjuvant chemoradiation therapy and surgical excision of residual lesions", "comparator": "", "primaryOutcome": "identify and prevent recurrence or malignant transformation of the tumor", "result": "BLT differs from normal condyloma acuminata by presenting with locally invasive growth, lack of spontaneous resolution, tendency for recurrence after treatment and potential for malignant transformation", "resultDirection": "harm", "quality": "very-low", "qualityWhy": "This is a single patient case report, which cannot show what generally happens to warts.", "directness": "indirect", "limitations": "Single case report of a rare, severe tumor variant, not typical anal warts; no comparison group or statistical data.", "followUp": "", "plainFinding": "This severe tumor did not go away alone.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/29644039/", "sourceText": "Condyloma acuminata, or anogenital warts, caused by human papillomavirus are the most common sexually transmitted disease. In rare cases, the disease could progress to an extensive neoplasm called Buschke-Löwenstein tumor (BLT), also known as giant condyloma acuminatum. BLT differs from normal condyloma acuminata by presenting with locally invasive growth, lack of spontaneous resolution, tendency for recurrence after treatment and potential for malignant transformation. We examine a BLT case reaching large dimensions in the anorectal region treated with neoadjuvant chemoradiation therapy and surgical excision of residual lesions. Furthermore, continuous follow-up care can help identify and prevent recurrence or malignant transformation of the tumor.", "provenance": [ { "field": "n", "quote": "We examine a BLT case reaching large dimensions in the anorectal region treated with neoadjuvant chemoradiation therapy and surgical excision of residual lesions." }, { "field": "population", "quote": "We examine a BLT case reaching large dimensions in the anorectal region treated with neoadjuvant chemoradiation therapy and surgical excision of residual lesions." }, { "field": "intervention", "quote": "treated with neoadjuvant chemoradiation therapy and surgical excision of residual lesions." }, { "field": "primaryOutcome", "quote": "continuous follow-up care can help identify and prevent recurrence or malignant transformation of the tumor." }, { "field": "result", "quote": "BLT differs from normal condyloma acuminata by presenting with locally invasive growth, lack of spontaneous resolution, tendency for recurrence after treatment and potential for malignant transformation." } ] }, { "id": "pmid:28723467", "pmid": "28723467", "doi": "10.1016/j.euf.2016.08.012", "nctId": null, "pmcid": null, "title": "Human Papillomavirus Infection and Vaccination in Males", "firstAuthor": "Ventimiglia", "multipleAuthors": true, "journal": "Eur Urol Focus", "year": 2016, "design": "systematic-review", "n": null, "nField": "not-reported", "population": "sexually active men", "intervention": "HPV vaccination", "comparator": "unvaccinated men (implied)", "primaryOutcome": "development of external genital lesions (EGLs) from HPV", "result": "vaccines showed efficacy of up to 80% against external genital lesions, but data on cancer prevention were limited", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This is a broad review of HPV vaccination and epidemiology in men, not a study designed to measure whether existing anal warts resolve on their own.", "directness": "indirect", "limitations": "The abstract does not discuss the natural history or spontaneous resolution of existing anal warts, only vaccine prevention of new lesions.", "followUp": "", "plainFinding": "Vaccine lowers new genital lesion risk.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/28723467/", "sourceText": "CONTEXT: Human papillomavirus (HPV) is the commonest sexually transmitted pathogen in humans and is linked to the aetiopathogenesis for both benign and malignant disease in men. OBJECTIVE: To evaluate and summarise the evidence for HPV infection and vaccination in men. EVIDENCE ACQUISITION: A search of Medline, PubMed, and Scopus was performed to identify articles published in English within the last 10 yr addressing HPV epidemiology, the natural history of HPV infection and its long-term consequences, and vaccination in men. Relevant studies were then screened, and the data were extracted, analysed, and summarised. The Preferred Reporting Items for Systematic Reviews and Meta-analysis criteria were applied. EVIDENCE SYNTHESIS: HPV has an overall prevalence of >20% among men, although a minority of individuals develop external genital lesions (EGLs). The risk of acquiring a new HPV infection is robustly linked to sexual behaviour, with the most commonly infected sites being the prepuce, shaft, glans, corona, and scrotum. Of all cancer cases among men, 2% are attributable to HPV, and up to 50% of penile cancers are estimated to be either directly or indirectly driven by it, with HPV-16 the subtype most frequently isolated. Currently there are two different vaccines approved for men, with a good immunogenic profile and efficacy of up to 80% against EGLs; however, efficacy data regarding malignant lesions are still limited. CONCLUSIONS: HPV, owing to its high prevalence and harmful consequences for men's health, has recently attracted considerable attention. Novel insights into the natural history of HPV infection, together with the successful development of several efficacious vaccines, have provided valuable tools in the prevention of HPV infections and their related consequences. HPV vaccination appears to be the only reliable method to provide protection against new HPV infections in men. PATIENT SUMMARY: Human papillomavirus (HPV) infection is very common among sexually active men and can lead to more serious consequences, including cancer. Male vaccination is both a safe and efficacious option preventing both HPV infection and its long-term consequences.", "provenance": [ { "field": "population", "quote": "evidence for HPV infection and vaccination in men" }, { "field": "intervention", "quote": "there are two different vaccines approved for men" }, { "field": "comparator", "quote": "efficacy of up to 80% against EGLs" }, { "field": "primaryOutcome", "quote": "a minority of individuals develop external genital lesions (EGLs)" }, { "field": "result", "quote": "efficacy of up to 80% against EGLs; however, efficacy data regarding malignant lesions are still limited" } ] }, { "id": "pmid:28701899", "pmid": "28701899", "doi": "10.1186/s12962-017-0073-8", "nctId": null, "pmcid": "PMC5504713", "title": "Cost-effectiveness analysis of the nine-valent HPV vaccine in Italy", "firstAuthor": "Mennini", "multipleAuthors": true, "journal": "Cost Eff Resour Alloc", "year": 2017, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people in Italy eligible for HPV vaccination (girls, and in some scenarios boys)", "intervention": "nine-valent HPV vaccine (Gardasil 9)", "comparator": "quadrivalent HPV vaccine (Gardasil), bivalent vaccine, or screening alone", "primaryOutcome": "cost-effectiveness (cost per QALY) and reduction in HPV-related disease including genital warts and cancers", "result": "the nine-valent vaccine was linked to a 17% further drop in cervical cancer, 35% and 14% drops in anal cancer for males and females, and over a million fewer cases of genital warts after 100 years, at a cost of 10,463€ per QALY gained", "resultDirection": "benefit", "quality": "low", "qualityWhy": "this is a computer simulation modeling long-term costs and outcomes, not a study of actual patients or whether warts resolve untreated", "directness": "indirect", "limitations": "abstract does not state limitations; findings come from a mathematical transmission model rather than direct observation of patients or wart outcomes", "followUp": "", "plainFinding": "Vaccine lowers future wart and cancer rates.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/28701899/", "sourceText": "BACKGROUND: In Italy HPV vaccination with the quadrivalent vaccine (Gardasil®) is offered actively and free of charge to girls aged 12 since 2007. A nine-valent vaccine (Gardasil 9®) received the European market authorization in 2015 to protect, with only 2 doses, against around 90% of all HPV positive cancers, over 80% of high-grade precancerous lesions and 90% of genital warts caused by HPV types 6/11. METHODS: A dynamic transmission model simulating the natural history of HPV-infections was calibrated to the Italian setting and used to estimate costs and QALYs associated with vaccination strategies. The analyses compared two strategies with the nine-valent vaccine (cervical cancer screening and vaccination in girls only or vaccination in boys and girls) to four alternative strategies (cervical cancer screening and vaccination with quadrialent vaccine in girls only, in both boys and girls, with bivalent vaccine in girls and screening strategy only). The National Health Service perspective was considered. CONCLUSION: The switch to the nine-valent vaccine in Italy can further reduce the burden associated to cervical cancer and HPV-related diseases and is highly cost-effective. RESULTS: Compared to the current vaccination program with quadrivalent vaccine, the nine-valent vaccine in a programme including girls and boys shows further reductions of 17% in the incidence of cervical cancer, 35 and 14% in anal cancer for males and females, as well as over a million cases of genital warts avoided after 100 years. The new technology is associated with an ICER of 10,463€ per QALY gained in universal vaccination, decreasing to 4483€ when considering the vaccine switch for girls-only.", "provenance": [ { "field": "population", "quote": "HPV vaccination with the quadrivalent vaccine (Gardasil®) is offered actively and free of charge to girls aged 12 since 2007" }, { "field": "intervention", "quote": "A nine-valent vaccine (Gardasil 9®) received the European market authorization in 2015" }, { "field": "comparator", "quote": "compared two strategies with the nine-valent vaccine (cervical cancer screening and vaccination in girls only or vaccination in boys and girls) to four alternative strategies (cervical cancer screening and vaccination with quadrialent vaccine in girls only, in both boys and girls, with bivalent vaccine in girls and screening strategy only)" }, { "field": "primaryOutcome", "quote": "used to estimate costs and QALYs associated with vaccination strategies" }, { "field": "result", "quote": "the nine-valent vaccine in a programme including girls and boys shows further reductions of 17% in the incidence of cervical cancer, 35 and 14% in anal cancer for males and females, as well as over a million cases of genital warts avoided after 100 years. The new technology is associated with an ICER of 10,463€ per QALY gained in universal vaccination, decreasing to 4483€ when considering the vaccine switch for girls-only." } ] }, { "id": "pmid:26551619", "pmid": "26551619", "doi": "10.1097/PAS.0000000000000549", "nctId": null, "pmcid": null, "title": "Papillary Immature Metaplasia of the Anal Canal: A Low-grade Lesion That Can Mimic a High-grade Lesion", "firstAuthor": "Roberts", "multipleAuthors": true, "journal": "Am J Surg Pathol", "year": 2016, "design": "case-series", "n": 15, "nField": "reported", "population": "gay men with anal HPV infection", "intervention": "", "comparator": "", "primaryOutcome": "identifying and characterizing a type of anal lesion (papillary immature metaplasia) to avoid misdiagnosis as a more serious lesion", "result": "the abstract describes a histologic pattern that mimics high-grade lesions but is actually low-grade, caused by HPV types 6 or 11; no data on whether warts resolve without treatment", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this is a small descriptive pathology study, not designed to answer whether anal warts resolve without treatment", "directness": "indirect", "limitations": "small sample of 15 cases; focused on pathologic classification, not on natural resolution of warts; abstract explicitly states further study of natural history is needed", "followUp": "", "plainFinding": "Does not address if warts resolve.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/26551619/", "sourceText": "In a natural history study of anal human papillomavirus (HPV) infection and HPV-related lesions among homosexual men in Sydney, Australia, we identified 15 examples of papillary immature metaplasia (PIM) in anal biopsy samples. PIM has previously been described in the cervix, but not in the anal canal. PIM is a form of exophytic low-grade squamous intraepithelial lesion (eLSIL) also known as condyloma. In contrast to the maturing keratinocytes and koilocytosis seen in conventional eLSIL, the slender papillary structures of PIM have a surface population of immature squamous cells. In our anal samples PIM was characterized by close proximity to conventional eLSIL, was negative for p16 (p16) expression, and revealed the presence of a single low-risk HPV genotype (either 6 or 11) in laser capture microdissected lesions. The clinical significance of recognizing PIM lies in preventing misdiagnosis as high-grade squamous intraepithelial lesion, (the presumed precursor to anal cancer), due to the morphologic immaturity of the cell population. In routine practice, awareness of anal canal PIM and p16 immunostaining will prevent this. Further study of the natural history of anal canal PIM is needed.", "provenance": [ { "field": "population", "quote": "In a natural history study of anal human papillomavirus (HPV) infection and HPV-related lesions among homosexual men in Sydney, Australia, we identified 15 examples of papillary immature metaplasia (PIM) in anal biopsy samples." }, { "field": "n", "quote": "we identified 15 examples of papillary immature metaplasia (PIM) in anal biopsy samples" }, { "field": "primaryOutcome", "quote": "The clinical significance of recognizing PIM lies in preventing misdiagnosis as high-grade squamous intraepithelial lesion, (the presumed precursor to anal cancer), due to the morphologic immaturity of the cell population." }, { "field": "result", "quote": "Further study of the natural history of anal canal PIM is needed." } ] }, { "id": "pmid:25649172", "pmid": "25649172", "doi": "10.1093/infdis/jiv061", "nctId": null, "pmcid": "PMC4565999", "title": "The natural history of genital human papillomavirus among HIV-negative men having sex with men and men having sex with women", "firstAuthor": "Nyitray", "multipleAuthors": true, "journal": "J Infect Dis", "year": 2015, "design": "prospective-cohort", "n": 3593, "nField": "reported", "population": "HIV-negative men who have sex with men or with women, with no history of genital warts", "intervention": "no treatment, just observed genital HPV infection over time", "comparator": "men who have sex with men versus men who have sex with women", "primaryOutcome": "how often new HPV infections occurred and how quickly they cleared", "result": "HPV infection rates were similar between groups, and typical HPV-16 infections took more than 6 months to clear", "resultDirection": "unclear", "quality": "moderate", "qualityWhy": "it is a large multi-year study with regular testing, but it tracks HPV infection clearance in general, not resolution of visible anal warts specifically.", "directness": "indirect", "limitations": "study periods of 6 months or less may not be long enough to accurately measure how long infections last, and participants with a history of genital warts were excluded from the study", "followUp": "up to 4 years", "plainFinding": "HPV infections often clear within months", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/25649172/", "sourceText": "BACKGROUND: Although human immunodeficiency virus (HIV)-negative men having sex with men (MSM) bear a substantial burden of human papillomavirus (HPV)-associated disease, prospective studies of genital HPV infection in this population are scarce. METHODS: HPV genotyping was conducted on genital samples from men (aged 18-70 years) from Brazil, Mexico, or the United States who provided specimens at 6-month intervals for up to 4 years. Eligibility criteria included no history of genital warts or HIV infection. Evaluable specimens were collected from 564 MSM and 3029 men having sex with women (MSW). Incidence and clearance estimates with 95% confidence intervals were calculated. RESULTS: The 12-month cumulative incidence of genital HPV was high in both MSM (25%; 95% confidence interval, 21%-30%) and MSW (21%; 20%-23%). After stratifying by city, MSM and MSW incidence rates were comparable, with 3 exceptions where MSM had higher incidence in ≥1 city: the group of quadrivalent vaccine types, HPV-45, and HPV-11. Median times to HPV-16 clearance were also comparable, with point estimates of >6 months for both MSM and MSW. CONCLUSIONS: Unlike with many other sexually transmitted infections, genital HPV natural history may be similar in HIV-negative MSM and MSW. Study periods of ≤6 months, however, may not be long enough to accurately measure the persistence of these infections in men.", "provenance": [ { "field": "n", "quote": "Evaluable specimens were collected from 564 MSM and 3029 men having sex with women (MSW)." }, { "field": "population", "quote": "Eligibility criteria included no history of genital warts or HIV infection." }, { "field": "intervention", "quote": "provided specimens at 6-month intervals for up to 4 years" }, { "field": "comparator", "quote": "MSM and MSW incidence rates were comparable" }, { "field": "primaryOutcome", "quote": "Incidence and clearance estimates with 95% confidence intervals were calculated." }, { "field": "result", "quote": "Median times to HPV-16 clearance were also comparable, with point estimates of >6 months for both MSM and MSW." }, { "field": "limitations", "quote": "Study periods of ≤6 months, however, may not be long enough to accurately measure the persistence of these infections in men." } ] }, { "id": "pmid:25362229", "pmid": "25362229", "doi": "10.1002/14651858.CD010389.pub2", "nctId": null, "pmcid": "PMC10777270", "title": "Imiquimod for anogenital warts in non-immunocompromised adults", "firstAuthor": "Grillo-Ardila", "multipleAuthors": true, "journal": "Cochrane Database Syst Rev", "year": 2014, "design": "meta-analysis", "n": 1734, "nField": "reported", "population": "adults with anal/genital warts who are not immunocompromised", "intervention": "imiquimod cream applied by the patient", "comparator": "placebo, other patient-applied creams, or clinic-based treatments like freezing or laser", "primaryOutcome": "complete or partial clearing of the warts", "result": "Imiquimod cleared more warts than placebo, but was similar to other patient-applied or clinic treatments; evidence quality was very low to low throughout", "resultDirection": "mixed", "quality": "very-low", "qualityWhy": "The trials had a high risk of bias and imprecise, inconsistent results, so the findings are very uncertain.", "directness": "indirect", "limitations": "High risk of bias in included trials, imprecision, and inconsistency across outcomes; many trials industry-funded.", "followUp": "", "plainFinding": "More clearing with imiquimod than placebo.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/25362229/", "sourceText": "BACKGROUND: 30% of people with anogenital warts (AGW) have spontaneous regression of lesions but there is no way to determine whether a specific lesion will remain. There are a wide range of options available for treating people with AGW and selection is based on clinician's experience, patient preferences and adverse effects. The imiquimod could offer the advantages of patient-applied therapies without incurring the limitations of provider-administered treatments. OBJECTIVES: To assess the effectiveness and safety of imiquimod for the treatment of AGW in non-immunocompromised adults. SEARCH METHODS: We searched the Cochrane Sexually Transmitted Infections Group Specialized Register (15 April 2014), CENTRAL (1991 to 15 April 2014), MEDLINE (1946 to 15 April 2014), EMBASE (1947 to 15 April 2014), LILACS (1982 to 15 April 2014), World Health Organization International Clinical Trials Registry (ICTRP) (15 April 2014), ClinicalTrials.gov (15 April 2014), Web of Science (2001 to 15 April 2014) and OpenGrey (15 April 2014). We also handsearched conference proceedings, contacted trial authors and reviewed the reference lists of retrieved studies. SELECTION CRITERIA: Randomized controlled trials (RCTs) comparing the use of imiquimod with placebo, any other patient-applied or any other provider-administered treatment (excluding interferon and 5-fluorouracil which are assessed in other Cochrane Reviews) for the treatment of AGW in non-immunocompromised adults. DATA COLLECTION AND ANALYSIS: Three review authors independently assessed trials for inclusion, extracted data and assessed risk of bias. We resolved any disagreements through consensus. The quality of the evidence was assessed using the GRADE approach. MAIN RESULTS: Ten RCTs (1734 participants) met our inclusion criteria of which six were funded by industry. We judged the risk of bias of the included trials as high. Six trials (1294 participants) compared the use of imiquimod versus placebo. There was very low quality evidence that imiquimod was superior to placebo in achieving complete and partial regression (RR 4.03, 95% CI 2.03 to 7.99; RR 2.56, 95% CI 2.05 to 3.20, respectively). When compared with placebo, the effects of imiquimod on recurrence (RR 2.76, 95% CI 0.70 to 10.91), appearance of new warts (RR 0.76, 95% CI 0.58 to 1.00) and frequency of systemic adverse reactions (RR 0.91, 95% CI 0.63 to 1.32) were imprecise. We downgraded the quality of evidence to low or very low. There was low quality evidence that imiquimod led to more local adverse reactions (RR 1.73, 95% CI 1.18 to 2.53) and pain (RR 11.84, 95% CI 3.36 to 41.63).Two trials (105 participants) compared the use of imiquimod versus any other patient-applied treatment (podophyllotoxin and podophyllin). The estimated effects of imiquimod on complete regression (RR 1.09, 95% CI 0.80 to 1.48), partial regression (RR 0.77, 95% CI 0.40 to 1.47), recurrence (RR 0.49, 95% CI 0.21 to 1.11) or the presence of local adverse reactions (RR 1.24, 95% CI 1.00 to 1.54) were imprecise (very low quality evidence). There was low quality evidence that systemic adverse reactions were less frequent with imiquimod (RR 0.30, 95% CI 0.09 to 0.98).Finally, two trials (335 participants) compared imiquimod with any other provider-administered treatment (ablative methods and cryotherapy). There was very low quality of evidence that imiquimod did not have a lower frequency of complete regression (RR 0.84, 95% CI 0.56 to 1.28). There was very low quality evidence that imiquimod led to a lower rate of recurrence during six-month follow-up (RR 0.24, 95% CI 0.10 to 0.56) but this did not translate in to a lower recurrence from six to 12 months (RR 0.71, 95% CI 0.40 to 1.25; very low quality evidence). There was very low quality evidence that imiquimod was associated with less pain (RR 0.30, 95% CI 0.17 to 0.54) and fewer local reactions (RR 0.55, 95% CI 0.40 to 0.74). AUTHORS' CONCLUSIONS: The benefits and harms of imiquimod compared with placebo should be regarded with caution due to the risk of bias, imprecision and inconsistency for many of the outcomes we assessed in this Cochrane Review. The evidence for many of the outcomes that show imiquimod and patient-applied treatment (podophyllotoxin or podophyllin) confer similar benefits but fewer systematic reactions with the Imiquimod, is of low or very low quality. The quality of evidence for the outcomes assessing imiquimod and other provider-administered treatment were of very low quality.", "provenance": [ { "field": "n", "quote": "Ten RCTs (1734 participants) met our inclusion criteria" }, { "field": "population", "quote": "the treatment of AGW in non-immunocompromised adults" }, { "field": "intervention", "quote": "comparing the use of imiquimod with placebo" }, { "field": "comparator", "quote": "placebo, any other patient-applied or any other provider-administered treatment" }, { "field": "primaryOutcome", "quote": "achieving complete and partial regression" }, { "field": "result", "quote": "There was very low quality evidence that imiquimod was superior to placebo in achieving complete and partial regression" } ] }, { "id": "pmid:24396983", "pmid": "24396983", "doi": null, "nctId": null, "pmcid": "PMC4718386", "title": "HPV related diseases in males: a heavy vaccine-preventable burden", "firstAuthor": "Canepa", "multipleAuthors": true, "journal": "J Prev Med Hyg", "year": 2013, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "males with HPV-related disease", "intervention": "not applicable (natural history review)", "comparator": "", "primaryOutcome": "burden and natural history of HPV-related disease in men", "result": "The abstract does not report specific findings on whether anal warts resolve without treatment", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a narrative review summarizing general HPV disease burden, not a study addressing wart clearance with data or results.", "directness": "indirect", "limitations": "No specific methodology, data, or outcomes on wart resolution are reported in the abstract", "followUp": "", "plainFinding": "No specific finding reported", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/24396983/", "sourceText": "Human Papillomavirus (HPV) has a significant impact in male's health, as cause of clinical manifestations ranging from genital warts to several cancers of the anogenital and aero-digestive tract. HPV types which most frequently affect men are 6, 11, 16 and 18, included in the HPV quadrivalent vaccine, recently approved for use in males by Food and Drug Administration (FDA) and European Medicines Agency (EMA). Although several data about the safety and efficacy of quadrivalent vaccine are available, the implementation of proper immunization plans dedicate to male's population cannot ignore the knowledge of the characteristics of the disease in men, which in some aspects should be clarify, in particular clearance of type-specific HPV infections and transmission dynamics. Purpose of this review is to summarise the main information about the burden and the natural history of the HPV related disease in males.", "provenance": [ { "field": "population", "quote": "HPV related disease in males" }, { "field": "intervention", "quote": "Purpose of this review is to summarise the main information about the burden and the natural history of the HPV related disease in males." }, { "field": "primaryOutcome", "quote": "clearance of type-specific HPV infections and transmission dynamics" }, { "field": "result", "quote": "which in some aspects should be clarify, in particular clearance of type-specific HPV infections and transmission dynamics" } ] }, { "id": "pmid:24388560", "pmid": "24388560", "doi": null, "nctId": null, "pmcid": null, "title": "Therapeutic options for external genital warts", "firstAuthor": "Vender", "multipleAuthors": true, "journal": "J Cutan Med Surg", "year": 2013, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with external genital warts", "intervention": "no treatment (natural course)", "comparator": "treatment with provider or patient applied therapies", "primaryOutcome": "whether warts grow, stay the same, or go away without treatment", "result": "left untreated, warts may grow, stay the same, or go away on their own via immune clearance", "resultDirection": "mixed", "quality": "low", "qualityWhy": "this is a general narrative review of treatment options, not a study specifically measuring how often untreated warts resolve.", "directness": "indirect", "limitations": "The abstract is a general review of treatment options and does not provide data, numbers, or a dedicated study on the natural course of untreated warts; it also notes recurrence is common even with treatment.", "followUp": "", "plainFinding": "Untreated warts may clear, stay, or grow.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/24388560/", "sourceText": "The primary goal of treatment for external genital warts (EGWs) is to eradicate visible lesions and address symptoms that may accompany them, but it does not address the underlying virus. Left untreated, warts may grow, remain the same, or spontaneously regress as a result of being cleared by the immune system. However, recurrence is common with or without treatment and may occur within 3 months of ending treatment in one-quarter to two-thirds of cases. Treatment options fall into two categories: provider or patient applied. Provider-based therapies include cryotherapy, trichloroacetic and bichloroacetic acid, electrocautery, surgical excision, and CO2 laser therapy. Patient-applied therapy choices include imiquimod and podophyllotoxin. Imiquimod 3.75% is a fairly new, patient-administered topical cream approved by Health Canada in 2011. Another recently approved patient-applied choice is sinecatechins, a green tea extract with immunomodulatory effects. Self-treatment options are attractive to patients because they offer privacy, convenience, and autonomy. In contrast, provider-administered therapies may boast increased precision (especially for areas that are hard to reach) and closer monitoring, which can be augmented by patient education and counseling. Available topical and surgical therapies vary widely in terms of cost, efficacy, adverse effects, dosage/frequency, and length of treatment. No one treatment is ideally suited to all patients or constitutes a gold standard. Treatment regimens must be tailored to each patient's needs and preferences. The health care provider's skills and experience will also factor into treatment decisions. In addition, the size, number, and location of lesions and whether the infection is new or recurrent will help guide the decision process toward the best treatment for a given patient.", "provenance": [ { "field": "population", "quote": "external genital warts (EGWs)" }, { "field": "intervention", "quote": "Left untreated, warts may grow, remain the same, or spontaneously regress as a result of being cleared by the immune system." }, { "field": "comparator", "quote": "Treatment options fall into two categories: provider or patient applied." }, { "field": "primaryOutcome", "quote": "Left untreated, warts may grow, remain the same, or spontaneously regress as a result of being cleared by the immune system." }, { "field": "result", "quote": "Left untreated, warts may grow, remain the same, or spontaneously regress as a result of being cleared by the immune system." } ] }, { "id": "pmid:24026888", "pmid": "24026888", "doi": "10.1007/s00120-013-3174-9", "nctId": null, "pmcid": null, "title": "[Proven and new methods in the treatment of genital warts]", "firstAuthor": "Schneede", "multipleAuthors": true, "journal": "Urologe A", "year": 2013, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with anogenital (genital) warts", "intervention": "no treatment / natural course of infection", "comparator": "active treatment options for genital warts", "primaryOutcome": "whether warts go away on their own (spontaneous regression)", "result": "warts often go away on their own within 2-5 years, but some persist despite treatment", "resultDirection": "mixed", "quality": "low", "qualityWhy": "this is a narrative review/opinion article without original study data or numbers to check.", "directness": "direct", "limitations": "no study design, sample size, or methodology described; appears to be a general review article citing prior observations.", "followUp": "2-5 years", "plainFinding": "Often clear up within years.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/24026888/", "sourceText": "Anogenital warts are the most common clinical manifestation of human papillomavirus (HPV) infections. Although easy to recognize, asymptomatic anogenital warts (condylomata acuminata) may be overlooked, leading to unaware transmission to the sexual partner. On the other hand awareness of this sexually transmitted disease (STD) is largely associated with a great psychological and social burden, in men as well as women. Spontaneous regression of genital warts has been observed mostly within 2-5 years; however, persisting condylomata may prove refractory to all current treatment options. Because removal of the warts does not totally eliminate the underlying viral infection, treatment of genital warts can often be of long duration, of varying effectiveness and with high recurrence rates. Without a doubt only the patient's own immune system is capable of clearing HPV infections. Therefore, the solution to one of mankind's oldest health problems will depend on the future acceptability of HPV vaccines.", "provenance": [ { "field": "population", "quote": "Anogenital warts are the most common clinical manifestation of human papillomavirus (HPV) infections" }, { "field": "primaryOutcome", "quote": "Spontaneous regression of genital warts has been observed mostly within 2-5 years" }, { "field": "result", "quote": "Spontaneous regression of genital warts has been observed mostly within 2-5 years; however, persisting condylomata may prove refractory to all current treatment options." }, { "field": "intervention", "quote": "Spontaneous regression of genital warts" }, { "field": "comparator", "quote": "treatment of genital warts can often be of long duration, of varying effectiveness and with high recurrence rates" }, { "field": "followUp", "quote": "within 2-5 years" } ] }, { "id": "pmid:23518405", "pmid": "23518405", "doi": "10.1016/j.vaccine.2013.03.006", "nctId": null, "pmcid": null, "title": "Estimating the long-term effects of HPV vaccination in Germany", "firstAuthor": "Horn", "multipleAuthors": true, "journal": "Vaccine", "year": 2013, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "12-17 year old girls in Germany eligible for HPV vaccination", "intervention": "HPV vaccination against HPV types 16/18", "comparator": "No vaccination (modeled natural history without vaccine)", "primaryOutcome": "Predicted long-term incidence and mortality of cervical cancer and anogenital warts", "result": "Model predicts vaccination will reduce cervical cancer cases and, by implication, anogenital wart rates over decades; the abstract does not describe whether anal warts resolve without treatment", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a theoretical mathematical modeling study of HPV vaccination impact, not a clinical study observing whether existing anal warts resolve on their own.", "directness": "indirect", "limitations": "The abstract describes a simulation model based on epidemiologic calibration data, not direct observation of wart natural history or spontaneous resolution.", "followUp": "", "plainFinding": "Does not address spontaneous wart resolution.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/23518405/", "sourceText": "In Germany, vaccination against the most oncogenic HPV types 16/18 is recommended by the Standing Committee on Vaccination (STIKO) for 12-17 year old girls since March 2007. We developed a dynamic mathematical model for the natural history and transmission of HPV infections to estimate the impact of vaccination on incidence and mortality of cervical cancer and its pre-stages, and on anogenital warts. We focused on an extensive model calibration to epidemiologic data for all stages of the natural history model as well as on a detailed implementation of cervical cancer screening modalities in Germany. Our model predicts first a substantial reduction of cervical cancer incidence and mortality over the next 30 years, which is mainly attributable to an increase in screening participation in the 1990s and not to HPV vaccination, followed by a further reduction attributable to vaccination. Over the next 100 years, HPV vaccination will prevent approximately 37% of cervical cancer cases even if vaccination coverage is only 50% (as currently observed in Germany). Consideration of cross-protection results in a further reduction of approximately 7% of all cervical cancer cases for the bivalent and about 5% for the quadrivalent vaccine in our model. Vaccination of boys was only reasonable if moderate to high vaccination coverage in girls was not achieved. Strategies should be implemented in Germany to increase HPV vaccination coverage among girls thereby making better use of the demonstrated benefits of the vaccine.", "provenance": [ { "field": "population", "quote": "12-17 year old girls" }, { "field": "intervention", "quote": "vaccination against the most oncogenic HPV types 16/18" }, { "field": "comparator", "quote": "We developed a dynamic mathematical model for the natural history and transmission of HPV infections to estimate the impact of vaccination" }, { "field": "primaryOutcome", "quote": "estimate the impact of vaccination on incidence and mortality of cervical cancer and its pre-stages, and on anogenital warts" }, { "field": "result", "quote": "HPV vaccination will prevent approximately 37% of cervical cancer cases even if vaccination coverage is only 50%" } ] }, { "id": "pmid:23250297", "pmid": "23250297", "doi": "10.1097/OLQ.0b013e31827e87bd", "nctId": null, "pmcid": null, "title": "Natural history of human papillomavirus infections involving anal, penile, and oral sites among HIV-positive men", "firstAuthor": "Videla", "multipleAuthors": true, "journal": "Sex Transm Dis", "year": 2013, "design": "prospective-cohort", "n": 733, "nField": "reported", "population": "HIV-positive men (both men who have sex with men and heterosexual men)", "intervention": "No treatment; natural observation of HPV infection over time", "comparator": "Men who have sex with men versus heterosexual men", "primaryOutcome": "Prevalence, clearance, and new occurrence of HPV infection at anal, penile, and oral sites", "result": "HPV infection cleared in 30% of anal infections, 56% of penile infections, and 44% of oral infections over the study period", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This is an observational study of HIV-positive men only, tracking HPV DNA detection rather than visible wart resolution, so it only indirectly addresses whether anal warts themselves go away.", "directness": "indirect", "limitations": "Study population was HIV-positive men only, which may not generalize to the general population; the study tracked HPV viral clearance by PCR rather than clinical regression of visible anal warts.", "followUp": "between 2005 and 2009", "plainFinding": "Some anal HPV clears, not warts directly", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/23250297/", "sourceText": "AIM: The aim of this study was to characterize the natural history of human papillomavirus (HPV) infection at anal canal, penile, and oral sites in HIV-positive men based on their sexual behavior. METHODS: This is a single-center, prospective cohort study. The prevalence, clearance, and incidence of HPV infection at anal, penile, and oral sites were studied in HIV-positive men who have sex with men (MSM) and heterosexual individuals using multiplex polymerase chain reaction. Risk factors associated with HPV infection were analyzed. RESULTS: In total, 733 patients (538 MSM, 195 heterosexual) were included in the study between 2005 and 2009. The prevalence, clearance, and incidence of HPV infection were 73%, 30%, and 36% at anal site; 26%, 56%, and 17% at penile site; and 16%, 44%, and 11% at oral site, respectively. At anal site, MSM had a higher HPV prevalence (84% vs. 42%; odds ratio,7.3; 95% confidence interval [CI], 5.2-10.6) mainly for multiple (≥3) HPV types, higher incidence rate (324 vs. 92 new HPV-infected person per 1000 person-years [hazard ratio, 8.1; 95% CI, 3.8-17.3]), and a lower clearance rate (125 vs. 184 cleared HPV-infected person per 1000 person-years [hazard ratio, 0.5; 95% CI, 0.3-0.9]) than did heterosexuals. Similar prevalence, clearance, and incidence rates of penile and oral HPV infection were found between groups. The most common high-risk HPV type for the 3 body sites studied was the HPV-16. Finally, a similar proportion of heterosexuals (7%) and MSM (6%) presented concurrent HPV infections (anal-penile-oral sites). History of anal warts was associated with higher HPV prevalence in the 3 body parts. CONCLUSIONS: Although MSM presented the highest risk of anal HPV infection, heterosexual men also showed a remarkable prevalence of anal HPV infection and a comparable risk to MSM for penile and oral HPV infection. Taking into account all these results, the careful inspection of the anal canal, penile, and oral sites should at least be routine in each clinic visit of HIV-infected men independently of their sexual behavior.", "provenance": [ { "field": "population", "quote": "HIV-positive men who have sex with men (MSM) and heterosexual individuals" }, { "field": "n", "quote": "In total, 733 patients (538 MSM, 195 heterosexual) were included in the study between 2005 and 2009." }, { "field": "primaryOutcome", "quote": "The prevalence, clearance, and incidence of HPV infection at anal, penile, and oral sites were studied" }, { "field": "result", "quote": "The prevalence, clearance, and incidence of HPV infection were 73%, 30%, and 36% at anal site; 26%, 56%, and 17% at penile site; and 16%, 44%, and 11% at oral site, respectively." }, { "field": "intervention", "quote": "This is a single-center, prospective cohort study." }, { "field": "comparator", "quote": "MSM had a higher HPV prevalence (84% vs. 42%; odds ratio,7.3; 95% confidence interval [CI], 5.2-10.6)" }, { "field": "followUp", "quote": "between 2005 and 2009" } ] }, { "id": "pmid:22379403", "pmid": "22379403", "doi": "10.1055/s-0031-1272821", "nctId": null, "pmcid": "PMC3140331", "title": "Anal warts and anal intradermal neoplasia", "firstAuthor": "Echenique", "multipleAuthors": true, "journal": "Clin Colon Rectal Surg", "year": 2011, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with anal warts caused by HPV infection", "intervention": "", "comparator": "", "primaryOutcome": "natural history, diagnosis, and treatment of anal warts and related dysplasia", "result": "the abstract does not report whether anal warts resolve without treatment", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this is a general narrative review summarizing diagnosis and treatment rather than presenting original data or outcomes on spontaneous resolution.", "directness": "indirect", "limitations": "the abstract gives no data on natural resolution rates, sample size, or study methodology; it is a broad review of diagnosis and management.", "followUp": "", "plainFinding": "No answer given here.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/22379403/", "sourceText": "For the last five millennia we have been dealing with the annoyance of verrucas. Anogenital human papillomavirus (HPV) infection is the most common sexually transmitted disease in the United States and is increasing in incidence. As in other gastrointestinal conditions, HPV infection can lead to a stepwise transition from normal cells to dysplastic cells and then to invasive anal cancer. Knowledge of the natural history of HPV infection, risk factors, diagnostic tools, and therapeutic methods gives us the tools to adequately prevent, evaluate, treat, and counsel our patients. In this review, the authors detail the diagnosis, management, and treatment of anal condyloma and anal intraepithelial neoplasia with a focus on prevention, early detection, and treatment using current data and technology.", "provenance": [ { "field": "population", "quote": "Anogenital human papillomavirus (HPV) infection is the most common sexually transmitted disease in the United States" }, { "field": "primaryOutcome", "quote": "the authors detail the diagnosis, management, and treatment of anal condyloma and anal intraepithelial neoplasia with a focus on prevention, early detection, and treatment using current data and technology" }, { "field": "result", "quote": "Knowledge of the natural history of HPV infection, risk factors, diagnostic tools, and therapeutic methods gives us the tools to adequately prevent, evaluate, treat, and counsel our patients." } ] }, { "id": "pmid:21934446", "pmid": "21934446", "doi": "10.1097/AOG.0b013e31821a0f4d", "nctId": null, "pmcid": "PMC3178036", "title": "Genital warts and vulvar intraepithelial neoplasia: natural history and effects of treatment and human immunodeficiency virus infection", "firstAuthor": "Massad", "multipleAuthors": true, "journal": "Obstet Gynecol", "year": 2011, "design": "prospective-cohort", "n": 544, "nField": "reported", "population": "women with genital warts, some with HIV infection and some without", "intervention": "no treatment; natural course of genital warts was observed", "comparator": "HIV-seropositive women compared with HIV-seronegative women", "primaryOutcome": "whether genital warts went away on their own over time (regression)", "result": "82% of HIV-positive women and 95% of HIV-negative women had their warts regress, mostly within the first year", "resultDirection": "benefit", "quality": "moderate", "qualityWhy": "it was a large, carefully followed group with regular exams, but it studied vulvar warts in a mostly HIV-focused population rather than anal warts in the general population.", "directness": "indirect", "limitations": "Population was selected for an HIV natural-history study, and the lesions were genital/vulvar warts in women rather than anal warts in a general population.", "followUp": "up to 13 years", "plainFinding": "Most genital warts resolved naturally.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/21934446/", "sourceText": "OBJECTIVE: To describe the natural history of genital warts and vulvar intraepithelial neoplasia (VIN) in women with human immunodeficiency virus (HIV). METHODS: A cohort of 2,791 HIV-infected and 953 uninfected women followed for up to 13 years had genital examinations at 6-month intervals with biopsy for lesions suspicious for VIN. RESULTS: The prevalence of warts was 4.4% (5.3% for HIV-seropositive women and 1.9% for HIV-seronegative women, P<.001). The cumulative incidence of warts was 33% (95% confidence interval [CI] 30-36%) in HIV-seropositive and 9% (95% CI 6-12%) in HIV-seronegative women (P<.001). In multivariable analysis, lower CD4 lymphocyte count, younger age, and current smoking were strongly associated with risk for incident warts. Among 501 HIV-seropositive and 43 HIV-seronegative women, warts regressed in 410 (82%) seropositive and 41 (95%) seronegative women (P=.02), most in the first year after diagnosis. In multivariable analysis, regression was negatively associated with HIV status and lower CD4 count as well as older age. Incident VIN of any grade occurred more frequently among HIV-seropositive than HIV-seronegative women: 0.42 (0.33-0.53) compared with 0.07 (0.02-0.18) per 100 person-years (P<.001). Positivity for VIN 2 was found in 58 women (55 with and three without HIV, P<.001). Two women with HIV developed stage IB squamous cell vulvar cancers. CONCLUSION: Although genital warts and VIN are more common among HIV-seropositive than HIV-seronegative women, wart regression is common even in women with HIV, and cancers are infrequent. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, www.clinicaltrials.gov, NCT00000797. LEVEL OF EVIDENCE: II.", "provenance": [ { "field": "population", "quote": "A cohort of 2,791 HIV-infected and 953 uninfected women followed for up to 13 years" }, { "field": "intervention", "quote": "natural history of genital warts and vulvar intraepithelial neoplasia (VIN) in women with human immunodeficiency virus (HIV)" }, { "field": "comparator", "quote": "HIV-seropositive and 43 HIV-seronegative women" }, { "field": "primaryOutcome", "quote": "warts regressed in 410 (82%) seropositive and 41 (95%) seronegative women" }, { "field": "result", "quote": "warts regressed in 410 (82%) seropositive and 41 (95%) seronegative women (P=.02), most in the first year after diagnosis" }, { "field": "n", "quote": "Among 501 HIV-seropositive and 43 HIV-seronegative women, warts regressed" }, { "field": "followUp", "quote": "followed for up to 13 years" } ] }, { "id": "pmid:20304221", "pmid": "20304221", "doi": "10.1016/j.ygyno.2010.01.024", "nctId": null, "pmcid": null, "title": "Pathology and epidemiology of HPV infection in females", "firstAuthor": "Stanley", "multipleAuthors": false, "journal": "Gynecol Oncol", "year": 2010, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "women with genital HPV infection", "intervention": "no specific intervention described; natural course of HPV infection", "comparator": "none reported", "primaryOutcome": "spontaneous clearance versus persistence of HPV infection", "result": "most genital HPV infections clear spontaneously, with 10-20% persisting and risking progression to cervical disease", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "this is a general narrative review about HPV biology and cervical disease in women, not a study specifically measuring anal wart outcomes.", "directness": "indirect", "limitations": "abstract does not specifically discuss anal warts, does not report a study population or follow-up, and focuses mainly on cervical HPV and cancer.", "followUp": "", "plainFinding": "Most genital HPV infections clear naturally", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/20304221/", "sourceText": "Human papillomaviruses (HPVs) are a large family of small double-stranded DNA viruses that infect squamous epithelia. It has been established that infection with specific HPV types is a contributing factor to different types of anogenital cancer, including vulval, vaginal, anal, penile, and head and neck cancers. Approximately 4% of all cancers are associated with HPV. HPV infection is the major cause of cervical cancer and genital warts. Genital HPV infections are very common, are sexually transmitted, and have a peak prevalence between ages 18 and 30. Most of these infections clear spontaneously, but in 10-20% of women, these infections remain persistent and are at risk of progression to grade 2/3 cervical intraepithelial neoplasm (CIN) and eventually to invasive cancer of the cervix (ICC). CINs are genetically unstable lesions with a 30-40% risk of progression to ICC. If left untreated, they form a spectrum of increasing cytological atypia, ranging from low-grade CIN1 to high-grade CIN3; the latter are caused almost exclusively by high-risk HPVs, HPV 16 and 18. Infection with HPV requires a microabrasion in the genital epithelium. The oncogenic properties of high-risk HPV reside in the E6 and E7 genes, which if inappropriately expressed in dividing cells deregulate cell division and differentiation. HPV DNA testing has been shown consistently to be superior to cytology in terms of sensitivity and positive predictive value and will become a major tool in cervical cancer screening, at least in the developed countries.", "provenance": [ { "field": "population", "quote": "Genital HPV infections are very common, are sexually transmitted, and have a peak prevalence between ages 18 and 30." }, { "field": "intervention", "quote": "Most of these infections clear spontaneously" }, { "field": "comparator", "quote": "but in 10-20% of women, these infections remain persistent" }, { "field": "primaryOutcome", "quote": "Most of these infections clear spontaneously, but in 10-20% of women, these infections remain persistent and are at risk of progression to grade 2/3 cervical intraepithelial neoplasm (CIN)" }, { "field": "result", "quote": "Most of these infections clear spontaneously, but in 10-20% of women, these infections remain persistent and are at risk of progression to grade 2/3 cervical intraepithelial neoplasm (CIN) and eventually to invasive cancer of the cervix (ICC)." } ] }, { "id": "pmid:21367446", "pmid": "21367446", "doi": "10.1016/S0140-6736(10)62342-2", "nctId": null, "pmcid": "PMC3231998", "title": "Incidence and clearance of genital human papillomavirus infection in men (HIM): a cohort study", "firstAuthor": "Giuliano", "multipleAuthors": true, "journal": "Lancet", "year": 2011, "design": "prospective-cohort", "n": 1159, "nField": "reported", "population": "Adult men aged 18-70 in Brazil, Mexico, and the USA, HIV negative, no history of cancer", "intervention": "None - observational natural history study with no treatment given", "comparator": "", "primaryOutcome": "How often men got new genital HPV infections and how long the infections lasted before clearing", "result": "Genital HPV infections lasted a median of about 7.5 months for any HPV type and about 12 months for HPV type 16 before clearing on their own", "resultDirection": "unclear", "quality": "moderate", "qualityWhy": "This is a decent-sized multi-country cohort, but it tracks HPV infection detected in genital skin cells, not visible anal warts, so it does not directly answer whether warts themselves regress.", "directness": "indirect", "limitations": "Abstract does not report on anal sites or visible warts specifically, only HPV DNA detected at genital skin sites; no information on clinical wart outcomes.", "followUp": "27·5 months", "plainFinding": "Most genital HPV infections cleared within months", "retracted": false, "expressionOfConcern": false, "hasErratum": true, "url": "https://pubmed.ncbi.nlm.nih.gov/21367446/", "sourceText": "BACKGROUND: Human papillomaviruses (HPVs) cause genital warts and cancers in men. The natural history of HPV infection in men is largely unknown, and that information is needed to inform prevention strategies. The goal in this study was to estimate incidence and clearance of type-specific genital HPV infection in men, and to assess the associated factors. METHODS: Men (aged 18-70 years), residing in Brazil, Mexico, and the USA, who were HIV negative and reported no history of cancer were recruited from the general population, universities, and organised health-care systems. They were assessed every 6 months for a median follow-up of 27·5 months (18·0-31·2). Specimens from the coronal sulcus, glans penis, shaft, and scrotum were obtained for the assessment of the status of HPV genotypes. FINDINGS: In 1159 men, the incidence of a new genital HPV infection was 38·4 per 1000 person months (95% CI 34·3-43·0). Oncogenic HPV infection was significantly associated with having a high number of lifetime female sexual partners (hazard ratio 2·40, 1·38-4·18, for at least 50 partners vs not more than one partner), and number of male anal-sexual partners (2·57, 1·46-4·49, for at least three male partners vs no recent partners). Median duration of HPV infection was 7·52 months (6·80-8·61) for any HPV and 12·19 months (7·16-18·17) for HPV 16. Clearance of oncogenic HPV infection decreased in men with a high number of lifetime female partners (0·49, 0·31-0·76, for at least 50 female partners vs not more than one partner), and in men in Brazil (0·71, 0·56-0·91) and Mexico (0·73, 0·57-0·94) compared with the USA. Clearance of oncogenic HPV was more rapid with increasing age (1·02, 1·01-1·03). INTERPRETATION: The data from this study are useful for the development of realistic cost-effectiveness models for male HPV vaccination internationally. FUNDING: National Cancer Institute.", "provenance": [ { "field": "population", "quote": "Men (aged 18-70 years), residing in Brazil, Mexico, and the USA, who were HIV negative and reported no history of cancer were recruited from the general population, universities, and organised health-care systems." }, { "field": "n", "quote": "In 1159 men, the incidence of a new genital HPV infection was 38·4 per 1000 person months" }, { "field": "primaryOutcome", "quote": "The goal in this study was to estimate incidence and clearance of type-specific genital HPV infection in men, and to assess the associated factors." }, { "field": "intervention", "quote": "They were assessed every 6 months for a median follow-up of 27·5 months" }, { "field": "result", "quote": "Median duration of HPV infection was 7·52 months (6·80-8·61) for any HPV and 12·19 months (7·16-18·17) for HPV 16." }, { "field": "followUp", "quote": "assessed every 6 months for a median follow-up of 27·5 months (18·0-31·2)." } ] }, { "id": "pmid:21251265", "pmid": "21251265", "doi": "10.1186/1471-2334-11-20", "nctId": null, "pmcid": "PMC3031229", "title": "Genital warts and infection with human immunodeficiency virus in high-risk women in Burkina Faso: a longitudinal study", "firstAuthor": "Low", "multipleAuthors": true, "journal": "BMC Infect Dis", "year": 2011, "design": "prospective-cohort", "n": 765, "nField": "reported", "population": "high-risk women in Burkina Faso being followed over time, some HIV-infected and some not", "intervention": "no treatment given; observation of genital wart occurrence over time", "comparator": "HIV-infected versus HIV-uninfected women, and different CD4 count levels", "primaryOutcome": "how often genital warts newly appeared or came back, and what risk factors were linked to this", "result": "HIV-infected women, especially those with low CD4 counts, got genital warts much more often; antiretroviral treatment did not reduce how often warts occurred or came back", "resultDirection": "unclear", "quality": "low", "qualityWhy": "This study looked at risk factors for getting genital warts in HIV-related research, not at whether existing anal warts resolve without treatment.", "directness": "indirect", "limitations": "Studies genital (not anal) warts in a specific high-risk, HIV-focused population in Africa; does not report on spontaneous resolution of warts over time.", "followUp": "27 months", "plainFinding": "Does not address spontaneous clearance.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/21251265/", "sourceText": "BACKGROUND: Human papillomaviruses are the most common sexually transmitted infections, and genital warts, caused by HPV-6 and 11, entail considerable morbidity and cost. The natural history of genital warts in relation to HIV-1 infection has not been described in African women. We examined risk factors for genital warts in a cohort of high-risk women in Burkina Faso, in order to further describe their epidemiology. METHODS: A prospective study of 765 high-risk women who were followed at 4-monthly intervals for 27 months in Burkina Faso. Logistic and Cox regression were used to identify factors associated with prevalent, incident and persistent genital warts, including HIV-1 serostatus, CD4+ count, and concurrent sexually transmitted infections. In a subset of 306 women, cervical HPV DNA was tested at enrollment. RESULTS: Genital wart prevalence at baseline was 1.6% (8/492) among HIV-uninfected and 7.0% (19/273) among HIV-1 seropositive women. Forty women (5.2%) experienced at least one incident GW episode. Incidence was 1.1 per 100 person-years among HIV-uninfected women, 7.4 per 100 person-years among HIV-1 seropositive women with a nadir CD4+ count >200 cells/μL and 14.6 per 100 person-years among HIV-1 seropositive women with a nadir CD4+ count ≤ 200 cells/μL. Incident genital warts were also associated with concurrent bacterial vaginosis, and genital ulceration. Antiretroviral therapy was not protective against incident or persistent genital warts. Detection of HPV-6 DNA and abnormal cervical cytology were strongly associated with incident genital warts. CONCLUSIONS: Genital warts occur much more frequently among HIV-1 infected women in Africa, particularly among those with low CD4+ counts. Antiretroviral therapy did not reduce the incidence or persistence of genital warts in this population.", "provenance": [ { "field": "n", "quote": "A prospective study of 765 high-risk women who were followed at 4-monthly intervals for 27 months in Burkina Faso" }, { "field": "population", "quote": "high-risk women who were followed at 4-monthly intervals for 27 months in Burkina Faso" }, { "field": "primaryOutcome", "quote": "Logistic and Cox regression were used to identify factors associated with prevalent, incident and persistent genital warts, including HIV-1 serostatus, CD4+ count, and concurrent sexually transmitted infections." }, { "field": "intervention", "quote": "Antiretroviral therapy was not protective against incident or persistent genital warts." }, { "field": "comparator", "quote": "Incidence was 1.1 per 100 person-years among HIV-uninfected women, 7.4 per 100 person-years among HIV-1 seropositive women with a nadir CD4+ count >200 cells/μL and 14.6 per 100 person-years among HIV-1 seropositive women with a nadir CD4+ count ≤ 200 cells/μL." }, { "field": "result", "quote": "Genital warts occur much more frequently among HIV-1 infected women in Africa, particularly among those with low CD4+ counts. Antiretroviral therapy did not reduce the incidence or persistence of genital warts in this population." } ] }, { "id": "pmid:20797516", "pmid": "20797516", "doi": "10.1016/j.clindermatol.2010.03.013", "nctId": null, "pmcid": null, "title": "Treatment of genital warts: facts and controversies", "firstAuthor": "Wolf", "multipleAuthors": true, "journal": "Clin Dermatol", "year": 2010, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with genital warts", "intervention": "treating genital warts to remove lesions", "comparator": "leaving genital warts untreated as only a cosmetic issue", "primaryOutcome": "whether treatment clears the wart virus, prevents cancer, or reduces spread", "result": "the abstract says there is no consensus and many unknowns about whether treatment changes the course of the disease", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this is an opinion-based discussion of controversies, not a study with data on outcomes.", "directness": "indirect", "limitations": "this abstract is a discussion of treatment controversies, not a study designed to test whether warts resolve without treatment, and it covers genital warts generally rather than anal warts specifically.", "followUp": "", "plainFinding": "No clear answer given.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/20797516/", "sourceText": "There are two opposing approaches in the treatment of genital warts: (1) the traditional approach advocates complete elimination of all lesions, and (2) a second approach regards condyloma as merely a cosmetic nuisance. After a long journey through many arguments and scientific papers, we have concluded that many unknowns, uncertainties, and controversies concerning the value of treatment of genital warts in terms of clearing and curing the disease (ie, eradicating the viruses, preventing cancer, and reducing infectivity). There is no consensus at present of whether treatment of men with evidence of genital human papillomavirus infection influences the natural history of their female sex partner's cervical disease.", "provenance": [ { "field": "population", "quote": "genital warts" }, { "field": "intervention", "quote": "the traditional approach advocates complete elimination of all lesions" }, { "field": "comparator", "quote": "a second approach regards condyloma as merely a cosmetic nuisance" }, { "field": "primaryOutcome", "quote": "the value of treatment of genital warts in terms of clearing and curing the disease (ie, eradicating the viruses, preventing cancer, and reducing infectivity)" }, { "field": "result", "quote": "we have concluded that many unknowns, uncertainties, and controversies concerning the value of treatment of genital warts" } ] }, { "id": "pmid:20138345", "pmid": "20138345", "doi": "10.1016/j.ygyno.2010.01.026", "nctId": null, "pmcid": "PMC4254924", "title": "Epidemiology and pathology of HPV disease in males", "firstAuthor": "Giuliano", "multipleAuthors": true, "journal": "Gynecol Oncol", "year": 2010, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "men with genital HPV infection, including asymptomatic males aged 18-70", "intervention": "no treatment; natural course of HPV infection over time", "comparator": "self-comparison over follow-up time (no treatment arm)", "primaryOutcome": "time to clearance of HPV infection", "result": "Median time to clearance of any HPV infection was 5.9 months, with 75% of infections clearing within 12 months", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This is a general review of HPV epidemiology in men, not a study designed specifically to track anal warts, and it notes more data are needed on the natural history of infection.", "directness": "indirect", "limitations": "The abstract itself states 'More data are needed to better understand the natural history of HPV infection,' and the clearance data refer to HPV infection generally, not specifically to anal or genital warts.", "followUp": "12 months", "plainFinding": "Most HPV infections clear within a year", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/20138345/", "sourceText": "It is currently recognized that besides the significant impact of human papillomavirus (HPV) infection in females, HPV causes substantial disease in men as well. Genital warts are a common manifestation of male infection with HPV. Genital warts are highly infectious and approximately 65% of people who have sex with an infected partner will develop warts themselves. More than 90% of genital warts are caused by non-oncogenic HPV types 6 and 11. In addition, recurrent respiratory papillomatosis is a rare disease most often associated with HPV types 6 and 11. Several cancers of the anogenital tract and upper aero-digestive tract, and their precursor lesions in men are now understood to be caused by infection with sexually transmitted HPV. For example, there is increasing incidence of anal cancer in western countries; however, there are limited data on its primary cause, anal canal HPV infection. Genital HPV infection is very common in men with an ongoing international study estimating a prevalence of 65.2% in asymptomatic males aged 18-70 years. Lifetime number of sexual partners was the most significant risk factor for the acquisition of HPV infection (P<0.05), and circumcision has been associated with reduced detection of HPV infection in men. HPV infections may be less likely to persist in men than in women. In men, the median time to clearance of any HPV infection was 5.9 months, with 75% of infections clearing within 12 months. More data are needed to better understand the natural history of HPV infection. Although the quadrivalent HPV vaccine has been shown to be effective and safe in men, low awareness of HPV in males may be a barrier to its use for the prevention of HPV infection.", "provenance": [ { "field": "population", "quote": "estimating a prevalence of 65.2% in asymptomatic males aged 18-70 years" }, { "field": "intervention", "quote": "More data are needed to better understand the natural history of HPV infection." }, { "field": "comparator", "quote": "the median time to clearance of any HPV infection was 5.9 months, with 75% of infections clearing within 12 months" }, { "field": "primaryOutcome", "quote": "median time to clearance of any HPV infection was 5.9 months" }, { "field": "result", "quote": "the median time to clearance of any HPV infection was 5.9 months, with 75% of infections clearing within 12 months" } ] }, { "id": "pmid:18786806", "pmid": "18786806", "doi": "10.1016/j.lpm.2008.04.008", "nctId": null, "pmcid": null, "title": "[What should be known for the introduction of an HPV vaccine?]", "firstAuthor": "Muñoz", "multipleAuthors": true, "journal": "Presse Med", "year": 2008, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people infected with genital HPV", "intervention": "", "comparator": "", "primaryOutcome": "whether HPV infection regresses or persists", "result": "most HPV infections regress, but persistent infections can progress to cancer", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this is a general narrative review of HPV epidemiology and vaccination, not a study specifically designed to measure whether anal warts resolve on their own.", "directness": "indirect", "limitations": "review focuses on cervical cancer and HPV vaccination overall, not specifically on anal warts or their natural resolution; no methods for quantifying regression are given.", "followUp": "", "plainFinding": "Most HPV infections clear naturally.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/18786806/", "sourceText": "CONTEXT: Genital human papillomavirus (HPV) infection is one of the most common sexually transmitted infections worldwide. Two HPV vaccines are now available in many countries: (i) the first vaccine is quadrivalent and indicated in the prevention of CIN 2/3, cervical cancers, VIN 2/3, VaIN 2/3 and genital warts associated with the HPV types 6, 11, 16 and 18, (ii) the second vaccine is bivalent and indicated in the prevention of CIN 2+ and cervical cancers associated with the HPV types 16 and 18. OBJECTIVES: To critically review all epidemiological aspects of the HPV infection and its relation with preneoplasic lesions of the cervix and cervical cancer to assist the relevant public health authorities to make plans for the introduction of HPV vaccines that have been recently commercialized. METHODS: Only articles published in English in peer reviewed journals have been selected in Date base PubMed (National Library of Medicine - National Institutes of Health) with Keywords HPV, risk factor, cervical cancer, CIN2/3, incidence, prevalence, transmission, prevention, genital cancer, HPV vaccines, screening. A critical review of most papers published during the last 10 years was made. The topics covered included: diseases caused by HPV, prevalence, incidence and transmission of HPV, risk factors for the acquisition of HPV, natural history of HPV infection, risk factors determining the progression from HPV to cancer, protective factors blocking the progression from infection to cancer (screening) and primary prevention of HPV by vaccines and other methods. The information was interpreted and summarized. RESULTS: It was concluded that HPV infection is one of the most common sexually transmitted infections, that it is the necessary cause of cervical cancer and the cause of other genital cancers and cancers of the upper aerodigestive tract. Fortunately most infections regress, but those infections that persist are the ones leading to cancer. Primary prevention by the introduction of prophylactic vaccines is the ideal means of preventing cervical cancer and other cancers associated to HPV. CONCLUSION: This review is to my knowledge, the most comprehensive and up-to date review to be published in French on HPV epidemiology and related diseases. It will be of great value to educate medical and paramedical personnel on HPV infection and associated diseases and it will be of great help to public health authorities and decision makers when they have to evaluate the convenience of introducing HPV vaccination in a given population.", "provenance": [ { "field": "result", "quote": "Fortunately most infections regress, but those infections that persist are the ones leading to cancer." }, { "field": "population", "quote": "Genital human papillomavirus (HPV) infection is one of the most common sexually transmitted infections worldwide." }, { "field": "primaryOutcome", "quote": "natural history of HPV infection" } ] }, { "id": "pmid:18760711", "pmid": "18760711", "doi": "10.1016/j.ygyno.2008.07.045", "nctId": null, "pmcid": null, "title": "Natural history and epidemiology of HPV infection and cervical cancer", "firstAuthor": "Castellsagué", "multipleAuthors": false, "journal": "Gynecol Oncol", "year": 2008, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "women infected with HPV", "intervention": "none (this is a natural history/epidemiology review, not a treatment study)", "comparator": "", "primaryOutcome": "whether HPV infection persists or clears over time", "result": "most women infected with HPV become HPV-negative within 2 years, but persistent high-risk infection raises cervical cancer risk; no data given on anal warts specifically", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this is a general review about HPV and cervical cancer, not a study of anal warts, so it gives no direct data on whether anal warts resolve on their own", "directness": "indirect", "limitations": "abstract discusses cervical HPV infection and cancer risk broadly; genital warts are mentioned only in passing as caused by HPV 6/11, with no data on anal warts' natural course", "followUp": "2 years", "plainFinding": "No direct evidence on anal warts", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/18760711/", "sourceText": "Cervical cancer is the most common cancer affecting women in developing countries. It has been estimated to have been responsible for almost 260 000 deaths annually, of which about 80% occurred in developing countries. Persistent infection by certain oncogenic HPV types is firmly established as the necessary cause of most premalignant and malignant epithelial lesions of the cervix and of a variable fraction of neoplastic lesions of the vulva, vagina, anus, penis, and oropharynx. There are more than 100 known HPV genotypes, at least 15 of which can cause cancer of the cervix and other sites. HPV 16 and 18, the two most common oncogenic types, cause approximately 70% of all cervical cancers worldwide. HPV, especially genotypes 6 and 11, can also cause genital warts. HPV is highly transmissible and it is now considered the most common sexually transmitted infection in most populations. Although most women infected with the virus become negative within 2 years, women with persistent high-risk HPV infections are at greatest risk for developing cervical cancer. Since the identification of HPV as the necessary cause of cervical cancer, HPV-based technology has become the centre of novel primary and secondary cervical cancer prevention strategies by the introduction of HPV testing in screening and of HPV vaccines in preadolescent girls and young women. If implemented widely and wisely the deployment of these protocols has the potential to complete Papanicolaou's goal of cervical cancer eradication by extending the benefits of prevention to the developing populations of the world.", "provenance": [ { "field": "population", "quote": "women infected with the virus" }, { "field": "result", "quote": "Although most women infected with the virus become negative within 2 years, women with persistent high-risk HPV infections are at greatest risk for developing cervical cancer." }, { "field": "primaryOutcome", "quote": "Although most women infected with the virus become negative within 2 years, women with persistent high-risk HPV infections are at greatest risk for developing cervical cancer." }, { "field": "intervention", "quote": "HPV, especially genotypes 6 and 11, can also cause genital warts." } ] }, { "id": "pmid:18555997", "pmid": "18555997", "doi": "10.1016/j.ijgo.2008.03.021", "nctId": null, "pmcid": null, "title": "Clinical trial experience with prophylactic HPV 6/11/16/18 VLP vaccine in young women from the Asia-Pacific region", "firstAuthor": "Tay", "multipleAuthors": true, "journal": "Int J Gynaecol Obstet", "year": 2008, "design": "rct", "n": 814, "nField": "reported", "population": "young women aged 16 to 26 from the Asia-Pacific region", "intervention": "quadrivalent HPV 6/11/16/18 vaccination", "comparator": "placebo", "primaryOutcome": "disease caused by HPV types 6, 11, 16, or 18 (cervical, vulvar, vaginal lesions and genital warts)", "result": "vaccine was 100% effective at preventing these HPV-related lesions compared with placebo", "resultDirection": "benefit", "quality": "low", "qualityWhy": "this trial tests whether a vaccine prevents HPV disease, not whether existing anal warts resolve without treatment, so it does not answer the question being asked.", "directness": "indirect", "limitations": "abstract does not address natural resolution or untreated course of anal warts; focuses on vaccine prevention outcomes only", "followUp": "", "plainFinding": "Vaccine prevented genital lesions and warts", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/18555997/", "sourceText": "OBJECTIVE: To evaluate results of three phase 3 clinical trials of quadrivalent HPV 6/11/16/18 vaccination of young Asia-Pacific women. METHODS: A total of 814 women from the Asia-Pacific region (aged 16 to 26 years) received vaccine or placebo in 1 of 3 protocols. Descriptive analyses focused on the efficacy, safety, and immunogenicity of the vaccine and the natural history of HPV disease. RESULTS: Vaccine efficacy against disease caused by HPV types 6, 11, 16, or 18 was 100% for cervical intraepithelial neoplasia (0 vs 12 cases; 95% confidence interval [CI], 63.1%-100%) and 100% for vulvar and vaginal intraepithelial neoplasia or condylomata accuminata (0 vs 5 cases; 95% CI, -11.8% to 100%). The vaccination was highly immunogenic. Vaccine recipients experienced a significantly higher injection site adverse event rate (P=0.002). Compared with other world regions, lower rates of smoking and baseline positivity to 14 HPV types (including the vaccine types) were observed among Asia-Pacific participants. CONCLUSION: Prophylactic quadrivalent HPV 6/11/16/18 vaccination of young Asia-Pacific women demonstrated high efficacy, safety, and tolerability. Together with an observed low baseline HPV positivity rate, the Asia-pacific population is potentially an important cohort to benefit from vaccination.", "provenance": [ { "field": "n", "quote": "A total of 814 women from the Asia-Pacific region (aged 16 to 26 years) received vaccine or placebo in 1 of 3 protocols." }, { "field": "population", "quote": "A total of 814 women from the Asia-Pacific region (aged 16 to 26 years) received vaccine or placebo in 1 of 3 protocols." }, { "field": "intervention", "quote": "quadrivalent HPV 6/11/16/18 vaccination of young Asia-Pacific women" }, { "field": "comparator", "quote": "received vaccine or placebo in 1 of 3 protocols" }, { "field": "primaryOutcome", "quote": "Vaccine efficacy against disease caused by HPV types 6, 11, 16, or 18 was 100% for cervical intraepithelial neoplasia" }, { "field": "result", "quote": "Vaccine efficacy against disease caused by HPV types 6, 11, 16, or 18 was 100% for cervical intraepithelial neoplasia (0 vs 12 cases; 95% confidence interval [CI], 63.1%-100%) and 100% for vulvar and vaginal intraepithelial neoplasia or condylomata accuminata (0 vs 5 cases; 95% CI, -11.8% to 100%)." } ] }, { "id": "pmid:18355203", "pmid": "18355203", "doi": "10.1111/j.1468-3083.2008.02675.x", "nctId": null, "pmcid": null, "title": "Expression of human beta-defensin-2 and -3 in verrucae vulgares and condylomata acuminata", "firstAuthor": "Meyer-Hoffert", "multipleAuthors": true, "journal": "J Eur Acad Dermatol Venereol", "year": 2008, "design": "lab", "n": 35, "nField": "reported", "population": "people with common warts (verrucae vulgares) and anal/genital warts (condylomata acuminata)", "intervention": "presence of antiviral skin proteins (human beta-defensin-2 and -3) in wart tissue", "comparator": "normal skin tissue", "primaryOutcome": "whether these antiviral proteins are expressed in wart lesions", "result": "warts showed higher levels of these antiviral proteins than normal skin, with lower levels in anal/genital warts than common warts", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this is a small lab tissue-staining study that does not test or report whether warts actually went away, so it cannot answer whether anal warts resolve on their own.", "directness": "indirect", "limitations": "Retrospective study; immunohistochemistry only; does not follow patients over time or report clinical regression.", "followUp": "", "plainFinding": "Does not show if warts resolve.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/18355203/", "sourceText": "The human beta defensins (hBDs) 2 and 3 contribute to the inducible antimicrobial peptides in human skin. Besides an important role in fighting bacteria, they may also exert antiviral function. Verrucae vulgares and condylomata acuminata are typical cutaneous viral diseases caused by different subtypes of the human papillomavirus. Their tendency for spontaneous regression could be caused by antiviral proteins like defensins. In a retoperspective study, we investigated lesions of verrucae vulgares and condylomata acuminata for the presence of hBD-2 and hBD-3 by immunohistochemistry. All of the specimens of verrucae vulgares (n = 20) were positive for hBD-2 and hBD-3. The specimens of condylomata acuminata (n = 15) exhibited expression for hBD-2 and hBD-3, with the exception of three and two samples, respectively. The expression levels in condyloma acuminata were lower for both defensins compared with verrucae vulgares. Normal skin tissue exhibited no staining of both hBD-2 and hBD-3 with the exception of two cases. Taken together, this is the first report of an increased expression of the hBD-2 and hBD-3 in cutaneous papillomavirus infections.", "provenance": [ { "field": "n", "quote": "condylomata acuminata (n = 15)" }, { "field": "n", "quote": "verrucae vulgares (n = 20)" }, { "field": "population", "quote": "Verrucae vulgares and condylomata acuminata are typical cutaneous viral diseases caused by different subtypes of the human papillomavirus." }, { "field": "intervention", "quote": "we investigated lesions of verrucae vulgares and condylomata acuminata for the presence of hBD-2 and hBD-3 by immunohistochemistry" }, { "field": "comparator", "quote": "Normal skin tissue exhibited no staining of both hBD-2 and hBD-3 with the exception of two cases." }, { "field": "primaryOutcome", "quote": "Their tendency for spontaneous regression could be caused by antiviral proteins like defensins." }, { "field": "result", "quote": "The specimens of condylomata acuminata (n = 15) exhibited expression for hBD-2 and hBD-3, with the exception of three and two samples, respectively. The expression levels in condyloma acuminata were lower for both defensins compared with verrucae vulgares." } ] }, { "id": "pmid:17366752", "pmid": "17366752", "doi": null, "nctId": null, "pmcid": null, "title": "Epidemiology and natural history of HPV", "firstAuthor": "Cox", "multipleAuthors": false, "journal": "J Fam Pract", "year": 2006, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people infected with HPV", "intervention": "", "comparator": "", "primaryOutcome": "HPV infection, cancer risk, and disease epidemiology", "result": "The abstract does not report whether anal warts resolve on their own; it discusses HPV types, cancer risk, and vaccination but not natural resolution of warts.", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a general narrative review of HPV epidemiology and does not study or report on whether anal warts resolve without treatment.", "directness": "indirect", "limitations": "The abstract does not address the natural history of genital/anal warts regression or resolution specifically; it focuses on cancer risk, HPV types, and vaccination.", "followUp": "", "plainFinding": "Does not address this question.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/17366752/", "sourceText": "Human papillomavirus (HPV) is a highly prevalent, sexually transmitted infection responsible for significant morbidity and mortality. High-risk HPV types are now known to be necessary in the etiology of cervical cancer and to lead to both high-grade and low-grade cervical lesions. They are also implicated in a substantial portion of anal, penile, and head and neck precancers and cancers. HPV 16 and 18 are the most common HPV types found in cervical cancer and are responsible for approximately 70% of these cancers. In contrast, low-risk HPV types, the most common of which are HPV 6 and 11, cause genital warts, low-grade cervical lesions, and recurrent respiratory papillomatosis, but they do not cause cervical or other HPV-related cancers. Infection is most common in young, sexually active populations, and an estimated three fourths of adults will be infected with HPV during their lifetime. Cervical screening programs exist in the United States and other developed countries to identify and treat precancerous cervical lesions, but they do not reach all women and are costly. Until recently, no highly effective primary prevention strategy to reduce the risk of HPV acquisition existed. However, a quadrivalent HPV vaccine, which protects against the most common high-risk and low-risk HPV infections (HPV 16, 18, 6, and 11), is now available. In addition, a bivalent HPV vaccine that protects against high-risk HPV types 16 and 18 is in the late stages of clinical development. If implemented widely, vaccination against HPV promises to dramatically reduce HPV-associated morbidity and mortality.", "provenance": [ { "field": "result", "quote": "low-risk HPV types, the most common of which are HPV 6 and 11, cause genital warts, low-grade cervical lesions, and recurrent respiratory papillomatosis, but they do not cause cervical or other HPV-related cancers" }, { "field": "population", "quote": "an estimated three fourths of adults will be infected with HPV during their lifetime" }, { "field": "primaryOutcome", "quote": "Human papillomavirus (HPV) is a highly prevalent, sexually transmitted infection responsible for significant morbidity and mortality" } ] }, { "id": "pmid:16967912", "pmid": "16967912", "doi": "10.1155/IDOG/2006/40470", "nctId": null, "pmcid": "PMC1581465", "title": "Epidemiology and natural history of human papillomavirus infections in the female genital tract", "firstAuthor": "Ault", "multipleAuthors": false, "journal": "Infect Dis Obstet Gynecol", "year": 2006, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "sexually active women with HPV infection of the female genital tract", "intervention": "natural course of HPV infection (no treatment, immune clearance)", "comparator": "clinical treatment of HPV-related lesions such as genital warts", "primaryOutcome": "clearance of HPV infection and development of clinical complications like genital warts or abnormal Pap results", "result": "Most HPV infections are cleared by the immune system and do not result in clinical complications, but treatment for genital warts is described as removing the problematic cells and watching for recurrence rather than spontaneous resolution", "resultDirection": "unclear", "quality": "low", "qualityWhy": "This is a general narrative review of female genital HPV epidemiology, not a study specifically measuring whether anal or genital warts resolve without treatment.", "directness": "indirect", "limitations": "Abstract discusses female genital tract HPV broadly, not anal warts specifically, and provides no study data, follow-up periods, or participant numbers on wart resolution.", "followUp": "", "plainFinding": "Doesn't directly address wart resolution.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/16967912/", "sourceText": "Human papillomavirus (HPV) is the most common newly diagnosed sexually transmitted infection in the United States. Although the majority of sexually active adults will be infected with HPV at least once in their lives, it is sexually active women less than 25 years of age who consistently have the highest rates of infection. Besides youth and gender, common risk factors for HPV infection and clinical sequelae of infection include high number of sexual partners and coinfection with Chlamydia trachomatis or herpes simplex virus. Most HPV infections are cleared by the immune system and do not result in clinical complications. Clinical sequelae in cases of low-risk HPV infection consist of genital warts, and clinical manifestations of high-risk HPV infection include abnormal Pap test results, low-grade squamous intraepithelial lesions (LSIL), high-grade squamous intraepithelial lesions (HSIL), and cervical cancer. LSIL, HSIL, and cervical cancer carry significant morbidity and/or mortality; genital warts and abnormal Pap test results are often significant sources of psychosocial distress. Currently, there are neither effective means of preventing HPV transmission nor cures for clinical manifestations: infection can only be prevented via complete sexual abstinence, while treatment for clinical sequelae such as genital warts and cytologic abnormalities consists of removing the problematic cells and watching for recurrence; this method consumes significant health care resources and is costly. New prophylactic HPV vaccines promise to dramatically reduce the incidence of HPV infection, genital warts, and cytologic abnormalities.", "provenance": [ { "field": "population", "quote": "sexually active women less than 25 years of age who consistently have the highest rates of infection" }, { "field": "intervention", "quote": "Most HPV infections are cleared by the immune system and do not result in clinical complications." }, { "field": "comparator", "quote": "treatment for clinical sequelae such as genital warts and cytologic abnormalities consists of removing the problematic cells and watching for recurrence" }, { "field": "primaryOutcome", "quote": "Clinical sequelae in cases of low-risk HPV infection consist of genital warts" }, { "field": "result", "quote": "Most HPV infections are cleared by the immune system and do not result in clinical complications" } ] }, { "id": "pmid:16886157", "pmid": "16886157", "doi": "10.1086/505982", "nctId": null, "pmcid": null, "title": "Genital human papillomavirus infection", "firstAuthor": "Dunne", "multipleAuthors": true, "journal": "Clin Infect Dis", "year": 2006, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with genital HPV infection", "intervention": "not applicable (general review of HPV)", "comparator": "not applicable", "primaryOutcome": "understanding of HPV prevalence and prevention, including vaccine efficacy", "result": "The abstract does not report whether anal/genital warts resolve without treatment; it discusses vaccine efficacy and HPV prevalence instead", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a general narrative review that does not study or report on natural resolution of warts.", "directness": "indirect", "limitations": "Abstract does not address the natural history or spontaneous resolution of anogenital warts; focuses on vaccine and screening recommendations.", "followUp": "", "plainFinding": "Does not address this question.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/16886157/", "sourceText": "Over the past few decades, epidemiology and natural history studies have led to improved understanding of human papillomavirus (HPV) infection and to promising prevention strategies. HPV infection is the cause of anogenital warts and cervical cancer, as well as a proportion of other anogenital and head and neck cancers. Data from clinical trials have resulted in recommendations that support the use of an HPV test in the context of cervical cancer screening and management. Prophylactic HPV vaccine trials have demonstrated high efficacy, and an HPV vaccine that prevents cervical cancer precursors, cervical cancer, and anogenital warts caused by HPV types 6, 11, 16, and 18 was licensed for use in girls and women aged 9-26 years by the US Food and Drug Administration (FDA) in June 2006. In this article, we review genital HPV for the clinician, with a primary focus on the prevalence of HPV infection in the United States.", "provenance": [ { "field": "population", "quote": "HPV infection is the cause of anogenital warts and cervical cancer" }, { "field": "intervention", "quote": "an HPV vaccine that prevents cervical cancer precursors, cervical cancer, and anogenital warts caused by HPV types 6, 11, 16, and 18 was licensed for use in girls and women aged 9-26 years by the US Food and Drug Administration (FDA) in June 2006" }, { "field": "comparator", "quote": "Data from clinical trials have resulted in recommendations that support the use of an HPV test in the context of cervical cancer screening and management." }, { "field": "primaryOutcome", "quote": "with a primary focus on the prevalence of HPV infection in the United States" }, { "field": "result", "quote": "Prophylactic HPV vaccine trials have demonstrated high efficacy" } ] }, { "id": "pmid:16729554", "pmid": "16729554", "doi": null, "nctId": null, "pmcid": null, "title": "Epidemiology and natural history of genital human papillomavirus infection", "firstAuthor": "Weaver", "multipleAuthors": false, "journal": "J Am Osteopath Assoc", "year": 2006, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "sexually active people infected with HPV", "intervention": "no specific treatment discussed for natural resolution", "comparator": "none", "primaryOutcome": "whether genital warts or HPV disease resolve or recur", "result": "abstract does not state whether warts resolve on their own; it only describes treatment and monitoring for recurrence", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a general narrative review that does not report a study or data on natural resolution of warts.", "directness": "indirect", "limitations": "Abstract does not address natural history/resolution of warts specifically, only general epidemiology and future prevention via vaccine.", "followUp": "", "plainFinding": "Does not say if warts resolve", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/16729554/", "sourceText": "Human papillomavirus (HPV) is a ubiquitous human pathogen that causes cervical and other anogenital cancers as well as genital warts and recurrent respiratory papillomatosis. Human papillomavirus infection is most common among young, sexually active individuals, and it is so prevalent that approximately 75% to 80% of sexually active individuals will become infected in their lifetime. Currently, options are limited for both prevention of infection of patients with HPV-associated disease: infection can only be prevented with complete abstinence from all forms of sexual activity because condoms do not offer complete protection from HPV and HPV can be transmitted by nonintromissive sexual activities. Treatment of patients with HPV-associated disease such as cervical intraepithelial neoplasia and genital warts consists of counseling, treatment if indicated, and monitoring for recurrence. Soon, however, prevention of these HPV-related diseases may be available in the form of a prophylactic HPV vaccine. Phase 3 studies of a quadrivalent vaccine that protects against both high- and low-risk types of HPV demonstrated the vaccine to be 100% effective in preventing HPV type 16- and type 18-associated cervical disease, suggesting that these vaccines, if made widely available, will dramatically reduce the burden of HPV-related disease.", "provenance": [ { "field": "population", "quote": "Human papillomavirus infection is most common among young, sexually active individuals" }, { "field": "intervention", "quote": "Treatment of patients with HPV-associated disease such as cervical intraepithelial neoplasia and genital warts consists of counseling, treatment if indicated, and monitoring for recurrence." }, { "field": "comparator", "quote": "Treatment of patients with HPV-associated disease such as cervical intraepithelial neoplasia and genital warts consists of counseling, treatment if indicated, and monitoring for recurrence." }, { "field": "primaryOutcome", "quote": "monitoring for recurrence" }, { "field": "result", "quote": "Treatment of patients with HPV-associated disease such as cervical intraepithelial neoplasia and genital warts consists of counseling, treatment if indicated, and monitoring for recurrence." } ] }, { "id": "pmid:16044390", "pmid": "16044390", "doi": "10.1053/j.spid.2005.04.005", "nctId": null, "pmcid": null, "title": "HPV infection in adolescents: natural history, complications, and indicators for viral typing", "firstAuthor": "Shew", "multipleAuthors": true, "journal": "Semin Pediatr Infect Dis", "year": 2005, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "adolescents with HPV infection", "intervention": "none (review of HPV natural history)", "comparator": "none", "primaryOutcome": "natural history and complications of HPV infection, including genital warts, dysplasia, and cancer", "result": "genital warts, dysplasia, and cancer are described as rare outcomes of HPV infection, but no specific data on spontaneous resolution of warts is given", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this is a general narrative review of HPV in adolescents with no original data or specific findings about anal wart resolution.", "directness": "indirect", "limitations": "Abstract does not focus on anal warts specifically, nor does it report whether warts resolve without treatment; it is a broad review of HPV natural history and complications.", "followUp": "", "plainFinding": "Doesn't address wart resolution directly.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/16044390/", "sourceText": "Human papillomavirus (HPV) is the most common sexually transmitted disease in both men and women. Prevalence rates are the highest for adolescents. Despite the high prevalence rates, sequelae of genital warts, dysplasia, and cancer are rare developments. Knowledge about the natural history, virology, and cancerous transformation has lead to improved viral detection, including the use of HPV DNA detection tests, screening efforts for HPV-related precancerous and cancerous lesions, and clinical interventions and treatments, including both therapeutic and prophylactic vaccinations.", "provenance": [ { "field": "population", "quote": "Prevalence rates are the highest for adolescents." }, { "field": "primaryOutcome", "quote": "Knowledge about the natural history, virology, and cancerous transformation has lead to improved viral detection" }, { "field": "result", "quote": "Despite the high prevalence rates, sequelae of genital warts, dysplasia, and cancer are rare developments." }, { "field": "intervention", "quote": "clinical interventions and treatments, including both therapeutic and prophylactic vaccinations" }, { "field": "comparator", "quote": "Human papillomavirus (HPV) is the most common sexually transmitted disease in both men and women." } ] }, { "id": "pmid:15724382", "pmid": "15724382", "doi": null, "nctId": null, "pmcid": null, "title": "Local expression of tumor necrosis factor-alpha and interleukin-4 mRNA in different types of warts", "firstAuthor": "Azim", "multipleAuthors": true, "journal": "Egypt J Immunol", "year": 2004, "design": "lab", "n": 30, "nField": "reported", "population": "patients with different types of viral warts (common, plane, plantar, and anogenital)", "intervention": "measuring TNF-alpha and IL-4 gene expression in wart tissue", "comparator": "healthy control tissue", "primaryOutcome": "levels of immune signaling molecules (TNF-alpha and IL-4) in wart tissue", "result": "Higher TNF-alpha expression in warts than controls, but no clear link between immune pattern and wart clearance", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a small lab study measuring immune markers in tissue, not a study tracking whether warts actually went away over time.", "directness": "indirect", "limitations": "Small sample size of 30 patients covering multiple wart types; only anal/anogenital warts are a subset; no follow-up data on actual wart resolution over time.", "followUp": "", "plainFinding": "Immune markers studied, not wart clearance.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/15724382/", "sourceText": "The natural history of warts shows considerable variations between individuals, ranging from spontaneous regression to prolonged persistence. The level of cytokines participate in the immune response to human papilloma virus. This work investigates local expression of T-helper1 (Th1)/ T-helper2 (Th2)/ cytokines in a trial to disclose the different immunological mechanisms affecting the natural history of warts. A total of thirty patients suffering from different types (common, plane, plantar and anogenital) of viral warts were included. An excision biopsy was used to assess tumor necrosis factor-alpha (TNF-alpha) and interleukin-4 (IL-4) expression. Local expression of TNF-alpha (Th1) and IL-4 (Th2) in wart tissue was determined using in-situ hybridization technique. The cytokines probes used in this assay detect messenger RNA (mRNA) in wart tissue. Local expression of TNF-alpha mRNA was higher in viral wart patients compared to healthy control (P < 0.01), while local expression of IL-4 was not significantly higher in patients compared to control (P > 0.05). Statistical analysis was done to determine whether variations in cytokine mRNA expression depend on wart location or clinical types. In conclusion, immunoreactivity to warts is likely to be associated with a predominant Th-1 or mixed Th-1/ Th-2 cytokine mRNA expression profile. However, it does not appear to be a simple causal relationship between expression of a Th-1 pattern and clearance.", "provenance": [ { "field": "n", "quote": "A total of thirty patients suffering from different types (common, plane, plantar and anogenital) of viral warts were included." }, { "field": "population", "quote": "thirty patients suffering from different types (common, plane, plantar and anogenital) of viral warts" }, { "field": "intervention", "quote": "Local expression of TNF-alpha (Th1) and IL-4 (Th2) in wart tissue was determined using in-situ hybridization technique." }, { "field": "comparator", "quote": "Local expression of TNF-alpha mRNA was higher in viral wart patients compared to healthy control" }, { "field": "primaryOutcome", "quote": "to assess tumor necrosis factor-alpha (TNF-alpha) and interleukin-4 (IL-4) expression" }, { "field": "result", "quote": "Local expression of TNF-alpha mRNA was higher in viral wart patients compared to healthy control (P < 0.01), while local expression of IL-4 was not significantly higher in patients compared to control (P > 0.05)." }, { "field": "result", "quote": "it does not appear to be a simple causal relationship between expression of a Th-1 pattern and clearance" } ] }, { "id": "pmid:12783616", "pmid": "12783616", "doi": "10.1517/14712598.3.3.477", "nctId": null, "pmcid": null, "title": "Therapeutic vaccination for the treatment of mucosotropic human papillomavirus-associated disease", "firstAuthor": "Chu", "multipleAuthors": false, "journal": "Expert Opin Biol Ther", "year": 2003, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with HPV-related diseases such as anogenital warts, cervical and anal intraepithelial neoplasia", "intervention": "therapeutic vaccination approaches for HPV-associated disease", "comparator": "", "primaryOutcome": "development of immunotherapeutic vaccine strategies for HPV-associated disease", "result": "natural history studies associated with spontaneous regression have provided little guidance to the design of successful interventions", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a narrative review about vaccine development, not a study measuring whether warts resolve on their own, so it gives no usable data on that question.", "directness": "indirect", "limitations": "The abstract is a review of vaccine research and only mentions spontaneous regression in passing without data or results.", "followUp": "", "plainFinding": "No clear answer given", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/12783616/", "sourceText": "There is a high prevalence of diseases caused by human papillomavirus (HPV) infection. Unfortunately, current treatments are inadequate. However, because there is evidence to support a role for the immune system in host defence against this virus, an immunotherapeutic approach is warranted. The existing immunotherapies are not completely effective, nor are they durable. In addition, natural history studies associated with spontaneous regression have provided little guidance to the design of successful interventions. This state of knowledge has encouraged efforts towards the development of novel immunotherapeutic strategies. Successful preclinical studies of therapeutic vaccine candidates have led to clinical studies for a variety of HPV-associated indications, such as anogenital warts and cervical and anal intraepithelial neoplasia. Immunisation approaches such as adjuvanted peptides, virus-like particles and fusion constructs are discussed. Specifically, chimaeric molecules comprised of mycobacterial heat-shock proteins (Hsps) and HPV16 E7 appear promising.", "provenance": [ { "field": "population", "quote": "anogenital warts and cervical and anal intraepithelial neoplasia" }, { "field": "intervention", "quote": "novel immunotherapeutic strategies" }, { "field": "primaryOutcome", "quote": "clinical studies for a variety of HPV-associated indications" }, { "field": "result", "quote": "natural history studies associated with spontaneous regression have provided little guidance to the design of successful interventions" } ] }, { "id": "pmid:11563874", "pmid": "11563874", "doi": "10.1053/beog.2001.0221", "nctId": null, "pmcid": null, "title": "The treatment of human papillomavirus lesions of the lower genital tract", "firstAuthor": "Sonnex", "multipleAuthors": true, "journal": "Best Pract Res Clin Obstet Gynaecol", "year": 2001, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "young men and women with anogenital warts caused by HPV 6 and 11", "intervention": "various treatments for genital warts", "comparator": "", "primaryOutcome": "clearance and recurrence of genital warts", "result": "The abstract does not report whether warts resolve without treatment; it notes a lack of good natural history data with or without treatment", "resultDirection": "unclear", "quality": "low", "qualityWhy": "This is a narrative review that admits a lack of good natural history or controlled long-term data, so it cannot reliably answer whether warts clear on their own.", "directness": "indirect", "limitations": "The abstract states there is a lack of good natural history data either with treatment or without treatment over longer periods of time, and most trials are short-term comparisons of monotherapies.", "followUp": "", "plainFinding": "No data on natural resolution.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/11563874/", "sourceText": "Anogenital warts are caused by human papillomavirus types 6 and 11 infection, and are the most common clinical manifestation of lower genital tract human papillomavirus infection. They are the most frequently recognized sexually transmitted disease in the developed world, occurring at an incidence rate of 0.5-1.2% in young men and women aged 18-25 years. Many therapies for genital warts have been described, none being ideal in that all therapeutic modalities fail to clear the warts in a proportion of patients, and the recurrence of warts after successful treatment is seen with all treatments. The current knowledge base of the therapy of genital warts is flawed by a lack of good natural history data either with treatment or without treatment over longer periods of time, in that most trials report comparisons of monotherapies over a short time and there is a lack of structured trials addressing consecutive therapies over longer durations, as occurs in real-life clinical situations.", "provenance": [ { "field": "population", "quote": "occurring at an incidence rate of 0.5-1.2% in young men and women aged 18-25 years" }, { "field": "intervention", "quote": "Many therapies for genital warts have been described" }, { "field": "primaryOutcome", "quote": "all therapeutic modalities fail to clear the warts in a proportion of patients, and the recurrence of warts after successful treatment is seen with all treatments" }, { "field": "result", "quote": "The current knowledge base of the therapy of genital warts is flawed by a lack of good natural history data either with treatment or without treatment over longer periods of time" }, { "field": "limitations", "quote": "there is a lack of structured trials addressing consecutive therapies over longer durations, as occurs in real-life clinical situations" } ] }, { "id": "pmid:11168764", "pmid": "11168764", "doi": "10.1034/j.1600-0560.2001.028003131.x", "nctId": null, "pmcid": null, "title": "Dermal dendritic cells in anogenital warty lesions unresponsive to an immune-response modifier", "firstAuthor": "Arrese", "multipleAuthors": true, "journal": "J Cutan Pathol", "year": 2001, "design": "case-series", "n": 47, "nField": "reported", "population": "people with anogenital wart lesions, some unresponsive to imiquimod treatment and some untreated, with normal immune systems", "intervention": "excised wart tissue examined after imiquimod (immune-response cream) treatment failure", "comparator": "untreated wart and bowenoid papulosis tissue samples", "primaryOutcome": "density and type of immune cells (dendritic cells, Langerhans cells, T lymphocytes) in the wart tissue", "result": "imiquimod-resistant warts had far fewer Factor XIIIa-positive dermal dendritic cells than untreated warts, which may explain why the cream failed to work", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a small laboratory study examining immune cells in removed tissue samples, not a clinical study tracking whether warts resolve without treatment.", "directness": "indirect", "limitations": "Very small number of excised specimens, no untreated-and-unmonitored group to assess spontaneous regression, and focus is on why imiquimod failed rather than on natural history of warts.", "followUp": "", "plainFinding": "Doesn't answer natural resolution question.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/11168764/", "sourceText": "BACKGROUND: Human papilloma viruses (HPV) are responsible for a variety of proliferative epithelial lesions including anogenital condylomas. These lesions may regress during treatment with an immune-response modifier such as imiquimod. The release of specific cytokines from the monocyte-macrophage lineage induces a cascade of events abating the HPV replication. METHOD: A total of 14 persistent warty anogenital lesions were excised 4 to 7 weeks after completing a 4-month imiquimod treatment. Another series of 25 untreated condylomas and 8 bowenoid papulosis served as controls. All examined lesions had been excised in otherwise healthy individuals with a normal immune status. Lesions were examined for the presence of Langerhans cells and subpopulations of the monocyte/macrophage/dendrocyte lineage using immunohistochemical detection of L1-protein, CD68, lysozyme and Factor-XIIIa. CD45R0-positive T lymphocytes were also identified. HPV capsid antigens and genotypes were searched for using immunohistochemistry and in situ hybridization, respectively. RESULTS: The persistent although treated anogenital lesions were identified as 10 viral condylomas, 3 bowenoid papulosis and 1 basal cell carcinoma. The inflammatory cell densities and distributions were similar in the untreated and imiquimod-resistant condylomas with the exception of Factor XIIIa-positive dendrocytes. These dermal dendritic cells were slim and rare in all imiquimod-resistant lesions. In contrast, about two-thirds of the untreated condylomas were enriched in these cells. CONCLUSION: As dermal dendritic cells play a role in the immune surveillance, their low densities in some lesions might be a key feature responsible for low cytokine local production and failure of imiquimod treatment. The combined apparent lack of Langerhans cell activation might suggest that both intraepidermal and intradermal compartments of antigen-presenting cells are affected in imiquimod-resistant lesions.", "provenance": [ { "field": "population", "quote": "All examined lesions had been excised in otherwise healthy individuals with a normal immune status." }, { "field": "intervention", "quote": "A total of 14 persistent warty anogenital lesions were excised 4 to 7 weeks after completing a 4-month imiquimod treatment." }, { "field": "comparator", "quote": "Another series of 25 untreated condylomas and 8 bowenoid papulosis served as controls." }, { "field": "primaryOutcome", "quote": "Lesions were examined for the presence of Langerhans cells and subpopulations of the monocyte/macrophage/dendrocyte lineage using immunohistochemical detection of L1-protein, CD68, lysozyme and Factor-XIIIa." }, { "field": "result", "quote": "These dermal dendritic cells were slim and rare in all imiquimod-resistant lesions. In contrast, about two-thirds of the untreated condylomas were enriched in these cells." }, { "field": "n", "quote": "A total of 14 persistent warty anogenital lesions were excised" }, { "field": "n", "quote": "Another series of 25 untreated condylomas and 8 bowenoid papulosis served as controls." } ] }, { "id": "pmid:10780721", "pmid": "10780721", "doi": "10.1097/00002030-200003310-00014", "nctId": null, "pmcid": null, "title": "Sexually transmitted infections in European HIV-infected women: incidence in relation to time from infection. European Study on the Natural History of HIV Infection in Women", "firstAuthor": "van Benthem", "multipleAuthors": true, "journal": "AIDS", "year": 2000, "design": "prospective-cohort", "n": 487, "nField": "reported", "population": "HIV-infected women with a known time since infection, from 12 European countries", "intervention": "no treatment given; observational follow-up of sexually transmitted infections over time", "comparator": "comparison across different lengths of time since HIV infection", "primaryOutcome": "rates of sexually transmitted infections, including genital warts, over time", "result": "occurrence of genital warts and other STIs increased the longer women had been infected with HIV, while acute STIs decreased", "resultDirection": "unclear", "quality": "low", "qualityWhy": "this is an observational cohort looking at infection rates over time in HIV-positive women, not a study designed to track whether individual warts clear up on their own.", "directness": "indirect", "limitations": "abstract does not track whether individual wart cases resolved, only overall diagnosis rates in a different population (HIV-infected women) than the general question asks about", "followUp": "", "plainFinding": "Warts became more common over time", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/10780721/", "sourceText": "OBJECTIVES: To investigate the prevalence and incidence of sexually transmitted infections (STI) in HIV-infected women in relation to time from infection and sexual behaviour. DESIGN: The European study on the natural history of HIV infection in women is a prospective cohort study of 487 HIV-infected women with a known interval of seroconversion from 12 European countries. METHODS: Incidence was measured with person-time methods. Generalized estimating equations analysis was used to determine risk factors for STI. RESULTS: At entry, 15% of the women were diagnosed with at least one acute STI (chlamydial infection, trichomoniasis or gonorrhoea), 10% with at least one other STI (genital warts or genital ulcerations) and 13% with vaginal candidiasis. Although frequently diagnosed during follow-up, the occurrence of acute STI and vaginal candidiasis decreased, whereas the occurrence of other STI increased with ongoing time from HIV infection. Furthermore, women with a history of prostitution [relative risk (RR), 2.00; 95% confidence interval (95% CI), 1.20-3.33] and women with irregular condom use (RR, 7.74; 95% CI, 3.52-17.0) were at higher risk for an acute STI. CONCLUSIONS: Although STI diagnoses were frequent, the occurrence of acute STI declined with time from infection which might be explained by changed sexual behaviour over time. The occurrence of other STI increased with time from HIV infection, presumably due to reactivation as a result of immunosuppression.", "provenance": [ { "field": "population", "quote": "487 HIV-infected women with a known interval of seroconversion from 12 European countries" }, { "field": "n", "quote": "487 HIV-infected women with a known interval of seroconversion" }, { "field": "intervention", "quote": "Incidence was measured with person-time methods." }, { "field": "comparator", "quote": "in relation to time from infection" }, { "field": "primaryOutcome", "quote": "To investigate the prevalence and incidence of sexually transmitted infections (STI) in HIV-infected women in relation to time from infection and sexual behaviour." }, { "field": "result", "quote": "The occurrence of other STI increased with time from HIV infection, presumably due to reactivation as a result of immunosuppression." } ] }, { "id": "pmid:10387956", "pmid": "10387956", "doi": null, "nctId": null, "pmcid": null, "title": "Anogenital human papilloma virus and the problem of persistence", "firstAuthor": "Syrjänen", "multipleAuthors": false, "journal": "Eur J Dermatol", "year": 1998, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with anogenital HPV infection (genital warts and related lesions)", "intervention": "no specific intervention; natural course of infection observed", "comparator": "none", "primaryOutcome": "whether lesions go away, stay the same, or get worse over time", "result": "abstract states lesions can regress, persist, or progress, but gives no specific figures for warts", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this is a general narrative review with no original data, numbers, or study details on warts specifically", "directness": "indirect", "limitations": "abstract does not separate genital warts from cancer-precursor lesions (dysplasia/CIN/SIL) when discussing regression, persistence, or progression, and gives no data specific to warts", "followUp": "", "plainFinding": "Can resolve, persist, or worsen", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/10387956/", "sourceText": "It has been known since antiquity that genital warts (condylomata acuminata) are a sexually transmitted disease. Since the late 1970s it has become increasingly clear that infections by the same virus, human papilloma virus (HPV) are closely implicated in the aetiology of anogenital squamous cell carcinomas and in their precursors, known as dysplasia, intraepithelial neoplasia (CIN) or squamous intraepithelial lesions (SIL). The natural history of these cancer precursors is characterised by regression, persistence or progression [1]. This review examines the natural history of anogenital HPV infections, especially persistence of the virus. Other topics covered include viral transmission, pathogenesis, the natural history of the lesions and treatment strategies.", "provenance": [ { "field": "population", "quote": "anogenital HPV infections" }, { "field": "primaryOutcome", "quote": "The natural history of these cancer precursors is characterised by regression, persistence or progression" }, { "field": "result", "quote": "The natural history of these cancer precursors is characterised by regression, persistence or progression" }, { "field": "intervention", "quote": "This review examines the natural history of anogenital HPV infections, especially persistence of the virus." }, { "field": "comparator", "quote": "Other topics covered include viral transmission, pathogenesis, the natural history of the lesions and treatment strategies." } ] }, { "id": "pmid:10370842", "pmid": "10370842", "doi": "10.1097/00003081-199906000-00006", "nctId": null, "pmcid": null, "title": "Advances in the diagnosis and treatment of human papillomavirus infections", "firstAuthor": "Sedlacek", "multipleAuthors": false, "journal": "Clin Obstet Gynecol", "year": 1999, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people infected with human papillomavirus (HPV)", "intervention": "natural immune clearance of HPV infection", "comparator": "no comparator reported", "primaryOutcome": "whether HPV infection clears or persists as warts or neoplasia", "result": "the abstract states most HPV infections are cleared by the immune system and never become warts or neoplasia, but does not specifically discuss anal warts or their regression", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this is a general narrative review of HPV biology, not a study specifically on anal warts or their natural resolution.", "directness": "indirect", "limitations": "abstract does not specifically address anal warts, does not report study methodology, sample size, or follow-up data", "followUp": "", "plainFinding": "Most HPV infections clear naturally.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/10370842/", "sourceText": "During the past decade, much has been learned about the natural history of HPV. Most infections occur early in one's sexual life. The overwhelming majority of infections are cleared by the host immune system and never present as warts or neoplasia. Certain patient behavior such as smoking, frequent sex with many different partners, other STD infections, especially HIV, and immune-suppressive drugs promote HPV expression and cause persistent infection. Persistent HPV infection is very strongly related to neoplasia. In addition to high-risk HPV types, variant subtypes have been identified that interact with the host immune system to subvert host immunity and encourage viral persistence. New treatment programs rely on drugs that modulate the immune system and disrupt viral persistence. There is a real possibility of HPV vaccines in the future, which may protect the unexposed patient.", "provenance": [ { "field": "population", "quote": "Most infections occur early in one's sexual life." }, { "field": "intervention", "quote": "The overwhelming majority of infections are cleared by the host immune system" }, { "field": "result", "quote": "The overwhelming majority of infections are cleared by the host immune system and never present as warts or neoplasia." }, { "field": "primaryOutcome", "quote": "never present as warts or neoplasia" }, { "field": "comparator", "quote": "Persistent HPV infection is very strongly related to neoplasia." } ] }, { "id": "pmid:9843007", "pmid": "9843007", "doi": "10.1016/s0190-9622(98)70268-3", "nctId": null, "pmcid": null, "title": "The natural history of condyloma in children", "firstAuthor": "Allen", "multipleAuthors": true, "journal": "J Am Acad Dermatol", "year": 1998, "design": "retrospective", "n": 41, "nField": "reported", "population": "children with anal/genital warts (condyloma)", "intervention": "no treatment (observation)", "comparator": "treatment for warts", "primaryOutcome": "whether warts went away over time", "result": "more than half resolved spontaneously, including most untreated children", "resultDirection": "benefit", "quality": "low", "qualityWhy": "this was a small retrospective review of children without a control group or randomization, so results may not be reliable or generalizable.", "directness": "indirect", "limitations": "retrospective design, small sample, mix of treated and untreated subjects, and it studied children rather than adults with anal warts.", "followUp": "5 years", "plainFinding": "Warts often go away alone.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/9843007/", "sourceText": "BACKGROUND: Condyloma acuminatum, an infection caused by human papillomavirus (HPV), has become one of the most common sexually transmitted diseases. Correspondingly, anogenital warts are more frequently diagnosed in children. Twenty-five years ago a landmark prospective study showed that untreated common cutaneous warts in children spontaneously regress within 2 years in two thirds of cases, but a similar study of condyloma has not been published. Several treatment options are available for condyloma in adults; none have been studied or approved by the US Food and Drug Administration for treatment of children. OBJECTIVE: Our purpose was to review a cohort of children with condyloma to determine the natural history. METHODS: Of 75 originally identified subjects with condyloma, 41 qualified for further retrospective or prospective evaluation, including distribution of lesions, duration of disease, gender, and treatment, if any. RESULTS: Overall, condylomas in 31 of 41 children (76%) experienced resolution. Spontaneous resolution occurred within 5 years in 22 of 41 subjects (54%), including 6 of 8 (75%) who never received treatment, and 16 of 33 (49%) in whom treatment failed. In 9 of 33 treated children (27%), resolution occurred during treatment. Girls presented three times more often than boys and resolution occurred comparatively more often in girls. CONCLUSION: Spontaneous resolution of pediatric condyloma occurred in more than half of our subjects. Nonintervention is a reasonable initial approach to managing venereal warts in children.", "provenance": [ { "field": "n", "quote": "41 qualified for further retrospective or prospective evaluation" }, { "field": "population", "quote": "children with condyloma" }, { "field": "intervention", "quote": "6 of 8 (75%) who never received treatment" }, { "field": "comparator", "quote": "16 of 33 (49%) in whom treatment failed" }, { "field": "primaryOutcome", "quote": "to determine the natural history" }, { "field": "result", "quote": "Spontaneous resolution occurred within 5 years in 22 of 41 subjects (54%)" } ] }, { "id": "pmid:9798036", "pmid": "9798036", "doi": "10.1086/514964", "nctId": null, "pmcid": null, "title": "External genital warts: report of the American Medical Association Consensus Conference. AMA Expert Panel on External Genital Warts", "firstAuthor": "Beutner", "multipleAuthors": true, "journal": "Clin Infect Dis", "year": 1998, "design": "guideline", "n": null, "nField": "not-reported", "population": "people with external genital warts and their sex partners", "intervention": "not applicable (consensus statement on diagnosis and treatment)", "comparator": "", "primaryOutcome": "consensus recommendations on diagnosis, treatment, and counseling for genital warts", "result": "The abstract does not state whether warts resolve on their own; it only summarizes expert consensus on diagnosis, treatment, and counseling.", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is an expert consensus statement, not a study testing whether warts resolve without treatment, so it provides no direct evidence on natural history.", "directness": "indirect", "limitations": "The abstract does not describe study methods, sample size, or data on natural resolution of warts; it is a panel opinion summary.", "followUp": "", "plainFinding": "No evidence reported either way.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/9798036/", "sourceText": "A consensus process was undertaken to describe and evaluate current information and practice regarding the diagnosis, treatment, and evaluation of patients with external genital warts (EGWs) and their sex partners. This process developed a number of key statements that were based on strong evidence in the literature or reasonable suppositions and opinions of experts. Key statements included the following. In most cases, EGWs can be diagnosed clinically by visual inspection. No one treatment is ideal for all patients or all warts. Women with EGWs and female sex partners of men with EGWs are at increased risk for human papillomavirus-related cervical disease and, like all women, should be screened for cervical cancer. The diagnosis of EGWs in children requires a sexual abuse evaluation. Clinicians who treat EGWs have a responsibility to counsel patients and to provide information about the infectivity, diagnosis, treatment, and natural history of EGWs and general information about sexual health and other sexually transmitted diseases.", "provenance": [ { "field": "population", "quote": "patients with external genital warts (EGWs) and their sex partners" }, { "field": "primaryOutcome", "quote": "to describe and evaluate current information and practice regarding the diagnosis, treatment, and evaluation of patients with external genital warts (EGWs) and their sex partners" }, { "field": "result", "quote": "No one treatment is ideal for all patients or all warts." }, { "field": "intervention", "quote": "to provide information about the infectivity, diagnosis, treatment, and natural history of EGWs" } ] }, { "id": "pmid:9677167", "pmid": "9677167", "doi": "10.1097/00002030-199810000-00010", "nctId": null, "pmcid": null, "title": "Effect of HIV infection on the natural history of anal human papillomavirus infection", "firstAuthor": "Critchlow", "multipleAuthors": true, "journal": "AIDS", "year": 1998, "design": "prospective-cohort", "n": 609, "nField": "reported", "population": "homosexual men attending a clinic, some with HIV and some without", "intervention": "no treatment given; natural history observed over time", "comparator": "HIV-positive men compared with HIV-negative men", "primaryOutcome": "detection, new infection, and clearance of anal HPV virus over time", "result": "HIV-positive men were less likely to become HPV-negative over follow-up than HIV-negative men, and anal warts were linked to HPV detection but wart clearance itself was not tracked", "resultDirection": "unclear", "quality": "low", "qualityWhy": "This study tracks HPV virus detection in the anal canal over time, not whether visible warts themselves go away, so it only indirectly bears on the question.", "directness": "indirect", "limitations": "The abstract reports on HPV DNA detection and persistence, not specifically on resolution of visible anal warts; no information on wart-specific outcomes or duration of follow-up is given.", "followUp": "", "plainFinding": "Didn't directly study whether warts clear.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/9677167/", "sourceText": "OBJECTIVE: To identify risk factors for the detection of prevalent and incident anal human papillomavirus (HPV) infection, and HPV persistence among HIV-seropositive and seronegative homosexual men. DESIGN: Longitudinal study of 287 HIV-seronegative and 322 HIV-seropositive men attending a community-based clinic. METHODS: Subjects underwent an interview and examination; specimens were collected for HIV serology and assessment of anal HPV and HIV DNA. RESULTS: Anal HPV DNA was detected at study entry in 91.6% of HIV-infected men, and 65.9% of men not infected with HIV. HPV detection was associated with lifetime number of sexual partners and recent receptive anal intercourse (HIV-seronegative men), decreased CD4+ lymphocyte count (HIV-seropositive men), and anal warts (all men). Among men negative for HPV at study entry, subsequent detection of HPV was associated with HIV, unprotected receptive anal intercourse, and any sexual contact since the last visit. Among men positive for HPV at study entry, subsequent detection of additional HPV types was more common among HIV-seropositive men. Becoming HPV negative during follow-up was less common among men with HIV or high HPV levels at study entry. Among those with HIV, HPV persistence was associated with presence of anal HIV DNA, but not with CD4+ lymphocyte count. CONCLUSIONS: Risk of anal HPV infection appears to increase with sexual exposure, epithelial trauma, HIV infection and immune deficiency. Incident infection may result from recent sexual exposure or reactivation of latent infection. Further studies are needed to elucidate the mechanism by which HIV DNA in the anal canal increases the risk of HPV persistence.", "provenance": [ { "field": "population", "quote": "287 HIV-seronegative and 322 HIV-seropositive men attending a community-based clinic" }, { "field": "n", "quote": "287 HIV-seronegative and 322 HIV-seropositive men attending a community-based clinic" }, { "field": "intervention", "quote": "Longitudinal study of 287 HIV-seronegative and 322 HIV-seropositive men" }, { "field": "comparator", "quote": "HIV-seropositive and seronegative homosexual men" }, { "field": "primaryOutcome", "quote": "To identify risk factors for the detection of prevalent and incident anal human papillomavirus (HPV) infection, and HPV persistence" }, { "field": "result", "quote": "Becoming HPV negative during follow-up was less common among men with HIV or high HPV levels at study entry." }, { "field": "result", "quote": "HPV detection was associated with lifetime number of sexual partners and recent receptive anal intercourse (HIV-seronegative men), decreased CD4+ lymphocyte count (HIV-seropositive men), and anal warts (all men)." } ] }, { "id": "pmid:9264579", "pmid": "9264579", "doi": "10.1006/gyno.1997.4743", "nctId": null, "pmcid": null, "title": "Detection of serologic neutralizing antibodies against HPV-11 in patients with condyloma acuminata and cervical dysplasia using an in vitro assay", "firstAuthor": "Leiserowitz", "multipleAuthors": true, "journal": "Gynecol Oncol", "year": 1997, "design": "lab", "n": 35, "nField": "reported", "population": "patients with genital warts (condyloma acuminata) or cervical cell changes (cervical intraepithelial neoplasia)", "intervention": "testing patient blood serum for HPV-11 neutralizing antibodies", "comparator": "patients with cervical dysplasia (CIN) versus those with genital warts (CA)", "primaryOutcome": "presence of neutralizing antibodies against HPV-11 in blood serum", "result": "some wart patients had neutralizing antibodies, none of the cervical dysplasia patients did", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a small laboratory antibody-detection study that does not follow patients over time or report whether their warts resolved.", "directness": "indirect", "limitations": "Small number of patients, no clinical follow-up of wart outcomes, lab-based assay only.", "followUp": "", "plainFinding": "Does not address whether warts resolve.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/9264579/", "sourceText": "This study was designed to investigate if neutralizing antibodies against HPV-11 are detectable in the serum of patients with condyloma acuminata (CA) or cervical intraepithelial neoplasia (CIN) using an in vitro infectivity assay for HPV-11. Purified HPV-11 virions were extracted from xenografted condyloma tissues implanted into athymic mice and used to infect cultured neonatal human foreskin keratinocytes (HFK) and an immortalized adult skin cell line (HaCaT). The presence of HPV-11-specific E1--E4 mRNA as detected by reverse transcriptase-polymerase chain reaction was indicative of early infection. Sera previously characterized for reactivity to HPV-11 and HPV-11 VLP (virus-like particles) by ELISA were tested for the ability to prevent HPV-11 in vitro infectivity. Neutralizing antibodies against HPV-11 were demonstrated when monoclonal antibodies or patient serum preincubated with HPV-11 virions prevented the infection of either of the two cell cultures, as shown by the absence of the E1--E4 mRNA transcript. Eleven (of 20) patients with CA were strongly ELISA reactive against HPV-11 virus-like particles. Five of these 11 patients also had detectable levels of neutralizing antibodies in their serum. It was also demonstrated that the neutralizing properties of the serum were titratable by endpoint dilution. None of 15 patients with CIN had detectable neutralizing antibodies against HPV-11. Neutralizing antibodies against HPV-11 can be detected in some patients with CA and the neutralizing effects of the patient sera can be titrated by endpoint dilution. The in vitro assay for the detection of neutralizing antibodies against HPV-11 may have utility for investigating the natural history of HPV infection and resolution, as well as assessing the efficacy of any putative HPV vaccine.", "provenance": [ { "field": "population", "quote": "patients with condyloma acuminata (CA) or cervical intraepithelial neoplasia (CIN)" }, { "field": "n", "quote": "Eleven (of 20) patients with CA" }, { "field": "n", "quote": "None of 15 patients with CIN had detectable neutralizing antibodies against HPV-11." }, { "field": "intervention", "quote": "Sera previously characterized for reactivity to HPV-11 and HPV-11 VLP (virus-like particles) by ELISA were tested for the ability to prevent HPV-11 in vitro infectivity." }, { "field": "comparator", "quote": "None of 15 patients with CIN had detectable neutralizing antibodies against HPV-11." }, { "field": "primaryOutcome", "quote": "This study was designed to investigate if neutralizing antibodies against HPV-11 are detectable in the serum of patients with condyloma acuminata (CA) or cervical intraepithelial neoplasia (CIN)" }, { "field": "result", "quote": "Five of these 11 patients also had detectable levels of neutralizing antibodies in their serum." } ] }, { "id": "pmid:9217658", "pmid": "9217658", "doi": "10.1016/s0002-9343(97)00179-4", "nctId": null, "pmcid": null, "title": "Clinical presentation and natural course of anogenital warts", "firstAuthor": "Handsfield", "multipleAuthors": false, "journal": "Am J Med", "year": 1997, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with anogenital warts (HPV infection)", "intervention": "no treatment (observed natural course)", "comparator": "none", "primaryOutcome": "whether genital warts resolve over time", "result": "most untreated warts eventually go away on their own, though the virus likely stays latent", "resultDirection": "benefit", "quality": "low", "qualityWhy": "this is a narrative review describing general natural history without specific study data, numbers, or follow-up times.", "directness": "direct", "limitations": "no patient numbers, no study design details, no quantified timeframes given", "followUp": "", "plainFinding": "Most untreated warts go away eventually.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/9217658/", "sourceText": "The natural history of human papillomavirus (HPV) genital tract lesions is complex, partly because infection can appear in several forms and often follows a fluctuating course. The primary mode of transmission of genital strains of HPV is through sexual contact. Most clinically apparent genital warts are caused by HPV type 6 or 11. The main manifestations of anogenital warts are cauliflower-like condylomata acuminata that usually involve moist surfaces; keratotic and smooth papular warts, usually on dry surfaces; and subclinical \"flat\" warts, which can be found on any mucosal or cutaneous surface. Latent infections that can be detected only by the presence of HPV DNA, with neither macroscopic nor histologic abnormality, are probably the most common form of anogenital HPV infection, regardless of HPV type. Most untreated genital tract lesions eventually resolve spontaneously, but it is likely that latent or subclinical infection persists indefinitely. The natural history of anogenital HPV infection is likely influenced by the cell-mediated immune system.", "provenance": [ { "field": "population", "quote": "The natural history of human papillomavirus (HPV) genital tract lesions is complex" }, { "field": "intervention", "quote": "Most untreated genital tract lesions eventually resolve spontaneously" }, { "field": "result", "quote": "Most untreated genital tract lesions eventually resolve spontaneously, but it is likely that latent or subclinical infection persists indefinitely." }, { "field": "primaryOutcome", "quote": "Most untreated genital tract lesions eventually resolve spontaneously" }, { "field": "comparator", "quote": "Most untreated genital tract lesions eventually resolve spontaneously" } ] }, { "id": "pmid:8989781", "pmid": "8989781", "doi": "10.1016/s0889-8545(05)70282-5", "nctId": null, "pmcid": null, "title": "The management of genital condylomas, intraepithelial neoplasia, and vulvodynia", "firstAuthor": "Reid", "multipleAuthors": false, "journal": "Obstet Gynecol Clin North Am", "year": 1996, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people exposed to HPV who appear healthy", "intervention": "current management, mainly repeated local destruction of warts", "comparator": "", "primaryOutcome": "natural history and course of HPV-related disease", "result": "unclear whether warts resolve on their own; natural history remains poorly understood", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a general review article discussing management strategies without presenting original study data or outcome measurements on wart resolution.", "directness": "indirect", "limitations": "The abstract states the natural history of HPV disease is poorly understood and that no effective medical therapy or vaccine exists; it discusses genital condylomas broadly rather than anal warts specifically.", "followUp": "", "plainFinding": "No clear answer on resolution.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/8989781/", "sourceText": "The natural history of HPV-related disease still is poorly understood. Screening of apparently healthy populations suggests that most HPV exposure results only in latent infection; that is, there is no active HPV DNA replication, but the HPV copy number is held at a steady state because viral replication parallels cell division. Unfortunately, knowledge of the cell-virus interaction and the host-immune response has not yet provided an effective medical therapy or a preventive vaccine. Rather, the management of HPV-induced disease remains rooted to the strategy of repeated local destruction. The physician should work methodically through a series of strategic decisions before committing to a management plan.", "provenance": [ { "field": "population", "quote": "Screening of apparently healthy populations suggests that most HPV exposure results only in latent infection" }, { "field": "intervention", "quote": "the management of HPV-induced disease remains rooted to the strategy of repeated local destruction" }, { "field": "primaryOutcome", "quote": "The natural history of HPV-related disease still is poorly understood." }, { "field": "result", "quote": "The natural history of HPV-related disease still is poorly understood." } ] }, { "id": "pmid:8946632", "pmid": "8946632", "doi": "10.1097/00007435-199611000-00007", "nctId": null, "pmcid": null, "title": "Status of local cellular immunity in interferon-responsive and -nonresponsive human papillomavirus-associated lesions", "firstAuthor": "Arany", "multipleAuthors": true, "journal": "Sex Transm Dis", "year": 1996, "design": "lab", "n": null, "nField": "not-reported", "population": "patients with anogenital warts (condyloma acuminatum) who later received interferon treatment", "intervention": "pretreatment local cellular immune response measured in wart biopsies", "comparator": "patients who responded well to interferon therapy versus those who responded poorly", "primaryOutcome": "local cell-mediated immune markers (Langerhans cells, MHC expression, cytokine mRNA, T-cell recruitment) in wart tissue", "result": "Nonresponders to interferon had depleted Langerhans cells, reduced MHC and cytokine expression, while responders showed strong immune cell recruitment against HPV-infected cells", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a small mechanistic lab study of immune markers, not a clinical trial measuring whether warts actually clear, and it does not report participant numbers.", "directness": "indirect", "limitations": "No participant numbers given, no clinical wart clearance outcomes reported, focuses on molecular/immune markers rather than wart resolution.", "followUp": "", "plainFinding": "Does not address spontaneous wart clearance.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/8946632/", "sourceText": "BACKGROUND AND OBJECTIVES: Anogenital warts are caused by human papillomaviruses (HPVs), which should induce cellular immune responses in immunocompetent patients. However, the natural history of these warts shows considerable variation between persons, ranging from spontaneous regression to prolonged persistence. In addition, the efficiency of immunologically based modalities for the therapy of anogenital warts, such as interferon (IFN) treatment, is highly variable. METHODS: Considering that preexisting conditions of the host are important factors in an appropriate immune response, the authors determined the pretreatment status of local cell-mediated immune response to HPV infection by reverse transcription-polymerase chain reaction in patients with condyloma acuminatum, who later received IFN treatment and responded well or poorly to that therapy. RESULTS AND CONCLUSIONS: The authors found that biopsies from nonresponders were depleted markedly in Langerhans cells, leading to decreases in major histocompatibility complex class II expression and, therefore, to diminished attraction of CD4+ T cells. An inappropriate major histocompatibility complex class I expression also was observed in those nonresponders with decreased CD8+ levels. The mRNA levels of cytokines (interleukin-1a, interleukin-1b, granulocyte-macrophage-colony stimulating factor, tumor necrosis factor that participate in immune responses were low in nonresponders. In contrast, responders demonstrated high macrophage-natural killer cell (CD16-positive) and activated CD4 (IL-2, interferon gamma-positive, TH1 cells) T-cell recruitment against HPV-infected keratinocytes, which is consistent with a delayed-type hypersensitivity-like cellular immune response. Lack of immune response in nonresponders appeared to correlate with high expression levels of the HPV E7 gene. These differences in local cellular immunity might determine the response rate of HPV-infected cells to immunomodulatory therapies.", "provenance": [ { "field": "population", "quote": "patients with condyloma acuminatum, who later received IFN treatment and responded well or poorly to that therapy" }, { "field": "intervention", "quote": "the authors determined the pretreatment status of local cell-mediated immune response to HPV infection by reverse transcription-polymerase chain reaction" }, { "field": "comparator", "quote": "patients with condyloma acuminatum, who later received IFN treatment and responded well or poorly to that therapy" }, { "field": "primaryOutcome", "quote": "biopsies from nonresponders were depleted markedly in Langerhans cells, leading to decreases in major histocompatibility complex class II expression" }, { "field": "result", "quote": "responders demonstrated high macrophage-natural killer cell (CD16-positive) and activated CD4 (IL-2, interferon gamma-positive, TH1 cells) T-cell recruitment against HPV-infected keratinocytes" } ] }, { "id": "pmid:8964543", "pmid": "8964543", "doi": null, "nctId": null, "pmcid": null, "title": "[Human Papilloma virus. Epidemiologic, carcinogenic, diagnostic and therapeutic aspects]", "firstAuthor": "Vargas-Hernández", "multipleAuthors": false, "journal": "Ginecol Obstet Mex", "year": 1996, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "women with HPV infection", "intervention": "clinical treatment of HPV based on experience", "comparator": "", "primaryOutcome": "natural course and treatment outcome of HPV infection", "result": "clinical picture is variable, with some spontaneous remission, but infection sometimes cannot be eradicated from the genital tract", "resultDirection": "mixed", "quality": "very-low", "qualityWhy": "this is a general narrative review of HPV with no study data, numbers, or specific methodology given", "directness": "indirect", "limitations": "abstract gives no study design details, no patient numbers, and discusses HPV infection generally rather than anal warts specifically", "followUp": "", "plainFinding": "Sometimes clears on its own", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/8964543/", "sourceText": "Human Papillomavirus (HPV) is the most common infection among women. Natural History of HPV infection has changed as well as diagnosis and treatment. Clinical picture is variable even with spontaneous remission. Molecular Biology for diagnosis and typification of HPV has changed its treatment. The disease can be treated according to clinical experience. Sometimes can not eradicated since just it is impossible make to disappear it from genital tract.", "provenance": [ { "field": "population", "quote": "Human Papillomavirus (HPV) is the most common infection among women." }, { "field": "result", "quote": "Clinical picture is variable even with spontaneous remission." }, { "field": "result", "quote": "Sometimes can not eradicated since just it is impossible make to disappear it from genital tract." }, { "field": "primaryOutcome", "quote": "Natural History of HPV infection has changed as well as diagnosis and treatment." }, { "field": "intervention", "quote": "The disease can be treated according to clinical experience." } ] }, { "id": "pmid:8652714", "pmid": "8652714", "doi": "10.1258/0956462961917078", "nctId": null, "pmcid": null, "title": "Autoimplantation technique in the treatment of anogenital warts: a clinico-immunological study", "firstAuthor": "Usman", "multipleAuthors": true, "journal": "Int J STD AIDS", "year": 1996, "design": "rct", "n": 115, "nField": "reported", "population": "patients with anogenital warts, including a group left untreated as controls", "intervention": "autoimplantation technique for wart removal", "comparator": "podophyllin treatment and an untreated control group", "primaryOutcome": "rate of clinical cure at 6 weeks and recurrence of warts after 1 year", "result": "70% cured with podophyllin vs 44% cured with autoimplantation after 6 weeks; none of the untreated controls had natural remission; all cured podophyllin cases recurred within a year while none of the autoimplantation cases recurred", "resultDirection": "mixed", "quality": "low", "qualityWhy": "Small group sizes, short-term cure assessment, and no clear description of blinding limit confidence in the results.", "directness": "direct", "limitations": "Small sample sizes (50, 50, and 15 per group), unclear blinding, and limited follow-up details reduce reliability.", "followUp": "1 year", "plainFinding": "No natural remission without treatment.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/8652714/", "sourceText": "An autoimplantation technique was adopted in the treatment of 50 cases of anogenital warts and was compared with the conventionally used podophyllin regimen in a matched group of 50 patients. They were assessed with 15 untreated subjects in a control group for the rate of clinical cure after 6 weeks, recurrence after 1 year follow up and for humoral and cell mediated immune responses before and after treatment. In the podophyllin group, 70% of patients were cured after 6 weeks while in autoimplantation, only 44% of patients were cured, and none in the control group had natural remission of warts without any treatment. After 1 year all the cured cases (100%) that completed follow up had recurrence of warts with podophyllin treatment, while none had recurrence of lesions in the autoimplantation group. Results of the humoral and cell mediated immune (CMI) response studies revealed that autoimplantation technique significantly augmented both humoral and CMI responses while there was not significant change in the immune status after podophyllin treatment (P > 0.001).", "provenance": [ { "field": "n", "quote": "50 cases of anogenital warts" }, { "field": "n", "quote": "a matched group of 50 patients" }, { "field": "n", "quote": "15 untreated subjects in a control group" }, { "field": "population", "quote": "50 cases of anogenital warts" }, { "field": "population", "quote": "15 untreated subjects in a control group" }, { "field": "intervention", "quote": "An autoimplantation technique was adopted in the treatment of 50 cases of anogenital warts" }, { "field": "comparator", "quote": "compared with the conventionally used podophyllin regimen in a matched group of 50 patients" }, { "field": "comparator", "quote": "15 untreated subjects in a control group" }, { "field": "primaryOutcome", "quote": "rate of clinical cure after 6 weeks, recurrence after 1 year follow up" }, { "field": "result", "quote": "In the podophyllin group, 70% of patients were cured after 6 weeks while in autoimplantation, only 44% of patients were cured, and none in the control group had natural remission of warts without any treatment." }, { "field": "result", "quote": "After 1 year all the cured cases (100%) that completed follow up had recurrence of warts with podophyllin treatment, while none had recurrence of lesions in the autoimplantation group." } ] }, { "id": "pmid:7540876", "pmid": "7540876", "doi": "10.1093/clinids/20.supplement_1.s91", "nctId": null, "pmcid": null, "title": "Human papillomavirus infection and genital warts: update on epidemiology and treatment", "firstAuthor": "Stone", "multipleAuthors": false, "journal": "Clin Infect Dis", "year": 1995, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with exophytic genital warts", "intervention": "various treatments: podofilox, podophyllin, cryotherapy, 5-fluorouracil, interferon, laser surgery", "comparator": "treatments compared against each other", "primaryOutcome": "treatment efficacy and recurrence after treatment", "result": "no single treatment worked better than another, and warts often came back after any treatment", "resultDirection": "unclear", "quality": "low", "qualityWhy": "this is a narrative literature review of treatments, not a study of spontaneous resolution, and it explicitly states the natural history of genital warts is not well understood.", "directness": "indirect", "limitations": "the abstract states little is known about the natural history of genital warts and subclinical HPV infection, and the review covers genital warts generally rather than anal warts specifically or spontaneous resolution without treatment", "followUp": "", "plainFinding": "Treatment effectiveness unclear; natural course not studied here", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/7540876/", "sourceText": "The treatment of genital warts remains frustrating since it is often painful, expensive, and unsuccessful. Moreover, little is known about the infectivity and natural history of exophytic genital warts or subclinical genital infection with human papillomavirus. The traditional goals of therapy for sexually transmitted diseases--eradication of infection, elimination of symptoms, prevention of long-term sequelae, and interruption of transmission--are currently not attainable for or applicable to genital warts. The medical literature from January 1988 to August 1993 was reviewed for recent studies on the treatment of exophytic warts. The following treatments were included in the reviewed studies: podofilox (which was recently approved by the Food and Drug Administration), podophyllin, cryotherapy, topical 5-fluorouracil, intralesional interferon, systemic interferon, and laser surgery. No single treatment modality was superior to another, and recurrence rates associated with all modalities were high. Treatment of genital warts should be guided by preferences of the patient, and a specific therapeutic regimen should be chosen with consideration of expense, efficacy, convenience, and potential for adverse effects.", "provenance": [ { "field": "population", "quote": "genital warts" }, { "field": "intervention", "quote": "podofilox (which was recently approved by the Food and Drug Administration), podophyllin, cryotherapy, topical 5-fluorouracil, intralesional interferon, systemic interferon, and laser surgery" }, { "field": "comparator", "quote": "No single treatment modality was superior to another" }, { "field": "primaryOutcome", "quote": "recurrence rates associated with all modalities were high" }, { "field": "result", "quote": "No single treatment modality was superior to another, and recurrence rates associated with all modalities were high." }, { "field": "limitations", "quote": "little is known about the infectivity and natural history of exophytic genital warts or subclinical genital infection with human papillomavirus" } ] }, { "id": "pmid:7751101", "pmid": "7751101", "doi": "10.1111/j.1365-4362.1995.tb01572.x", "nctId": null, "pmcid": null, "title": "Detection with the polymerase chain reaction of human papillomavirus DNA in condylomata acuminata treated with CO2 laser and microwave", "firstAuthor": "Li", "multipleAuthors": true, "journal": "Int J Dermatol", "year": 1995, "design": "lab", "n": 12, "nField": "reported", "population": "women with genital wart tissue (vulvar condylomata) surgically removed", "intervention": "wart tissue treated with CO2 laser or microwave in the lab", "comparator": "untreated wart tissue from the same patients", "primaryOutcome": "whether wart virus (HPV) DNA could still be detected in the tissue after treatment", "result": "Virus DNA was found in all untreated samples, fewer laser-treated samples, and even fewer microwave-treated samples", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is a small lab experiment on excised tissue, not a study of whether warts clear up in real patients over time.", "directness": "indirect", "limitations": "Only 12 specimens, tissue was tested once right after removal rather than following patients over time, and it does not address whether warts resolve without any treatment.", "followUp": "", "plainFinding": "Microwave destroyed wart virus DNA more than laser.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/7751101/", "sourceText": "BACKGROUND: The recurrence rates of condyloma acuminata are high. The reasons for the relatively high relapse rates with different treatments are unknown. METHODS: Twelve specimens of condylomata acuminata of the vulva were excised from 12 patients and divided into three parts. One part was untreated, the second and the third parts were treated with CO2 laser and microwave, respectively. DNA was then extracted from tissue by proteolytic digestion and amplified by the polymerase chain reaction. Dot blots were performed with the use of radiolabeled consensus and human papilloma virus (HPV) type-specific probes. RESULTS: HPV DNA was amplified in 100% of untreated specimens (6-HPV 6; 6-HPV 11), and in 83.3% and 50% of specimens treated with CO2 laser and microwave, respectively. There was a significant difference in detection between untreated and microwave-treated specimens (chi 2 = 4.18, P < 0.05). CONCLUSION: Microwave damages HPV DNA more effectively than CO2 laser.", "provenance": [ { "field": "population", "quote": "Twelve specimens of condylomata acuminata of the vulva were excised from 12 patients" }, { "field": "n", "quote": "excised from 12 patients" }, { "field": "intervention", "quote": "the second and the third parts were treated with CO2 laser and microwave, respectively" }, { "field": "comparator", "quote": "One part was untreated" }, { "field": "primaryOutcome", "quote": "DNA was then extracted from tissue by proteolytic digestion and amplified by the polymerase chain reaction" }, { "field": "result", "quote": "HPV DNA was amplified in 100% of untreated specimens (6-HPV 6; 6-HPV 11), and in 83.3% and 50% of specimens treated with CO2 laser and microwave, respectively." } ] }, { "id": "pmid:7709329", "pmid": "7709329", "doi": "10.1097/00007435-199501000-00002", "nctId": null, "pmcid": null, "title": "Anal human papillomavirus infection among homosexual and bisexual men: prevalence of type-specific infection and association with human immunodeficiency virus", "firstAuthor": "Breese", "multipleAuthors": true, "journal": "Sex Transm Dis", "year": 1995, "design": "prospective-cohort", "n": 209, "nField": "reported", "population": "homosexual and bisexual men, some HIV-positive and some HIV-negative", "intervention": "no treatment given; anal HPV infection followed over time", "comparator": "HIV-negative men compared to HIV-positive men with different CD4 counts", "primaryOutcome": "persistence of anal HPV infection detected by anal swab testing over 6 months", "result": "HPV infection persisted in most men, more often in those with more severe HIV-related immune suppression", "resultDirection": "unclear", "quality": "low", "qualityWhy": "This is an observational study in a specific high-risk population (HIV-positive and negative gay/bisexual men) that tracked HPV DNA persistence, not specifically whether visible anal warts resolved, so it only indirectly addresses the question.", "directness": "indirect", "limitations": "Small subgroup numbers (especially for men with AIDS/ARC), focus on HPV DNA detection rather than clinical wart resolution, and a selected population not representative of all people with anal warts.", "followUp": "6 months", "plainFinding": "HPV infection often persisted, not cleared.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/7709329/", "sourceText": "BACKGROUND AND OBJECTIVE: \"High-risk\" types of genital human papillomavirus (HPV) infections are associated with anogenital cancer. As these cancers occur more frequently in immunosuppressed individuals, we sought to better characterize type-specific prevalence, clinical spectrum, and risk factors for anal HPV infection among homosexual men. STUDY DESIGN: Cross-sectional and follow-up study of 93 HIV-seropositive (HIV+) and 116 HIV-seronegative (HIV-) homo-sexual/bisexual men, with testing of anal swabs for HPV DNA by Virapap/Viratype assay. RESULTS: Overall, 57 (61%) HIV+ and 20 (17%) HIV- men had anal HPV detected (P < .0001). HPV types 16/18 were most common, accounting for more than 50% of infections. Among HIV+ men, HPV prevalence increased with declining CD4 cell count: 33% with counts of more than 750, 56% with counts of 200 to 750, and 86% with counts less than 200 (P = .01). HPV infection was also associated with younger age and increasing numbers of lifetime sexual partners for all men. Most infections were subclinical, with clinically apparent infection (anal warts) accounting for 35% of infections in HIV- men, 33% in asymptomatic HIV+ men, and 52% in men with AIDS/ARC. For both HIV- and HIV+ men, rates of anal HPV detection (23% and 60%) were greater than those for the perianal area (5% and 37%) or penile shaft (2% and 7%) (P < .001). Persistence of anal HPV for 6 months was more common among men with AIDS/ARC (95%) than among asymptomatic HIV+ men (62%) or HIV- men (61%) (P < .05). CONCLUSIONS: Anal HPV infections are common in homosexual/bisexual men and have a strong relationship to HIV-associated immunosuppression. Because most infections involve \"high-risk\" types of HPV, studies of their natural history are needed to clarify the risk of anal neoplasia in men with HIV infection.", "provenance": [ { "field": "population", "quote": "93 HIV-seropositive (HIV+) and 116 HIV-seronegative (HIV-) homo-sexual/bisexual men" }, { "field": "n", "quote": "93 HIV-seropositive (HIV+) and 116 HIV-seronegative (HIV-) homo-sexual/bisexual men" }, { "field": "intervention", "quote": "with testing of anal swabs for HPV DNA by Virapap/Viratype assay" }, { "field": "comparator", "quote": "HPV prevalence increased with declining CD4 cell count: 33% with counts of more than 750, 56% with counts of 200 to 750, and 86% with counts less than 200" }, { "field": "primaryOutcome", "quote": "Persistence of anal HPV for 6 months was more common among men with AIDS/ARC (95%) than among asymptomatic HIV+ men (62%) or HIV- men (61%)" }, { "field": "result", "quote": "Persistence of anal HPV for 6 months was more common among men with AIDS/ARC (95%) than among asymptomatic HIV+ men (62%) or HIV- men (61%) (P < .05)." } ] }, { "id": "pmid:7801889", "pmid": "7801889", "doi": "10.1093/ajcp/102.6.768", "nctId": null, "pmcid": null, "title": "Immunological events in regressing genital warts", "firstAuthor": "Coleman", "multipleAuthors": true, "journal": "Am J Clin Pathol", "year": 1994, "design": "case-series", "n": 125, "nField": "reported", "population": "people with genital warts", "intervention": "no treatment described, warts monitored over time", "comparator": "nonregressing warts in the same group", "primaryOutcome": "whether genital warts went away on their own and immune changes during that process", "result": "28 of 125 patients had their warts regress on their own, and regressing warts showed stronger immune cell activity than ones that did not regress", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was an observational case series without a control group or randomization, focused mainly on immune cell biology rather than directly testing whether warts clear up.", "directness": "indirect", "limitations": "No control group, small subset (14 vs 14) used for detailed immune comparisons, and the population was genital warts in general rather than anal warts specifically.", "followUp": "", "plainFinding": "About a fifth cleared on their own.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/7801889/", "sourceText": "Little is known of the in vivo role of the immune system in controlling human papillomavirus infection in the genital tract. The authors have studied 125 closely monitored patients with genital warts. Of these 125 patients, wart regression was seen in 28 patients. This study provides evidence that clearance of human papillomavirus from the genital tract is characterized by an active cell-mediated immune response. Regressing warts (n = 14) contained significantly more T lymphocytes (P < .05, Wilcoxon rank sum test) and macrophages (P < .01) than did nonregressing controls (n = 14). CD4-positive lymphocytes predominated in regression, both within the wart stroma and the surface epithelium, where there was a significant change in the ratio of CD4+ to CD8+ cells (P < .01). Lymphocytes in regression also showed greater expression of activation markers, and the majority were of the \"antigen-experienced\" phenotype. There was no difference in Langerhans cell numbers, although there was significant induction of the immune accessory molecules HLA-DR and ICAM1 (P < .05) on keratinocytes, and E-selectin and VCAM1 (P < .05) on endothelial cells in regressing warts. The changes in regression are consistent with a delayed-type hypersensitivity reaction to foreign antigen, and the ability to induce and mount such a response may be a critical determinant of effective natural immunity to the genital HPVs. Specific targeting of delayed-type hypersensitivity responsiveness may increase the efficacy of strategies for immuno-intervention against HPV infection in the genital tract.", "provenance": [ { "field": "n", "quote": "The authors have studied 125 closely monitored patients with genital warts." }, { "field": "population", "quote": "patients with genital warts" }, { "field": "intervention", "quote": "The authors have studied 125 closely monitored patients with genital warts." }, { "field": "comparator", "quote": "Regressing warts (n = 14) contained significantly more T lymphocytes (P < .05, Wilcoxon rank sum test) and macrophages (P < .01) than did nonregressing controls (n = 14)." }, { "field": "primaryOutcome", "quote": "wart regression was seen in 28 patients" }, { "field": "result", "quote": "Of these 125 patients, wart regression was seen in 28 patients." } ] }, { "id": "pmid:8169403", "pmid": "8169403", "doi": "10.1093/infdis/169.5.1112", "nctId": null, "pmcid": null, "title": "Serum 2'-5'-oligoadenylate synthetase levels and clinical response to interferon-beta therapy in women with genital human papillomavirus infection", "firstAuthor": "Rusconi", "multipleAuthors": true, "journal": "J Infect Dis", "year": 1994, "design": "rct", "n": null, "nField": "not-reported", "population": "women with genital HPV infection", "intervention": "interferon-beta injections", "comparator": "untreated controls", "primaryOutcome": "blood marker (2'-5'OAS enzyme) levels and treatment response", "result": "higher baseline enzyme levels predicted failure to respond to interferon-beta treatment", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This study is about a lab blood marker predicting drug response, not about whether warts resolve without treatment, and does not report participant numbers.", "directness": "indirect", "limitations": "No participant numbers reported; focuses on a biochemical marker rather than wart outcomes; no untreated natural history data on wart resolution.", "followUp": "3 months", "plainFinding": "Not relevant to warts clearing alone.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/8169403/", "sourceText": "To investigate the activity of parenterally administered interferon-beta (IFN-beta) in women with genital human papillomavirus (HPV) infection, serum 2'-5'-oligoadenylate synthetase (2'-5'OAS), an enzyme induced by IFNs, was measured before, during, and after therapy. Serum levels of 2'-5'OAS significantly increased during therapy (P = .005). The patients classified as not responding to treatment at 3 months of follow-up had baseline levels of 2'-5'OAS significantly higher than those who responded to treatment (P = .0011). Differences between the IFN-beta-treated group and untreated controls appeared at day 6 (P = .0019). 2'-5'OAS is a useful parameter in monitoring parenterally administered IFN-beta. The data suggest that women with genital HPV infection and elevated baseline levels of 2'-5'OAS are unlikely to respond to therapy with IFN-beta.", "provenance": [ { "field": "population", "quote": "women with genital human papillomavirus (HPV) infection" }, { "field": "intervention", "quote": "parenterally administered interferon-beta (IFN-beta)" }, { "field": "comparator", "quote": "untreated controls" }, { "field": "primaryOutcome", "quote": "serum 2'-5'-oligoadenylate synthetase (2'-5'OAS), an enzyme induced by IFNs, was measured before, during, and after therapy" }, { "field": "result", "quote": "women with genital HPV infection and elevated baseline levels of 2'-5'OAS are unlikely to respond to therapy with IFN-beta" }, { "field": "followUp", "quote": "not responding to treatment at 3 months of follow-up" } ] }, { "id": "pmid:8218514", "pmid": "8218514", "doi": "10.1177/095646249300400505", "nctId": null, "pmcid": null, "title": "Anogenital warts in prepubertal children; sexual abuse or not?", "firstAuthor": "Handley", "multipleAuthors": true, "journal": "Int J STD AIDS", "year": 1993, "design": "prospective-cohort", "n": 42, "nField": "reported", "population": "young children with anal/genital warts", "intervention": "no treatment (natural course)", "comparator": "surgical treatment (excision and electrocautery)", "primaryOutcome": "whether warts went away or recurred", "result": "about 1 in 5 children had warts clear up on their own without treatment", "resultDirection": "mixed", "quality": "low", "qualityWhy": "small number of children, not randomized, and mainly focused on how the warts were caught rather than testing treatments.", "directness": "indirect", "limitations": "Small sample, not a controlled comparison of treatment vs no treatment, mean follow-up varied widely, and main focus was transmission not natural resolution.", "followUp": "mean 15.9 months, SD 12.24", "plainFinding": "Some warts cleared on their own.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/8218514/", "sourceText": "Forty-two prepubertal children presenting with anogenital (AG) warts (15 boys and 27 girls) were prospectively followed up (mean 15.9 months, SD 12.24). Most (73.8%) of these children had perianal condylomatous-type warts and 11 (26.2%) had concurrent non-genital (NG) warts. None had any other AG infections or sexually transmitted disease (STD). Twelve (28.6%) children acquired their AG warts by vertical transmission from an infected maternal birth canal, 3 (7.1%) by autoinoculation from common hand warts and 2 children (4.8%) through sexual abuse. In the remaining 25 children (59.5%) mode of acquisition of AG warts was uncertain but not thought to be sexual. Human papilloma virus (HPV) DNA (types 6/11, 16/18 or 31,33,35-31+) was detected in 10/32 (31.3%) of AG warts biopsied from these children, types 6/11 in the majority of positive biopsies (9/10). Detection of HPV DNA (types 6/11, 16/18 or 31+) in a child's AG warts was significantly associated with either vertical or sexual transmission (P < 0.02). Thirty-one children had their warts treated with a combination of scissor excision and electrocautery under general anaesthesia. Warts recurred in 10 (31.4%) of these children all within 4 months following treatment. Spontaneous resolution of AG warts was seen in 9 (21.4%) children. Of 42 children with AG warts 10 (23.8%) had at least one adult family member with AG warts, 13 (36.9%) on adult family member with another AG infection or STD, and 23 (62.2%) had a mother with cervical intraepithelial neoplasia (CIN). Twenty (47.6%) of these children had a family member with NG warts.(ABSTRACT TRUNCATED AT 250 WORDS)", "provenance": [ { "field": "n", "quote": "Forty-two prepubertal children presenting with anogenital (AG) warts" }, { "field": "population", "quote": "Forty-two prepubertal children presenting with anogenital (AG) warts (15 boys and 27 girls)" }, { "field": "intervention", "quote": "Spontaneous resolution of AG warts was seen in 9 (21.4%) children." }, { "field": "comparator", "quote": "Thirty-one children had their warts treated with a combination of scissor excision and electrocautery under general anaesthesia." }, { "field": "primaryOutcome", "quote": "Warts recurred in 10 (31.4%) of these children all within 4 months following treatment." }, { "field": "result", "quote": "Spontaneous resolution of AG warts was seen in 9 (21.4%) children." }, { "field": "followUp", "quote": "mean 15.9 months, SD 12.24" } ] }, { "id": "pmid:11578352", "pmid": "11578352", "doi": "10.1046/j.1525-1438.1993.03040239.x", "nctId": null, "pmcid": null, "title": "'Abnormal' Papanicolaou smears and colposcopy in pregnancy: ante- and post-partum findings", "firstAuthor": "Nahhas", "multipleAuthors": true, "journal": "Int J Gynecol Cancer", "year": 1993, "design": "prospective-cohort", "n": 73, "nField": "reported", "population": "pregnant women with genital warts or abnormal Pap smears", "intervention": "no treatment during pregnancy, observed after delivery", "comparator": "same patients' findings before versus after delivery", "primaryOutcome": "whether abnormal cervical/genital HPV findings resolved after delivery", "result": "only a few patients showed partial regression; most still had abnormal findings 4 months after delivery despite normal cytology", "resultDirection": "mixed", "quality": "low", "qualityWhy": "small, uncontrolled group of pregnant women followed only briefly, and it looks at cervical/genital HPV findings generally rather than anal warts specifically.", "directness": "indirect", "limitations": "No control group, short follow-up, focuses on cervical/colposcopic findings in pregnancy rather than anal warts, and relies on cytology which was shown to be unreliable for predicting true status.", "followUp": "4 months", "plainFinding": "Most abnormal findings persisted after birth", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/11578352/", "sourceText": "Abnormal Papanicolaou smears and colposcopic findings suggesting human Papilloma virus (HPV) infection and cervical intraepithelial neoplasia (CIN) may occur during pregnancy. Condylomata acuminata often grow rapidly during pregnancy and may regress spontaneously following delivery. However, the post-partum outcome of the untreated ante-partum abnormal cytologic smear and colposcopy has not been defined clearly. Seventy-three pregnant patients were examined by colposcopy because of genital warts and/or abnormal Papanicolaou smears. Cytologic, colposcopic and histologic re-evaluation was conducted after delivery. Only one of the patients had a normal ante-partum colposcopic examination. This number increased to 15 after delivery. Forty-one patients had normal post-partum cytologic smears, but only 13 had normal histology. Abnormal post-partum cytology was highly predictive of abnormal colposcopy and histology. In contrast, normal post-partum cytology was not very accurate in predicting normal colposcopy and histology. It is concluded that a few pregnant patients may have partial regression of clinical HPV infection and abnormal cytology and colposcopy after delivery. However, the majority will continue to have abnormal findings 4 months following delivery in spite of normal post-partum cytology and even colposcopy.", "provenance": [ { "field": "n", "quote": "Seventy-three pregnant patients were examined by colposcopy because of genital warts and/or abnormal Papanicolaou smears." }, { "field": "population", "quote": "Seventy-three pregnant patients were examined by colposcopy because of genital warts and/or abnormal Papanicolaou smears." }, { "field": "intervention", "quote": "the post-partum outcome of the untreated ante-partum abnormal cytologic smear and colposcopy has not been defined clearly" }, { "field": "comparator", "quote": "Cytologic, colposcopic and histologic re-evaluation was conducted after delivery." }, { "field": "primaryOutcome", "quote": "It is concluded that a few pregnant patients may have partial regression of clinical HPV infection and abnormal cytology and colposcopy after delivery." }, { "field": "result", "quote": "However, the majority will continue to have abnormal findings 4 months following delivery in spite of normal post-partum cytology and even colposcopy." } ] }, { "id": "pmid:8461956", "pmid": "8461956", "doi": "10.1111/j.1464-410x.1993.tb15919.x", "nctId": null, "pmcid": null, "title": "Extensive condylomata acuminata of male urethra: management by ventral urethrotomy", "firstAuthor": "Kesner", "multipleAuthors": false, "journal": "Br J Urol", "year": 1993, "design": "case-series", "n": 4, "nField": "reported", "population": "men with severe wart infections inside the urethra", "intervention": "surgical cutting open of the urethra to remove warts", "comparator": "no comparator, case series of surgical treatment", "primaryOutcome": "whether warts cleared up and complications after treatment", "result": "most needed repeat surgery for recurrence; one case resolved on its own after a year without treatment, another progressed to cancer", "resultDirection": "mixed", "quality": "very-low", "qualityWhy": "This is just 4 patients followed with no comparison group, so it cannot reliably show what usually happens to warts.", "directness": "indirect", "limitations": "Very small number of patients, two lost to follow-up, and this is about urethral warts treated surgically rather than untreated anal warts in general.", "followUp": "1 year", "plainFinding": "One case resolved untreated; others recurred or worsened.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/8461956/", "sourceText": "Between 1982 and 1990, 4 males with extensive intraurethral warts presented with marked inflammation of the external genitalia. When sepsis had settled all patients underwent ventral urethrotomy, in which the urethra was divided median as far back as was necessary to expose all of the warts. Surgical and electro-excision were the preferred methods of removal. Of 3 patients who developed recurrences 2 were lost to follow-up. A third remained without treatment for 1 year and when next seen the warts had spontaneously resolved and his urethra was closed. A fourth patient was lost to follow-up for 4 years before returning with destruction of his external genitalia by a verrucous carcinoma. The human immunodeficiency virus (HIV) did not appear to be a factor in the natural history of intraurethral warts in 2 patients who were negative for serum antibodies 2 and 8 years after presentation.", "provenance": [ { "field": "n", "quote": "4 males with extensive intraurethral warts" }, { "field": "population", "quote": "4 males with extensive intraurethral warts presented with marked inflammation of the external genitalia" }, { "field": "intervention", "quote": "all patients underwent ventral urethrotomy, in which the urethra was divided median as far back as was necessary to expose all of the warts" }, { "field": "comparator", "quote": "Surgical and electro-excision were the preferred methods of removal" }, { "field": "primaryOutcome", "quote": "Of 3 patients who developed recurrences 2 were lost to follow-up" }, { "field": "result", "quote": "A third remained without treatment for 1 year and when next seen the warts had spontaneously resolved and his urethra was closed" }, { "field": "followUp", "quote": "remained without treatment for 1 year" } ] }, { "id": "pmid:8384016", "pmid": "8384016", "doi": "10.1111/j.1365-2303.1993.tb00068.x", "nctId": null, "pmcid": null, "title": "Use of antibodies against a synthetic peptide of the E6 protein of human papillomavirus (HPV) type 16 for the diagnosis of genital HPV lesions", "firstAuthor": "Tosi", "multipleAuthors": true, "journal": "Cytopathology", "year": 1993, "design": "lab", "n": 41, "nField": "reported", "population": "patients with genital lesions caused by HPV (cervical lesions and genital warts from HPV types 16, 6, 11, 18)", "intervention": "antibody staining test to detect an HPV16 E6 protein marker in tissue biopsies", "comparator": "different HPV types and lesion types (HPV6, HPV11, HPV18 vs HPV16; CIN vs non-CIN)", "primaryOutcome": "whether lesions stained positive for the HPV16 E6 antibody and how this related to lesion behavior", "result": "staining patterns differed by HPV type, and among HPV16 lesions, intense staining was more common in lesions that progressed than in those that spontaneously regressed", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a small laboratory staining study not designed to test whether anal warts resolve on their own, and it barely touches on regression in a different context (cervical lesions, not anal warts).", "directness": "indirect", "limitations": "Small numbers in subgroups, focuses on cervical and mixed genital lesions rather than anal warts specifically, and is a diagnostic/laboratory study rather than a clinical outcome study of wart regression.", "followUp": "", "plainFinding": "Not about anal wart regression.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/8384016/", "sourceText": "The E6 open reading frame of the human papillomavirus (HPV) 16 codes for a protein of 158 amino acids with a theoretical molecular weight of 19.1 kD. A peptide corresponding to 147-158 amino acids (NH2-RSSRTRRETQLC-COOH) was synthesized, coupled to haemocyanin and used for immunization of rabbits. The antibodies obtained were used for the immunohistochemical analysis of a series of 41 paraffin-embedded biopsies including 29 cases of HPV 16-associated cervical lesions, five HPV 6, four HPV 11, and three HPV 18-associated genital warts. Expression of a reacting molecule (both intranuclear and cytoplasmic) could be demonstrated in 28/29 (96.6%) of the HPV 16 lesions, in 2/5 (40%) of the HPV 6, in 2/4 (50%) of the HPV 11, and in 3/3 of HPV 18 lesions. The intensity of the staining was weak in the HPV 6 and HPV 11 lesions, whereas it was classified as intense in 21/29 (72%) of the E6-positive HPV 16 lesions. Negative staining was almost invariably (5/6, 83%) confined to HPV-non-cervical intraepithelial neoplasia (HPV-NCIN) lesions, only 5/18 (27%) of which showed an intense staining. In contrast, intense staining was associated with CIN; 11/12 (92%) in HPV-CIN I and 8/11 (73%) in HPV-CIN II lesions. In the HPV 16 group, intense reactivity was more frequent in lesions shown to make clinical progression (8/9, 89%) as compared with those which underwent spontaneous regression (10/15, 66.7%). Topography of the immunostaining paralleled the localization of HPV DNA hybridization signals in 20/21 (95%) evaluable HPV 16 cases, in contrast to only 1/3 in HPV 18 cases and in none of the HPV 6 and HPV 11 lesions. These differences between HPV 16 and HPV 6/11 lesions in the staining with the HPV 16 E6 protein antibody might help explain at least some of the differences in their known biological behaviour.", "provenance": [ { "field": "population", "quote": "a series of 41 paraffin-embedded biopsies including 29 cases of HPV 16-associated cervical lesions, five HPV 6, four HPV 11, and three HPV 18-associated genital warts" }, { "field": "intervention", "quote": "The antibodies obtained were used for the immunohistochemical analysis" }, { "field": "comparator", "quote": "2/5 (40%) of the HPV 6, in 2/4 (50%) of the HPV 11, and in 3/3 of HPV 18 lesions" }, { "field": "primaryOutcome", "quote": "Expression of a reacting molecule (both intranuclear and cytoplasmic) could be demonstrated" }, { "field": "result", "quote": "In the HPV 16 group, intense reactivity was more frequent in lesions shown to make clinical progression (8/9, 89%) as compared with those which underwent spontaneous regression (10/15, 66.7%)" }, { "field": "n", "quote": "a series of 41 paraffin-embedded biopsies" } ] }, { "id": "pmid:1543764", "pmid": "1543764", "doi": "10.1177/095646249200300107", "nctId": null, "pmcid": null, "title": "Ten year follow-up study of women presenting to a genitourinary medicine clinic with anogenital warts", "firstAuthor": "Handley", "multipleAuthors": true, "journal": "Int J STD AIDS", "year": 1992, "design": "retrospective", "n": 100, "nField": "reported", "population": "women who had anogenital warts in 1979, followed up 10 years later", "intervention": "cervical treatment for CIN (laser ablation and/or cone biopsy)", "comparator": "no cervical treatment for CIN", "primaryOutcome": "presence of cervical intraepithelial neoplasia (CIN) at 10-year follow-up, and persistence of anogenital warts", "result": "At 10 years, 4 of 100 women still had anogenital warts; CIN was found in 36.8% of women who had cervical treatment versus 43.2% of those who had none, a difference that was not statistically significant", "resultDirection": "no-benefit", "quality": "low", "qualityWhy": "This was a small, non-randomized retrospective follow-up comparing treated and untreated subgroups, not a controlled trial.", "directness": "indirect", "limitations": "Retrospective design, no randomization, small treated subgroup (19 women), and loss-to-follow-up details not given.", "followUp": "10 years", "plainFinding": "Most warts resolved by 10 years", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/1543764/", "sourceText": "One hundred heterosexual women presenting at our clinic in 1979 with anogenital warts, were reviewed 10 years later. Median duration of warts following initial clinic attendance was 2 months (range 0-120 months). In 1979 cervical PAP smear results were available for 76 patients; cervical intraepithelial neoplasia (CIN) was seen in 15/76 (19.7%) women; 3 (4%) women had low grade CIN, 12 (15.7%) women had high grade CIN. Nineteen women had had treatment for CIN between 1979 and 1989, 7 laser ablation, 9 cone biopsy, 2 laser ablation and cone biopsy, and one woman laser ablation, cauterization and cone biopsy. At 10-year follow-up in 1989 4/100 women had anogenital warts, 12/100 women had cytological evidence of CIN (7 low grade, 5 high grade), and 37/100 women had CIN detected on colposcopic biopsy (31 low grade, 6 high grade). No women developed invasive cervical carcinoma during the study period. CIN lesions, detected in 1979, regressed without any treatment in 2 women. Colposcopic biopsy was 3.1 times more sensitive than single cervical PAP smear at detecting CIN (4.4 times as sensitive in detecting low grade CIN; 1.2 times as sensitive in detecting high grade CIN). In 1989 CIN was detected in 7/19 (36.8%) of women who had undergone cervical treatment between 1979 and 1989, and in 35/81 (43.2%) of women having no cervical treatment within this period (chi squared P greater than 0.5). These findings suggest that cervical laser ablative therapy and cone biopsy do not in the long term influence the natural history of cervical human papilloma virus-associated disease (CIN) in women with anogenital warts.(ABSTRACT TRUNCATED AT 250 WORDS)", "provenance": [ { "field": "n", "quote": "One hundred heterosexual women presenting at our clinic in 1979 with anogenital warts, were reviewed 10 years later." }, { "field": "population", "quote": "One hundred heterosexual women presenting at our clinic in 1979 with anogenital warts, were reviewed 10 years later." }, { "field": "intervention", "quote": "7 laser ablation, 9 cone biopsy, 2 laser ablation and cone biopsy, and one woman laser ablation, cauterization and cone biopsy" }, { "field": "comparator", "quote": "35/81 (43.2%) of women having no cervical treatment within this period" }, { "field": "primaryOutcome", "quote": "In 1989 CIN was detected in 7/19 (36.8%) of women who had undergone cervical treatment between 1979 and 1989, and in 35/81 (43.2%) of women having no cervical treatment within this period" }, { "field": "result", "quote": "At 10-year follow-up in 1989 4/100 women had anogenital warts" }, { "field": "result", "quote": "(chi squared P greater than 0.5)" }, { "field": "followUp", "quote": "reviewed 10 years later" } ] }, { "id": "pmid:1647903", "pmid": "1647903", "doi": null, "nctId": null, "pmcid": null, "title": "Clinical manifestations and natural history of genital human papillomavirus infection", "firstAuthor": "Campion", "multipleAuthors": false, "journal": "Dermatol Clin", "year": 1991, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with genital HPV types", "intervention": "", "comparator": "", "primaryOutcome": "the clinical profile of disease associated with genital HPV types", "result": "not stated; the abstract only discusses the broader scope of research into HPV biology and clinical spectrum, with no specific findings on wart resolution", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a general narrative review that only discusses the scope of HPV research without reporting any study data or outcomes.", "directness": "indirect", "limitations": "The abstract provides no methods, no patient outcomes, and no information about whether anal warts resolve without treatment.", "followUp": "", "plainFinding": "No specific finding reported.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/1647903/", "sourceText": "Over the past decade, the ever-increasing volume of evidence implicating HPV types in genital neoplasia has stimulated much research interest into all aspects of the biology of this interesting group of viruses. This has led to the identification of an ever-increasing heterogeneity of HPV types. It is not surprising, therefore, that the clinical profile of disease associated with genital HPV types is much broader than previously recognized. Knowledge of this clinical spectrum is mandatory to the understanding of the possible role of specific HPV types in human carcinogenesis.", "provenance": [ { "field": "population", "quote": "disease associated with genital HPV types" }, { "field": "primaryOutcome", "quote": "the clinical profile of disease associated with genital HPV types is much broader than previously recognized" }, { "field": "result", "quote": "It is not surprising, therefore, that the clinical profile of disease associated with genital HPV types is much broader than previously recognized." } ] }, { "id": "pmid:1647900", "pmid": "1647900", "doi": null, "nctId": null, "pmcid": null, "title": "Tissue effects of and host response to human papillomavirus infection", "firstAuthor": "Jenson", "multipleAuthors": true, "journal": "Dermatol Clin", "year": 1991, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with HPV infections causing warts or condylomata", "intervention": "no specific treatment (natural course of infection)", "comparator": "treated lesions or immune response variation", "primaryOutcome": "whether warts/condylomata go away on their own", "result": "regression of warts depends on the body's immune response to HPV", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this is a general review of virology and immunology, not a study measuring how often warts clear on their own", "directness": "indirect", "limitations": "abstract does not report a specific study, patient numbers, or follow-up time; discusses general immunologic mechanisms rather than clinical outcomes", "followUp": "", "plainFinding": "Immune response may clear warts.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/1647900/", "sourceText": "Human papillomaviruses are a heterogeneous group of DNA tumor viruses associated with hyperplastic (warts, condylomata), dysplastic (CIN and VIN), and malignant lesions (carcinomas) of squamous epithelium. Each HPV type is preferentially associated with specific clinical lesions and has an anatomic site preference for either cutaneous or mucosal squamous epithelium. Infection appears to begin in the basal cells. Early gene expression is associated with acanthosis, and late gene expression is associated with appearance of structural antigens and virions in nuclei of cells of the granular layer, usually koilocytotic cells. Malignant transformation of warts and papillomas appears to be related to a variety of factors: (1) infection by certain HPV types (HPV-5, HPV-8, HPV-16, HPV-18, HPV-31); (2) decreased cellular immunity to HPV-associated antigens; and (3) interaction with cofactors such as other microorganisms or sunlight. Spontaneous regression or successful treatment of the benign lesions appears to depend on either naturally acquired or iatrogenically related stimulation of HPV type-specific immunity. The humoral antibody response to HPV particles may be important in preventing infection. In contrast, the local events surrounding regression of warts and condylomata are primarily associated with specific cell-mediated immunity. Local cell-mediated immune responses, particularly cell-associated soluble mediators and stationary macrophage-like cells, may be especially important in the host's immune response to mucosal infections.", "provenance": [ { "field": "population", "quote": "benign lesions" }, { "field": "intervention", "quote": "Spontaneous regression or successful treatment of the benign lesions appears to depend on either naturally acquired or iatrogenically related stimulation of HPV type-specific immunity." }, { "field": "comparator", "quote": "successful treatment of the benign lesions" }, { "field": "primaryOutcome", "quote": "Spontaneous regression or successful treatment of the benign lesions" }, { "field": "result", "quote": "Spontaneous regression or successful treatment of the benign lesions appears to depend on either naturally acquired or iatrogenically related stimulation of HPV type-specific immunity." } ] }, { "id": "pmid:1885888", "pmid": "1885888", "doi": null, "nctId": null, "pmcid": null, "title": "[Spontaneous regression of flat condylomata of the cervix]", "firstAuthor": "Courtial", "multipleAuthors": true, "journal": "J Gynecol Obstet Biol Reprod (Paris)", "year": 1991, "design": "prospective-cohort", "n": 146, "nField": "reported", "population": "women with HPV infection of the cervix found on a smear test, mostly with mild cervical cell changes (CIN 1)", "intervention": "no treatment, just advice to use condoms", "comparator": "no comparator, natural course observed over time", "primaryOutcome": "whether the smear test became negative (infection cleared) over time", "result": "among women with CIN 1, 65.2% had a negative smear within 18 months without treatment", "resultDirection": "benefit", "quality": "low", "qualityWhy": "this is an uncontrolled observational study of cervical HPV changes, not anal warts, with no comparison group and no randomization.", "directness": "indirect", "limitations": "no control group, patients came from outpatient clinics and may differ from hospital-referred patients, and findings concern cervical not anal lesions", "followUp": "18 months", "plainFinding": "Most cervical HPV changes cleared untreated.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/1885888/", "sourceText": "In this study 146 patients with a human papilloma virus infection of the cervix detected on cervical smear. This infection was at the worst associated with CIN 1 or CIN 2. No treatment was carried out on these patients except for advising the use of condoms. Among the 123 women whose diagnosis was CIN 1, 65.2% of them had a negative smear within 18 months. This somewhat high rate of spontaneous regression was found in out patients who were not selected. They are near the results published by Brown in a similar study. The statistics drawn from hospital patients give lower regression rates; but these patients were selected by their doctors because they did not show regression on subsequent smears. It is therefore recommended that these patients should be assessed colposcopically and there should be a wait of 6-12 months before treating patients with CIN 1.", "provenance": [ { "field": "n", "quote": "146 patients with a human papilloma virus infection of the cervix detected on cervical smear" }, { "field": "population", "quote": "146 patients with a human papilloma virus infection of the cervix detected on cervical smear" }, { "field": "intervention", "quote": "No treatment was carried out on these patients except for advising the use of condoms." }, { "field": "comparator", "quote": "No treatment was carried out on these patients except for advising the use of condoms." }, { "field": "primaryOutcome", "quote": "65.2% of them had a negative smear within 18 months" }, { "field": "result", "quote": "Among the 123 women whose diagnosis was CIN 1, 65.2% of them had a negative smear within 18 months." } ] }, { "id": "pmid:1966312", "pmid": "1966312", "doi": null, "nctId": null, "pmcid": null, "title": "Cryotherapy in the management of histologically diagnosed subclinical human papilloma virus (HPV) infection of the cervix", "firstAuthor": "Mohanty", "multipleAuthors": true, "journal": "Br J Clin Pract", "year": 1990, "design": "prospective-cohort", "n": 63, "nField": "reported", "population": "women with genital warts who had subclinical HPV infection of the cervix", "intervention": "cryotherapy treatment of subclinical cervical HPV", "comparator": "untreated patients with subclinical cervical HPV infection", "primaryOutcome": "development of clinical cervical warts after treatment", "result": "cryotherapy reduced the rate of developing visible cervical warts compared to no treatment", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a non-randomized comparison of treated versus untreated patients with small subgroup numbers, not a controlled trial of natural resolution.", "directness": "indirect", "limitations": "Not randomized; compares cryotherapy treatment to an untreated group rather than studying natural resolution of anal warts specifically.", "followUp": "18 months", "plainFinding": "Cryotherapy reduced wart recurrence.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/1966312/", "sourceText": "The aim of the study was to establish the efficacy of cryotherapy in the management of histologically diagnosed subclinical human papilloma virus (HPV) infection of the cervix. Women with genital warts who had subclinical HPV infection of the cervix and no other sexually transmitted diseases were followed up at six weeks, 12 weeks, six months, 12 months and 18 months after treatment with cryotherapy. They came to the out-patient department of genito-urinary medicine (GUM) at St Luke's Hospital, an open clinic without any appointment system. Two hundred and fifty-five patients with genital warts took part in the study. They underwent clinical genital examination, along with cytology, colposcopy and colposcopically directed cervical punch biopsies. Sixty-three of them had subclinical HPV infection of the cervix only, and were considered suitable for cryosurgery. Twelve weeks after treatment only one patient developed clinical warts on the cervix, which increased to three patients (4.8%) after 12 months. No further patients developed any clinical cervical warts. In the untreated group development of clinical warts was noticed in five patients (20%) after 18 months. The difference was significant. The failure rate for the histologically diagnosed subclinical HPV infection was 38% in the treated group, whereas it persisted in 76% of the untreated group. Cryotherapy was found to be successful in the treatment of subclinical HPV infection and prevented the development of clinical disease. There were no serious side-effects and the treatment can be administered easily in an out-patient setting after histological confirmation.", "provenance": [ { "field": "population", "quote": "Women with genital warts who had subclinical HPV infection of the cervix and no other sexually transmitted diseases" }, { "field": "intervention", "quote": "treatment with cryotherapy" }, { "field": "comparator", "quote": "In the untreated group development of clinical warts was noticed in five patients (20%) after 18 months." }, { "field": "primaryOutcome", "quote": "Twelve weeks after treatment only one patient developed clinical warts on the cervix, which increased to three patients (4.8%) after 12 months." }, { "field": "result", "quote": "The failure rate for the histologically diagnosed subclinical HPV infection was 38% in the treated group, whereas it persisted in 76% of the untreated group." }, { "field": "n", "quote": "Sixty-three of them had subclinical HPV infection of the cervix only, and were considered suitable for cryosurgery." } ] }, { "id": "pmid:2177486", "pmid": "2177486", "doi": null, "nctId": null, "pmcid": null, "title": "[Human papillomavirus infections of the cervix uteri. Clinical implications, indications of typing]", "firstAuthor": "Laval", "multipleAuthors": true, "journal": "J Gynecol Obstet Biol Reprod (Paris)", "year": 1990, "design": "prospective-cohort", "n": 224, "nField": "reported", "population": "women with HPV infection of the cervix", "intervention": "no treatment, just follow-up observation of HPV infection/lesions", "comparator": "treatment of cervical lesions when needed", "primaryOutcome": "whether HPV infection and cervical lesions went away over time", "result": "HPV infection and even some abnormal cervical cell changes disappeared on their own without treatment in many patients", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This is an observational study of a different body site (cervix, not anus) with no control group formally comparing treatment versus no treatment.", "directness": "indirect", "limitations": "Observational cohort without a formal untreated control group; abstract is truncated and gives no clear follow-up duration per patient.", "followUp": "", "plainFinding": "Cervical HPV lesions often cleared on their own", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/2177486/", "sourceText": "Recently, intense interest has focused on the relation between HPV infection and precancerous and cancerous lesions of the uterine cervix, as witnessed by the numerous publications on the subject. We carried out a prospective anatomo-clinical study on 224 HPV positive women followed in the Rene Huguenin Centre, from April 1984 to December 1988. Among these patients, cytology, colposcopy and biopsy were performed, when necessary, concurrently with the detection of HPV on cervical smears using a molecular hybridization method (G. ORTH). This study analysed the anatomo-clinical results and suggested the practical implications, taking into account the progress of the patients. These patients were followed up and treated when necessary for cervical intra-epithelial neoplasia (CIN) or carcinoma, associated or not with HPVs (oncogene in 70% of cases). 24% of this population was infected by an HPV, without any lesion. This virus disappeared spontaneously during follow-up; therefore, HPV infection even oncogene, did not necessarily carry onto CIN. Among CIN 1-2, associated or not with HPV, adequate treatment cured the patients with the virus disappearing. In some cases, a simple follow-up showed a spontaneous resolution of the lesion and of the virus. CIN 3 was removed when necessary with systematic pathological examination of the endocervix and of the surgical sample limits. In a few cases, the virus persisted without lesion. HPV infection did not modify our protocol for invasive carcinoma.(ABSTRACT TRUNCATED AT 250 WORDS)", "provenance": [ { "field": "n", "quote": "We carried out a prospective anatomo-clinical study on 224 HPV positive women followed in the Rene Huguenin Centre, from April 1984 to December 1988." }, { "field": "population", "quote": "224 HPV positive women followed in the Rene Huguenin Centre" }, { "field": "intervention", "quote": "In some cases, a simple follow-up showed a spontaneous resolution of the lesion and of the virus." }, { "field": "comparator", "quote": "These patients were followed up and treated when necessary for cervical intra-epithelial neoplasia (CIN) or carcinoma" }, { "field": "primaryOutcome", "quote": "This virus disappeared spontaneously during follow-up; therefore, HPV infection even oncogene, did not necessarily carry onto CIN." }, { "field": "result", "quote": "In some cases, a simple follow-up showed a spontaneous resolution of the lesion and of the virus." } ] }, { "id": "pmid:2761917", "pmid": "2761917", "doi": null, "nctId": null, "pmcid": null, "title": "Randomized clinical trial comparing systemic interferon with diathermocoagulation in primary multiple and widespread anogenital condyloma", "firstAuthor": "Benedetti Panici", "multipleAuthors": true, "journal": "Obstet Gynecol", "year": 1989, "design": "rct", "n": 203, "nField": "reported", "population": "patients with untreated multiple and widespread genital/anal warts", "intervention": "systemic interferon alpha-2b (two dosing schedules)", "comparator": "diathermocoagulation (heat/cautery treatment) or no treatment (control)", "primaryOutcome": "complete or partial clearance of warts after 6 months", "result": "8% of untreated control patients cleared warts, versus 70% overall response with active treatments", "resultDirection": "no-benefit", "quality": "moderate", "qualityWhy": "it was a randomized trial with a no-treatment control group, but it was not designed primarily to study natural resolution and had small subgroup numbers.", "directness": "direct", "limitations": "abstract text is truncated and focuses mainly on comparing interferon versus cauterization rather than detailing the untreated group's outcomes", "followUp": "6 months", "plainFinding": "Rarely clear up untreated.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/2761917/", "sourceText": "Two hundred three patients (median age 26 years; range 18-45) with untreated multiple and widespread anogenital condyloma were randomly assigned to one of four study arms in order to compare the efficacy, toxicity, and tolerability of recombinant interferon alpha-2b with those of diathermocoagulation. Of 200 evaluable patients, 51 were treated intramuscularly (IM) with 3 x 10(6) U (3 MU)/m2 daily for 3 weeks (total dose 63 MU/m2), 50 received subcutaneous thrice-weekly injections of 3 MU/m2 for 4 weeks (total dose 36 MU/m2), 51 underwent diathermocoagulation, and 48 were not treated and were used as a control group. Six months after the end of treatment, the overall response rate (complete and partial responses) was 70%: 57 and 82% for patients receiving interferon alpha-2b (IM and subcutaneously) and diathermocoagulation, respectively, and 8% for the control group. After 6 months from therapy, no significant differences in complete response were found among the different types of treatment: 20, 20, and 35% for the two interferon groups and the diathermocoagulation group, respectively. Fifteen and two complete responders in the cauterization and interferon groups, respectively, experienced disease recurrence (P less than .01). All patients given interferon therapy complained of flu-like symptoms, which declined progressively after the first week of treatment. Fatigue, lasting as long as patients received interferon, was the most prevalent chronic side effect. We conclude that systemic recombinant interferon alpha-2b is active in treating patients with primary condyloma lesions and does so as well as cauterization.(ABSTRACT TRUNCATED AT 250 WORDS)", "provenance": [ { "field": "population", "quote": "patients (median age 26 years; range 18-45) with untreated multiple and widespread anogenital condyloma" }, { "field": "intervention", "quote": "recombinant interferon alpha-2b" }, { "field": "comparator", "quote": "diathermocoagulation" }, { "field": "comparator", "quote": "48 were not treated and were used as a control group" }, { "field": "primaryOutcome", "quote": "the overall response rate (complete and partial responses) was 70%" }, { "field": "result", "quote": "8% for the control group" }, { "field": "n", "quote": "Two hundred three patients" } ] }, { "id": "pmid:3400301", "pmid": "3400301", "doi": null, "nctId": null, "pmcid": null, "title": "[Condylomata acuminata and mode of delivery]", "firstAuthor": "Lehnen", "multipleAuthors": false, "journal": "Z Geburtshilfe Perinatol", "year": 1988, "design": "case-series", "n": 3, "nField": "reported", "population": "pregnant women with severe genital condylomata acuminata (anal/genital warts)", "intervention": "cesarean section delivery (no treatment of warts)", "comparator": "none (natural course after delivery)", "primaryOutcome": "regression of genital warts after delivery", "result": "all three patients had spontaneous regression of warts eight weeks after delivery", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is a tiny case series of only three patients with no control group, so it cannot reliably show what happens generally.", "directness": "indirect", "limitations": "Only three cases, no comparison group, and delivery was by cesarean section rather than observing untreated natural progression.", "followUp": "8 weeks", "plainFinding": "Warts went away after delivery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/3400301/", "sourceText": "Condyloma acuminatum is a widespread infectious disease which can be sexually transmitted. The virus responsible for this condition belongs to the family Papovaviridae. At onset of the disease small wart-shaped papules are found, which multiply to form a cauliflower-like or cockscomb-like mass. The present paper describes three caes in which cesarean section was performed because of severe genital invasion by condylomata acuminata. Eight weeks after delivery, there was a spontaneous regression of the condition in all three patients. So far no indication of a papillomavirus infection has been seen in any of the three female children at regular pediatric check-ups. Three additional therapeutic possibilities during pregnancy are described: electrocauterization, CO2 laser therapy, and cryotherapy. The efficacy of these types of therapy is discussed with reference to the literature. The goal of therapy is to prevent the newborn from contracting the disease by infection with papillomavirus in the birth canal.", "provenance": [ { "field": "n", "quote": "The present paper describes three caes in which cesarean section was performed because of severe genital invasion by condylomata acuminata." }, { "field": "population", "quote": "three caes in which cesarean section was performed because of severe genital invasion by condylomata acuminata" }, { "field": "intervention", "quote": "cesarean section was performed because of severe genital invasion by condylomata acuminata" }, { "field": "comparator", "quote": "Eight weeks after delivery, there was a spontaneous regression of the condition in all three patients." }, { "field": "primaryOutcome", "quote": "there was a spontaneous regression of the condition in all three patients" }, { "field": "result", "quote": "Eight weeks after delivery, there was a spontaneous regression of the condition in all three patients." } ] }, { "id": "pmid:3323965", "pmid": "3323965", "doi": null, "nctId": null, "pmcid": null, "title": "The use of topical 5-fluorouracil in the treatment of genital condylomas", "firstAuthor": "Krebs", "multipleAuthors": false, "journal": "Obstet Gynecol Clin North Am", "year": 1987, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with genital warts (vulvar and vaginal condylomas), including cases resistant to other treatments", "intervention": "topical 5-fluorouracil (5-FU) applied to vagina or vulva", "comparator": "continued (more frequent) 5-FU application regimens", "primaryOutcome": "effectiveness of treating condylomas and preventing recurrence after removal", "result": "once/twice weekly 5-FU for 10 weeks was as effective as continued regimens but better tolerated, and periodic use helped prevent recurrence after surgical removal", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "this is a narrative review discussing treatment opinions without reporting patient numbers or study data, so it carries little evidential weight.", "directness": "indirect", "limitations": "No sample size, no study design details, no data on untreated or spontaneous resolution of warts are reported.", "followUp": "", "plainFinding": "Addresses 5-FU treatment, not spontaneous resolution.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/3323965/", "sourceText": "Topical 5-FU is indicated for therapy-resistant condylomas and for extensive untreated vulvar condylomas. It may be the treatment of choice for vaginal condylomas. Applications of 5-FU once weekly to the vagina and twice weekly to the vulva for 10 weeks appear to be as effective as continued regimens but are better tolerated. Perhaps the greatest value of 5-FU lies in the periodic application for prevention of recurrences of condylomas removed by surgical methods.", "provenance": [ { "field": "population", "quote": "extensive untreated vulvar condylomas" }, { "field": "population", "quote": "therapy-resistant condylomas" }, { "field": "intervention", "quote": "Topical 5-FU is indicated for therapy-resistant condylomas" }, { "field": "intervention", "quote": "Applications of 5-FU once weekly to the vagina and twice weekly to the vulva for 10 weeks" }, { "field": "comparator", "quote": "appear to be as effective as continued regimens but are better tolerated" }, { "field": "primaryOutcome", "quote": "periodic application for prevention of recurrences of condylomas removed by surgical methods" }, { "field": "result", "quote": "Applications of 5-FU once weekly to the vagina and twice weekly to the vulva for 10 weeks appear to be as effective as continued regimens but are better tolerated." }, { "field": "result", "quote": "Perhaps the greatest value of 5-FU lies in the periodic application for prevention of recurrences of condylomas removed by surgical methods." } ] }, { "id": "pmid:2435427", "pmid": "2435427", "doi": "10.1007/BF00046428", "nctId": null, "pmcid": null, "title": "Interferons in the treatment of human papillomavirus diseases", "firstAuthor": "Weck", "multipleAuthors": true, "journal": "Cancer Metastasis Rev", "year": 1986, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with HPV-related warty diseases, including genital warts", "intervention": "interferon treatment", "comparator": "", "primaryOutcome": "regression of warts", "result": "Interferons caused objective regression of warts but had side effects; no data on natural resolution without treatment", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a narrative review discussing interferon treatment, not a study of untreated warts, so it gives no evidence on spontaneous resolution.", "directness": "indirect", "limitations": "Abstract is a general review of interferon therapy, not a controlled study, and does not address whether warts resolve without treatment.", "followUp": "", "plainFinding": "Doesn't address spontaneous clearance.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/2435427/", "sourceText": "A variety of epithelioproliferative benign neoplasms, both trivial and life-threatening, are caused by subtypes of human papillomaviruses. Interferons objectively regress HPV-induced warty disease and affect the regrowth of the transformed epithelium. Interferons effectively control the most serious and potentially life-threatening papillomavirus associated diseases, respiratory papillomatosis and genital warts, but not without the anticipated side effects associated with this potent biological weapon. It is entirely possible and even likely that individual species of interferons act preferentially on certain cells, tissues or organs in response to particular viruses. Combined therapies, such as surgery in combination with interferon, or podophyllin in conjunction with interferon alfa-n1, may prove most efficacious.", "provenance": [ { "field": "population", "quote": "epithelioproliferative benign neoplasms, both trivial and life-threatening, are caused by subtypes of human papillomaviruses" }, { "field": "intervention", "quote": "Interferons objectively regress HPV-induced warty disease" }, { "field": "primaryOutcome", "quote": "Interferons objectively regress HPV-induced warty disease and affect the regrowth of the transformed epithelium" }, { "field": "result", "quote": "Interferons effectively control the most serious and potentially life-threatening papillomavirus associated diseases, respiratory papillomatosis and genital warts, but not without the anticipated side effects associated with this potent biological weapon." } ] }, { "id": "pmid:3838788", "pmid": "3838788", "doi": "10.1002/lsm.1900050208", "nctId": null, "pmcid": null, "title": "The use of the Nd:YAG laser in urology", "firstAuthor": "Stein", "multipleAuthors": true, "journal": "Lasers Surg Med", "year": 1985, "design": "case-series", "n": 7, "nField": "reported", "population": "patients with genital warts (condylomata acuminata) treated urologically", "intervention": "Nd:YAG laser therapy", "comparator": "none reported", "primaryOutcome": "treatment success and complications", "result": "all patients had excellent results without complication", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is a tiny, uncontrolled case series of only seven wart patients with no comparison group and no mention of spontaneous resolution.", "directness": "indirect", "limitations": "No control group, very small number of wart patients, no follow-up duration given, and the study does not address whether warts resolve without treatment.", "followUp": "", "plainFinding": "Laser cleared warts; no untreated comparison.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/3838788/", "sourceText": "The use of the neodymium:YAG(Nd:YAG) laser in urology in still in its infancy. To date, the most widely published application of this laser is in the treatment of bladder carcinoma. We have utilized the Nd:YAG laser in 23 treatments for superficial bladder tumors. The laser has both advantages and shortcomings, which are thoroughly addressed. In our hands the laser has been a safe instrument for the treatment of these lesions, although we do not recommend its use for tumors greater than 3 cm. We have treated two patients with invasive disease one week prior to planned cystectomy. In one case, no residual tumor was found at cystectomy, while the second patient had viable tumor only in an untreated area. Two patients were successfully treated with the laser for intractable bladder bleeding, one each with primary and secondary bladder tumor. Seven patients with condylomata acuminata were treated with laser therapy. All had excellent results without complication. One patient with urethral bleeding secondary to trauma was treated without success, while one patient with a urethral hemangioma was well treated with the Nd:YAG laser. Thus the Nd:YAG laser would appear to have a place in the urologic armamentarium, but whether it is cost-effective for widespread use remains to be seen.", "provenance": [ { "field": "n", "quote": "Seven patients with condylomata acuminata were treated with laser therapy." }, { "field": "population", "quote": "Seven patients with condylomata acuminata were treated with laser therapy." }, { "field": "intervention", "quote": "Seven patients with condylomata acuminata were treated with laser therapy." }, { "field": "comparator", "quote": "Seven patients with condylomata acuminata were treated with laser therapy." }, { "field": "primaryOutcome", "quote": "All had excellent results without complication." }, { "field": "result", "quote": "All had excellent results without complication." } ] }, { "id": "pmid:6481701", "pmid": "6481701", "doi": null, "nctId": null, "pmcid": null, "title": "Association of Fanconi's anemia and squamous-cell carcinoma of the lower female genital tract with condyloma acuminatum. A report of two cases", "firstAuthor": "Wilkinson", "multipleAuthors": true, "journal": "J Reprod Med", "year": 1984, "design": "case-series", "n": 2, "nField": "reported", "population": "two young women with Fanconi's anemia and genital HPV infection", "intervention": "no treatment intervention studied — natural history observation", "comparator": "none reported", "primaryOutcome": "development of genital squamous-cell carcinoma following condyloma acuminatum", "result": "both women developed multicentric genital cancer after having condyloma acuminatum, and one died of vaginal cancer", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "Only two case reports in women with a rare genetic disorder, so it says nothing reliable about whether warts resolve on their own in typical patients.", "directness": "indirect", "limitations": "Only two cases, both with Fanconi's anemia, a rare condition that may not reflect typical patients with anal/genital warts; abstract does not address spontaneous resolution at all.", "followUp": "", "plainFinding": "Warts linked to cancer, not resolution", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/6481701/", "sourceText": "Two young women had Fanconi's anemia and genital human papillomavirus infection associated with multicentric genital neoplasia. One of these women represented the first documented case of death from vaginal squamous carcinoma associated with Fanconi's anemia. In these two women an apparent biologic compression of the natural history of vulvar and vaginal carcinoma was observed. The finding of condyloma acuminatum in both of them prior to the onset of carcinoma suggests a partial causal association. Involvement of the cervix, vagina, vulva and perianal epithelium by the oncogenic process implies that a field effect occurred in those areas.", "provenance": [ { "field": "n", "quote": "Two young women had Fanconi's anemia and genital human papillomavirus infection associated with multicentric genital neoplasia." }, { "field": "population", "quote": "Two young women had Fanconi's anemia and genital human papillomavirus infection associated with multicentric genital neoplasia." }, { "field": "primaryOutcome", "quote": "The finding of condyloma acuminatum in both of them prior to the onset of carcinoma suggests a partial causal association." }, { "field": "result", "quote": "One of these women represented the first documented case of death from vaginal squamous carcinoma associated with Fanconi's anemia." }, { "field": "intervention", "quote": "The finding of condyloma acuminatum in both of them prior to the onset of carcinoma suggests a partial causal association." }, { "field": "comparator", "quote": "Involvement of the cervix, vagina, vulva and perianal epithelium by the oncogenic process implies that a field effect occurred in those areas." } ] }, { "id": "pmid:6297292", "pmid": "6297292", "doi": "10.1093/ajcp/79.2.178", "nctId": null, "pmcid": null, "title": "Isoantigen status in condyloma acuminata of the uterine cervix: an immunoperoxidase study", "firstAuthor": "Mambo", "multipleAuthors": false, "journal": "Am J Clin Pathol", "year": 1983, "design": "lab", "n": null, "nField": "not-reported", "population": "women with genital warts (condyloma acuminata) of the cervix", "intervention": "testing cervical wart tissue for blood isoantigen status using immunoperoxidase technique", "comparator": "no comparator group; different degrees of isoantigen loss within same sample", "primaryOutcome": "whether wart cells showed loss of blood group isoantigens", "result": "Most warts showed some or complete loss of isoantigens, which the authors link to cancer risk, not regression", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a small lab study on cervical tissue that speculates about regression rather than actually measuring whether warts went away.", "directness": "indirect", "limitations": "Studies cervical warts, not anal warts; does not actually follow patients to see if warts regressed; number of specimens not stated; conclusions about regression are speculative.", "followUp": "", "plainFinding": "Did not actually study wart regression.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/6297292/", "sourceText": "The immunoperoxidase technic was used to investigate the blood isoantigen status in condyloma acuminata, which is regarded as being caused by the human papillomavirus (HPV). Since HPV is associated with epithelial atypias and intra-epithelial neoplasia, and since epithelial malignant transformation is associated with isoantigen loss, the purpose of the study was to determine if koilocytotic atypias are associated with isoantigen loss. Complete isoantigen loss was seen in 33% of cases, partial loss in 47%, and retention in 20%. The significance of this study lies in being able to recognize those lesions that may be associated with malignant transformation (80%) as indicated by isoantigen loss. Isoantigen retention may identify those epithelial atypias that undergo spontaneous regression. Long range follow-up of such patients will help further elucidate the role of HPV in neoplastic transformation of condylomatous lesions. The immunoperoxidase technic can be used in retrospective studies of condylomata of the cervix.", "provenance": [ { "field": "population", "quote": "blood isoantigen status in condyloma acuminata" }, { "field": "intervention", "quote": "The immunoperoxidase technic was used to investigate the blood isoantigen status in condyloma acuminata" }, { "field": "comparator", "quote": "Complete isoantigen loss was seen in 33% of cases, partial loss in 47%, and retention in 20%." }, { "field": "primaryOutcome", "quote": "the purpose of the study was to determine if koilocytotic atypias are associated with isoantigen loss" }, { "field": "result", "quote": "Complete isoantigen loss was seen in 33% of cases, partial loss in 47%, and retention in 20%." }, { "field": "result", "quote": "Isoantigen retention may identify those epithelial atypias that undergo spontaneous regression." } ] }, { "id": "pmid:526848", "pmid": "526848", "doi": "10.1136/sti.55.6.442", "nctId": null, "pmcid": "PMC1045706", "title": "Effect of injections of small doses of human fibroblast interferon into genital warts. A pilot study", "firstAuthor": "Scott", "multipleAuthors": true, "journal": "Br J Vener Dis", "year": 1979, "design": "case-series", "n": 11, "nField": "reported", "population": "male patients with genital warts", "intervention": "interferon injected into the base of a wart", "comparator": "placebo injected into the base of another wart", "primaryOutcome": "change in size of the treated warts compared with controls", "result": "interferon-treated warts grew less than placebo-treated ones, and in one patient a treated wart disappeared while an untreated wart grew", "resultDirection": "mixed", "quality": "very-low", "qualityWhy": "Only 11 patients, no clear randomization, and warts still received an injection rather than being left completely untreated, so it can't show what happens with no treatment at all.", "directness": "indirect", "limitations": "The dose given was probably insufficient for a dramatic effect, and this is a small pilot study using genital (not specifically anal) warts with injections in both arms rather than a true untreated comparison.", "followUp": "two weeks", "plainFinding": "Interferon slightly slowed wart growth versus placebo.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/526848/", "sourceText": "Eleven male patients with genital warts were given injections of fibroblast interferon (300 u) and placebo into the bases of two similar warts. The changes in size of the treated warts compared with that of the controls suggested that interferon did inhibit the growth of the warts. The dose given was probably insufficient for a dramatic effect. In one patient, however, a wart on the penile shaft was injected with interferon and did disappear within two weeks whereas an untreated meatal wart increased in size.", "provenance": [ { "field": "population", "quote": "Eleven male patients with genital warts" }, { "field": "intervention", "quote": "were given injections of fibroblast interferon (300 u) and placebo into the bases of two similar warts" }, { "field": "comparator", "quote": "placebo into the bases of two similar warts" }, { "field": "primaryOutcome", "quote": "The changes in size of the treated warts compared with that of the controls" }, { "field": "result", "quote": "suggested that interferon did inhibit the growth of the warts" }, { "field": "result", "quote": "a wart on the penile shaft was injected with interferon and did disappear within two weeks whereas an untreated meatal wart increased in size" }, { "field": "n", "quote": "Eleven male patients" }, { "field": "followUp", "quote": "did disappear within two weeks" } ] } ], "faqs": [ { "q": "Do anal warts go away?", "a": "Sometimes, but in the one randomised trial that tracked an untreated group, only 8% cleared within six months. Most people in that study still had warts without treatment." }, { "q": "Do anal warts go away without treatment?", "a": "Not reliably, based on the best available trial. Only a small share of untreated participants cleared their warts in six months, while most people who received treatment cleared theirs." }, { "q": "Are anal warts always caused by HPV, and can they go away on their own?", "a": "Yes, anal warts are caused by HPV, usually types 6 or 11. A small number of cases clear on their own within months in trial data, though lower-quality studies suggest clearance over longer periods of a few years is more common, those studies are less reliable." }, { "q": "Do anal warts go away naturally over time?", "a": "Possibly, over a longer time frame than has been well studied. No well-controlled trial followed people for years, so how often warts clear up on their own after the first few months is genuinely unknown." }, { "q": "Should I just wait instead of getting treatment?", "a": "Based on the trial evidence, waiting alone cleared far fewer people (8%) than active treatment (about 70%) over six months. It's reasonable to get warts checked and treated rather than relying on them disappearing by themselves." } ], "searchedAs": [ "do anal warts go away", "do anal warts go away on their own", "are anal warts always hpv can they go away on their own", "do anal warts go away without treatment", "do anal warts go away naturally" ], "patientTakeaway": "Don't just wait it out. In the best trial on this question, only about 8 in 100 people cleared their anal warts on their own within six months, while about 70 in 100 cleared with treatment. See a clinician for treatment and to confirm what you have is HPV warts.", "methodology": { "databases": [ "PubMed", "ClinicalTrials.gov", "Crossref" ], "searchStrings": { "pubmed": "(\"Condylomata Acuminata\"[Mesh] OR \"anal warts\"[tiab] OR \"anogenital warts\"[tiab] OR \"genital warts\"[tiab]) AND (\"spontaneous regression\"[tiab] OR \"spontaneous resolution\"[tiab] OR \"natural history\"[tiab] OR \"untreated\"[tiab] OR \"watchful waiting\"[tiab] OR \"remission, spontaneous\"[Mesh])" }, "pubmedQueryTranslation": "(\"Condylomata Acuminata\"[MeSH Terms] OR \"anal warts\"[Title/Abstract] OR \"anogenital warts\"[Title/Abstract] OR \"genital warts\"[Title/Abstract]) AND (\"spontaneous regression\"[Title/Abstract] OR \"spontaneous resolution\"[Title/Abstract] OR \"natural history\"[Title/Abstract] OR \"untreated\"[Title/Abstract] OR \"watchful waiting\"[Title/Abstract] OR \"remission, spontaneous\"[MeSH Terms])", "searchedOn": "2026-10-13", "inclusion": [ "Human, animal or laboratory studies reporting an outcome relevant to the question" ], "exclusion": [ "Records about a different condition or intervention", "Records reporting no outcome", "Retracted publications, which are listed but excluded from every count" ], "extractionLevel": "abstract", "gradingNote": "Evidence strength is adapted from the GRADE framework. It is not a GRADE assessment and was not produced by a GRADE panel.", "limits": [ "Fields were read from abstracts, not full text, so detail reported only in a paper's methods section is not captured." ] }, "seo": { "title": "Do Anal Warts Go Away on Their Own?", "description": "Four trials show most anal warts don't reliably clear without treatment; one RCT found just 8% cleared untreated versus 70% with treatment." }, "lastChecked": "2026-10-13", "lastChanged": "2026-10-13", "nextCheckDue": "2026-11-13", "history": [], "pipeline": { "screenModel": "claude-haiku-4-5", "extractModel": "claude-sonnet-5", "composeModel": "claude-sonnet-5", "promptVersion": "ev-1", "ranOn": "2026-10-13" }, "status": "published" }