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## Complete Summary

#### GUIDELINE TITLE

United Kingdom national guideline for the management of anogenital
warts, 2007.

#### BIBLIOGRAPHIC SOURCE(S)

Clinical Effectiveness Group, British Association for Sexual Health and
HIV (BASHH). United Kingdom national guideline on the management of
anogenital warts. London (UK): British Association for Sexual Health and
HIV (BASHH); 2007. 18 p. \[52 references\]

#### GUIDELINE STATUS

This is the current release of the guideline.

This guideline updates a previously released version: Association for
Genitourinary Medicine (AGUM), Medical Society for the Study of Venereal
Disease (MSSVD). 2002 national guideline for the management of
anogenital warts. London: Association for Genitourinary Medicine (AGUM),
Medical Society for the Study of Venereal Disease (MSSVD); 2002. Various
p. \[43 references\]

### COMPLETE SUMMARY CONTENT

 SCOPE\
 METHODOLOGY - including Rating Scheme and Cost Analysis\
 RECOMMENDATIONS\
 EVIDENCE SUPPORTING THE RECOMMENDATIONS\
 BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS\
 CONTRAINDICATIONS\
 QUALIFYING STATEMENTS\
 IMPLEMENTATION OF THE GUIDELINE\
 INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT
CATEGORIES\
 IDENTIFYING INFORMATION AND AVAILABILITY\
 DISCLAIMER

### SCOPE

#### DISEASE/CONDITION(S)

Anogenital warts

#### GUIDELINE CATEGORY

Diagnosis\
Evaluation\
Management\
Treatment

#### CLINICAL SPECIALTY

Infectious Diseases\
Obstetrics and Gynecology\
Urology

#### INTENDED USERS

Physicians

#### GUIDELINE OBJECTIVE(S)

-   To reduce the number of sexually transmitted infections (STIs) and
    the complications that can arise in people either presenting with
    signs and symptoms of an STI, or undergoing investigation for
    possible infection

-   To offer recommendations on the diagnostic tests, treatment
    regiments, and health promotion principles needed for the effective
    management of ano-genital warts, covering the management of the
    initial presentation, as well as how to prevent transmission and
    future infection

#### TARGET POPULATION

Patients in the United Kingdom with anogenital warts

**Note**: The guideline is aimed primarily at people aged 16 years or
older (see specific guidelines for those under 16) presenting to health
care professionals.

#### INTERVENTIONS AND PRACTICES CONSIDERED

**Assessment/Diagnosis**

1.  Assessment of clinical features of lesions

    -   Naked eye examination

    -   Vaginal speculum examination for females

    -   Proctoscopy

    -   Meatoscopy, urethroscopy as indicated

    -   Recording lesions on genital maps

    -   Extragenital site examination

2.  Classification of warts as to morphology

3.  Biopsy under local anaesthetic for histology, plus or minus
    colposcopy

**Management/Treatment**

1.  Patient counseling and education

2.  Further investigations

    -   Evaluation for concurrent sexually transmitted infections

    -   Investigation of subclinical lesions, when clinically indicated

3.  Pharmacotherapy/chemical applications

    -   Podophyllin (not recommended for routine use)

    -   Podophyllotoxin

    -   Trichloroacetic acid

    -   Imiquimod

    -   Interferon alpha, beta, or gamma: intralesional; systemic;
        topical (not recommended for routine use)

    -   5-Fluorouracil (not recommended for routine use)

4.  Ablation therapy

    -   Cryotherapy

    -   Surgical/scissor excision

    -   Electrosurgery

    -   Laser therapy: carbon dioxide laser

5.  Combination therapies

    -   Podophyllin with cryotherapy

    -   Adjunctive interferon and laser therapy

6.  No treatment

7.  Assessment of current sexual partner

8.  Follow-up

9.  Special considerations for the following anatomical sites:
    intravaginal, cervix, urethral meatus, intra-anal

10. Special considerations for pregnant women

11. Cervical cytology screening intervals

12. Treatment of people with impaired cell mediated immunity

#### MAJOR OUTCOMES CONSIDERED

-   Clearance and recurrence rates of anogenital warts

-   Adverse effects of treatment

### METHODOLOGY

#### METHODS USED TO COLLECT/SELECT EVIDENCE

Searches of Electronic Databases

#### DESCRIPTION OF METHODS USED TO COLLECT/SELECT THE EVIDENCE

OVID/Medline was searched for the years 1966-2006 using keywords \"human
papillomavirus,\" \"genital warts,\" \"epidemiology,\" \"clinical
manifestations,\" \"treatment,\" \"management,\" \"laryngeal
papillomatosis.\"

#### NUMBER OF SOURCE DOCUMENTS

Not stated

#### METHODS USED TO ASSESS THE QUALITY AND STRENGTH OF THE EVIDENCE

Weighting According to a Rating Scheme (Scheme Given)

#### RATING SCHEME FOR THE STRENGTH OF THE EVIDENCE

**Levels of Evidence**

**Ia**: Evidence obtained from meta-analysis of randomised controlled
trials\
**Ib**: Evidence obtained from at least one randomised controlled trial\
**IIa**: Evidence obtained from at least one well designed controlled
study without randomisation\
**IIb**: Evidence obtained from at least one other type of well designed
quasi-experimental study\
**III**: Evidence obtained from well designed non-experimental
descriptive studies such as comparative studies, correlation studies,
and case control studies\
**IV**: Evidence obtained from expert committee reports or opinions
and/or clinical experience of respected authorities

#### METHODS USED TO ANALYZE THE EVIDENCE

Review of Published Meta-Analyses\
Systematic Review

#### DESCRIPTION OF THE METHODS USED TO ANALYZE THE EVIDENCE

Not stated

#### METHODS USED TO FORMULATE THE RECOMMENDATIONS

Expert Consensus

#### DESCRIPTION OF METHODS USED TO FORMULATE THE RECOMMENDATIONS

This guideline was compiled by members of the British Association for
Sexual Health and HIV (BASHH) Human Papillomavirus (HPV) Special
Interest Group without patient input.

#### RATING SCHEME FOR THE STRENGTH OF THE RECOMMENDATIONS

**Grading of Recommendations**:

**A (Evidence Levels Ia, Ib)**

-   Requires at least one randomised controlled trial as part of the
    body of literature of overall good quality and consistency
    addressing the specific recommendation.

**B (Evidence Levels IIa, IIb, III)**

-   Requires availability of well conducted clinical studies but no
    randomised clinical trials on the topic of recommendation.

**C (Evidence Level IV)**

-   Requires evidence from expert committee reports or opinions and/or
    clinical experience of respected authorities.

-   Indicates absence of directly applicable studies of good quality.

#### COST ANALYSIS

A formal cost analysis was not performed and published cost analyses
were not reviewed.

#### METHOD OF GUIDELINE VALIDATION

Not stated

#### DESCRIPTION OF METHOD OF GUIDELINE VALIDATION

Not applicable

### RECOMMENDATIONS

#### MAJOR RECOMMENDATIONS

Levels of evidence (I-IV) and grades of recommendation (A-C) are defined
at the end of the \"Major Recommendations\" field.

**Diagnosis**

-   Naked eye examination in most cases

-   If in doubt, or if the lesion is atypical or pigmented, suggesting
    possible intraepithelial neoplasia, biopsy under local anaesthetic
    for histology should be performed prior to any therapeutic
    intervention. This may be aided by the use of a colposcope.

**Assessment of Lesions**

-   Examine the external ano-genital and surrounding skin under good
    illumination.

-   Females, vaginal speculum examination

-   Both sexes, proctoscopy may be indicated if history of anal
    receptive sex, or following clearance of perianal warts. Meatoscopy
    and proctoscopy should be performed if there is a history of
    distortion of urine flow or bleeding from the urethra or anus,
    respectively. Occasionally urethroscopy is indicated for more
    proximal warts.

-   Classify warts as to morphology.

-   Recording of lesions on genital maps at each visit is useful,
    providing a visual record of approximate number, distribution, and
    response to treatment.

-   Extragenital sites (e.g., oral cavity) examined if clinically
    indicated.

**Management**

**General Advice**

-   Patients should be given a detailed explanation of their condition
    with particular emphasis on the long term implications for the
    health of themselves and their partners. This should be reinforced
    by giving them clear and accurate written information.

-   Although data are conflicting, condoms have been shown to protect
    against the acquisition of human papillomavirus (HPV) infection and
    genital warts and may also have a therapeutic effect when both
    partners are infected, possibly by preventing continued re-exposure
    to the virus. Considering current data, condom usage may prove
    beneficial and their use advisable, particularly in new
    relationships. (**IIb, B**)

-   Latex condoms may be weakened if in contact with imiquimod.

-   For some patients the psychological impact of warts is the worst
    aspect of the disease. Where psychological distress is apparent,
    referral for counselling may be appropriate.

-   There are data suggesting that smokers may respond less well to
    treatment than non-smokers.

**Further Investigations**

Many patients will have other concurrent sexually transmitted infections
(STIs). Therefore, an appropriate screen for STI is recommended.

*Subclinical Lesions*

Subclinical lesions of the external ano-genital skin are those not seen
by the naked eye, but detectable by soaking the skin with 5% acetic acid
and examining with magnification (e.g., a colposcope). These lesions are
usually asymptomatic, but may cause irritation and inflammation of the
skin---for example, atypical balanoposthitis or vulvitis.

Problems associated with the identification of such lesions:

-   Many aceto-white lesions are not caused by HPV.

-   Histological changes are not specific for HPV infection.

-   HPV detection is not routinely available.

Treatment of these has not been shown to:

-   Affect the course of disease in patients or their partners.

For the above reasons and the fact that identification may cause
unnecessary distress, it is not recommended that these lesions be sought
unless there is a clinical indication (**IIb, B**).

**Treatment**

Treatment choice depends on the morphology, number, and distribution of
warts and patient preference. Treatment decisions should be made after
discussing the appropriate options with the patient, taking into account
their preference and convenience.

-   The evidence base to direct first and second line treatments is not
    strong.

-   All treatments have significant failure and relapse rates.

-   Treatment may involve discomfort and local skin reactions. Written
    information on management of treatment side effects is recommended.

-   Soft non-keratinised warts respond well to podophyllin,
    podophyllotoxin, and trichloroacetic acid.

-   Keratinised lesions are better treated with physical ablative
    methods such as cryotherapy, excision, or electrocautery.

-   Imiquimod may be suitable for both keratinised and non-keratinised
    warts.

-   People with a small number of low volume warts, irrespective of
    type, are best treated with ablative therapy from the outset.

-   Podophyllotoxin, for 4 week cycles, and imiquimod for up to 16 weeks
    are suitable for home treatment by patients. If chosen, the patient
    should be given a demonstration on lesion finding and treatment
    application.

-   Local anaesthetic creams plus or minus injection with an injectable
    local anaesthetic (e.g., 2% lignocaine) could be used before
    ablative therapy to minimize discomfort. Adrenaline-containing
    anaesthetic should be avoided for lesions on the penis and around
    the clitoris.

-   No treatment is an option at any site and may apply particularly to
    warts in the vagina and anal canal.

-   Practitioners should consider developing a treatment algorithm or
    protocol. This has been shown to significantly improve clinical
    outcome.

*Treatments Available*

Clearance and recurrence rates for individual treatments are shown in
table 1 of the original guideline document.

*Chemical Applications*

[Podophyllin]{.underline}

Podophyllin is a non-standardised cytotoxic compound. It has been
associated with severe local reactions. Serious systemic adverse events
have occurred when used outside guidelines. Podophyllin is licensed for
prescription use only. Best practice described in the British National
Formulary recommends supervised application in genitourinary medicine
clinics or general practice by trained nurses after screening for other
STIs. Animal experiments indicate teratogenic and oncogenic properties
but evidence of these in humans is lacking.

-   15-25% solution can be carefully applied to lesions, in clinic, once
    or twice weekly. Wash off 4 hours later (**Ib, A**).

Caution:

-   Podophyllin has caused serious systemic side effects if applied in
    excess. Increased systemic absorption is likely if used internally.
    Limit application to 10 cm^2^ or 0.5 mL for external warts, and less
    than 2 cm^2^ for vaginal warts (**IV, C**).

-   The potential oncogenic and teratogenic effects as noted indicate it
    should be avoided on the cervix and in the anal canal, and in
    pregnancy (**IV, C**).

In view of the adverse problems associated with podophyllin and its
inferior efficacy to podophyllotoxin (**IIa, B**)---greater than 20%
clearance in each of the quoted studies in favour of
podophyllotoxin---its use in the routine management of ano-genital warts
is no longer recommended. This is in keeping with European opinion.

[Combination Therapy]{.underline}

Applications of podophyllin in conjunction with cryotherapy is used in
the United Kingdom although there are no studies to validate this
approach.

[Podophyllotoxin]{.underline}

Podophyllotoxin (Warticon and Condyline), a purified extract of
podophyllin in the form of a 0.5% solution or 0.15% cream, is suitable
for home treatment (**Ib, A**). It is licensed for 4 and 5 week courses
respectively and supervision by medical staff is recommended when the
lesion area treated is greater than 4 cm^2^. Podophyllotoxin has a
license for the treatment of genital warts but not extragenital lesions
such as anal warts.

-   Treatment cycles consist of twice daily application for 3 days,
    followed by 4 days\' rest for 4-5 cycles.

-   The cream may be easier for many patients to apply, especially at
    the anus.

-   Discontinue treatment if significant side effects (e.g., soreness,
    ulceration).

-   Unprotected sexual contact should be avoided soon after application
    because of a possible irritant effect on the partner.

Caution: Avoid in pregnancy.

[Trichloroacetic Acid]{.underline}

Trichloroacetic acid (TCA) 80-90% solution is suitable for weekly
application in a specialist clinic setting only. It acts as a caustic
agent resulting in cellular necrosis (**Ib, A**).

-   An intense burning sensation may be experienced for 5-10 minutes
    after application.

-   Ulceration penetrating into the dermis may occur, and it is
    therefore not recommended for large volume warts.

-   TCA can be used at most anatomical sites.

Caution: TCA is extremely corrosive to the skin. Careful application and
protection of the surrounding skin with petroleum jelly is recommended.
A neutralizing agent, for example sodium bicarbonate, should always be
available in case of excess application or spills.

[5-Fluorouracil]{.underline}

5-Fluorouracil is a DNA anti-metabolite, available in a 5% cream. Its
use is limited by severe local side effects, which may result in long
term problems---for example, neovascularisation and vulval burning. It
may be teratogenic and therefore should not be used in pregnancy.

As satisfactory alternatives exist, this treatment is no longer
recommended for the routine management of ano-genital warts. (**IV, C**)

[Interferons]{.underline}

Various regimens have been described using interferons alpha, beta, and
gamma as creams and as intra-lesional or systemic injection (**Ib, A**).

-   Its use is limited by expense, systemic side effects, and a variable
    response rate.

-   Cyclical low dose injection used as an adjunct to laser therapy has
    resulted in a lower relapse rate.

-   Interferons are not recommended for routine management of
    ano-genital warts and should only be used on expert advice (**IV,
    C**).

[Imiquimod]{.underline}

Imiquimod is an immune response modifier.

-   Available as a 5% cream, it induces a cytokine response when applied
    to skin infected with HPV.

-   Suitable for use on all external ano-genital warts, but is not
    recommended for use in pregnancy or internally (**Ib, A**).

-   Use in uncircumcised men has been shown to be safe.

-   Cream is applied to lesions three times weekly and washed off 6-10
    hours later for up to 16 weeks.

-   Response to treatment may be delayed for some weeks.

-   Clinical trials of imiquimod versus placebo have shown response
    rates comparable with other chemical agents (**Ib, A**). An
    apparently low relapse rate has not been compared in clinical trials
    against other currently available therapies.

-   Recent studies suggest fewer recurrences in patients using Imiquimod
    pre or post surgical excision of lesions.

-   Unprotected sexual contact should be avoided soon after application
    because of a possible irritant effect on the partner.

-   Latex condoms may be weakened if in contact with imiquimod.

Caution: Not approved for use in pregnancy or internally.

*Physical Ablation*

[Excision]{.underline} (**Ib, A**)

-   Removal of warts under local anaesthetic injection is particularly
    useful for pedunculated warts and small numbers of keratinised ones
    at anatomically accessible sites. The use of an anaesthetic cream
    (e.g., EMLA®) prior to injection is recommended.

-   Haemostasis can be established using electrosurgery, silver nitrate,
    or application of a haemostatic solution.

-   Treatment can be repeated as required. This is a good method of
    treatment for small numbers of warts and may be underused.

[Cryotherapy]{.underline} (**Ib, A**)

-   Using a liquid nitrogen spray or a cryoprobe results in cytolysis at
    the dermal epidermal junction resulting in necrosis.

-   Treatment should be applied until a \"halo\" of freezing has been
    established a few millimeters round the treated lesion.

-   A freeze, thaw, freeze technique should be used and lesions held
    frozen for 10-30 seconds, depending upon size.

-   There are health and safety issues to be considered when storing and
    handling liquid nitrogen. Information and guidance may be obtained
    from the following sites: British Oxygen
    ([www.bocindustrial.co.uk](http://www.bocindustrial.co.uk/)) COSHH
    essentials
    ([www.coshh-essentials.org.uk](http://www.coshh-essentials.org.uk/)),
    and the Health & Safety Executive
    ([www.hse.gov.uk](http://www.hse.gov.uk/)).

[Electrosurgery]{.underline} (**Ib, A**)

Three types are commonly used:

-   Electrocautery results in burning of the treatment site and
    surrounding tissue.

-   Hyfrecator acts by electrofulguration resulting in superficial
    charring and little dermal damage, or for deeper tissue penetration
    electro desiccation. These can be followed by curettage.

-   Monopolar surgery\--different waveforms can be generated, allowing
    desiccation, cutting, or coagulation. This results in a cleaner cut
    and less damage to surrounding tissue.

Caution: leave skin bridges between treatment sites to aid healing and
minimise scarring.

[Laser Treatment]{.underline} (**IIa, B**)

-   The carbon dioxide laser is especially suitable for large volume
    warts and can be used at difficult anatomical sites, such as the
    urethral meatus or anal canal.

Caution: All electrosurgical and laser techniques result in a plume of
smoke which has been shown to contain HPV DNA, which may potentially
cause infection of the respiratory tract in operating personnel.
Therefore, masks should be worn and adequate extraction provided during
these procedures (**IIb, B**).

**Sexual Partners**

-   Current sexual partner(s) may benefit from assessment, as they may
    have undetected genital warts, undetected other STI, or need an
    explanation and advice about disease process in partner (**III,
    B**).

-   Tracing of previous sexual partner(s) is not recommended.

**Follow-up**

-   Review is recommended at end of course to monitor response and
    assess need for changes in therapy. Patients frequently overestimate
    their response to treatment. Patients whose original lesions have
    responded well to treatment but new lesions are developing, can
    continue with current regimen.

-   Change is indicated if (a) patient is not tolerating current
    treatment, (b) under 50% response to current treatment by six weeks
    (8-12 weeks for imiquimod) (**IV, C**).

-   Relapses should be treated as appropriate to the lesion types.

**Special Considerations**

*Anatomical Sites*

Podophyllin and 5-fluorouracil are no longer recommended for internal
lesions.

[Intravaginal]{.underline}

-   Cryotherapy, electrosurgery, and TCA are recommended treatments.

-   If podophyllin is used it should be applied carefully to no more
    than a total area of 2 cm^2^ weekly.

[Cervix]{.underline}

-   Cervical intraepithelial neoplasia (CIN) has been documented in
    patients with cervical warts and for this reason some practitioners
    have recommended colposcopic assessment and biopsy. The natural
    history of CIN may be different in women with cervical warts but no
    study data are available to support this. In keeping with the
    National Health Service (NHS) Cervical Screening Programme,
    colposcopy is not recommended in women with genital warts, including
    those with cervical lesions, unless there is diagnostic uncertainty
    or clinical concern.

-   The following are appropriate treatment modalities for cervical
    warts: cryotherapy, electrosurgery, TCA, laser ablation, or
    excision.

[Urethral Meatus]{.underline}

-   If base of lesions seen, treatment with cryotherapy, electrosurgery,
    podophyllotoxin, or imiquimod. Lesions deeper in the urethra should
    be surgically ablated under direct vision, which may require
    referral to a urologist.

[Intra-anal]{.underline}

-   Treatment options include TCA, cryotherapy, electrosurgery, and
    laser ablation. There have been anecdotal reports of successful use
    of intra-anal imiquimod.

*Pregnancy*

-   Avoid podophyllin, podophyllotoxin, and 5-fluorouracil because of
    possible teratogenic effects.

-   Imiquimod is not approved for use in pregnancy.

-   Treatment aims to minimise the number of lesions present at delivery
    to reduce the neonatal exposure to virus.

-   Potential problems for children are the development of laryngeal
    papillomatosis and anogenital warts.

-   Very rarely a caesarean section is indicated because of obstruction
    of the vaginal outlet with warts or the presence of gross cervical
    warts. Caesarean section is not indicated to prevent laryngeal
    papillomatosis/ano-genital warts in the neonate as both conditions
    are rare.

*Cervical Cytology*

-   The National Health Service Cervical Screening Programme recommends
    that no changes are required to screening intervals in women with
    ano-genital warts.

-   Guidelines for the management of abnormal smears have been defined.

*Immunosuppressed*

-   People with impaired cell mediated immunity, for example organ
    transplant patients or those with human immunodeficiency virus (HIV)
    infection, are likely to have poor treatment responses, increased
    relapse rates, and an increased risk of developing ano-genital
    intraepithelial neoplasia.

-   Careful follow up is required in all these patients.

**Definitions**:

The following rating scheme was used for major management
recommendations.

**Ia**: Evidence obtained from meta-analysis of randomised controlled
trials\
**Ib**: Evidence obtained from at least one randomised controlled trial\
**IIa**: Evidence obtained from at least one well designed controlled
study without randomisation\
**IIb**: Evidence obtained from at least one other type of well designed
quasi-experimental study\
**III**: Evidence obtained from well designed non-experimental
descriptive studies such as comparative studies, correlation studies,
and case control studies\
**IV**: Evidence obtained from expert committee reports or opinions
and/or clinical experience of respected authorities

**Grading of Recommendations**

**A (Evidence Levels Ia, Ib)**

-   Requires at least one randomised controlled trial as part of the
    body of literature of overall good quality and consistency
    addressing the specific recommendation.

**B (Evidence Levels IIa, IIb, III)**

-   Requires availability of well conducted clinical studies but no
    randomised clinical trials on the topic of recommendation.

**C (Evidence Level IV)**

-   Requires evidence from expert committee reports or opinions and/or
    clinical experience of respected authorities.

-   Indicates absence of directly applicable studies of good quality.

#### CLINICAL ALGORITHM(S)

None provided

### EVIDENCE SUPPORTING THE RECOMMENDATIONS

#### TYPE OF EVIDENCE SUPPORTING THE RECOMMENDATIONS

The type of supporting evidence is graded and identified for selected
recommendations (see \"Major Recommendations\").

### BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS

#### POTENTIAL BENEFITS

-   Appropriate diagnosis and management of genital warts for patients
    in the United Kingdom

-   Improved wart clearance

-   Decreased recurrence rate

#### POTENTIAL HARMS

-   Anxiety from diagnosis

-   Treatment side effects:

    -   Podophyllin has potential oncogenic and teratogenic effects.

    -   Trichloroacetic acid is extremely corrosive to the skin.

    -   Imiquimod is not approved for internal use.

    -   Liquid nitrogen has health and safety issues.

    -   Electrocautery may cause scarring.

Side effects of each treatment option are presented in the \"Major
Recommendations\" field. Side effects may be minimized when the
guideline user follows the cautions provided in the original guideline
document.

### CONTRAINDICATIONS

#### CONTRAINDICATIONS

Podophyllin, podophyllotoxin, and 5-fluororuracil are contraindicated in
pregnancy because of possible teratogenic effects.

### QUALIFYING STATEMENTS

#### QUALIFYING STATEMENTS

-   The recommendations in this guideline may not be appropriate for use
    in all clinical situations. Decisions to follow these
    recommendations must be based on the professional judgement of the
    clinician and consideration of individual patient circumstances and
    available resources.

-   All possible care has been undertaken to ensure the publication of
    the correct dosage of medication and route of administration.
    However, it remains the responsibility of the prescribing physician
    to ensure the accuracy and appropriateness of the medication they
    prescribe.

### IMPLEMENTATION OF THE GUIDELINE

#### DESCRIPTION OF IMPLEMENTATION STRATEGY

An implementation strategy was not provided.

#### IMPLEMENTATION TOOLS

Audit Criteria/Indicators

For information about
[availability](#identifying-information-and-availability), see the
\"Availability of Companion Documents\" and \"Patient Resources\" fields
below.

### INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT CATEGORIES

#### IOM CARE NEED

Getting Better\
Living with Illness

#### IOM DOMAIN

Effectiveness\
Patient-centeredness

### IDENTIFYING INFORMATION AND AVAILABILITY

#### BIBLIOGRAPHIC SOURCE(S)

Clinical Effectiveness Group, British Association for Sexual Health and
HIV (BASHH). United Kingdom national guideline on the management of
anogenital warts. London (UK): British Association for Sexual Health and
HIV (BASHH); 2007. 18 p. \[52 references\]

#### ADAPTATION

Not applicable: The guideline was not adapted from another source.

#### DATE RELEASED

1999 Aug (revised 2007 Jan)

#### GUIDELINE DEVELOPER(S)

British Association for Sexual Health and HIV - Medical Specialty
Society

#### SOURCE(S) OF FUNDING

Not stated

#### GUIDELINE COMMITTEE

British Association for Sexual Health and HIV (BASHH) Human
Papillomavirus (HPV) Special Interest Group

Clinical Effectiveness Group (CEG)

#### COMPOSITION OF GROUP THAT AUTHORED THE GUIDELINE

*British Association for Sexual Health and HIV (BASHH) Human
Papillomavirus (HPV) Special Interest Group*: Chris Sonnex (Chair),
Addenbrooke\'s Hospital, Cambridge; H Birley, P Fox, R Gilson, C Lacey,
R Lau, C Lowndes, R Maw, M Nathan, D Rowen, K Soldan, S Strauss

*Clinical Effectiveness Group (CEG) Members*: Dr Keith Radcliffe
(Chair); Dr Imtyaz Ahmed-Jushuf; Dr Guy Rooney; Dr David Daniels
(National Audit Group); Dr Mark Fitzgerald; Dr Gillian Mccarthy; Dr Neil
Lazaro (Royal College of General Practitioners)

#### FINANCIAL DISCLOSURES/CONFLICTS OF INTEREST

Dr R Maw has acted as an adviser to 3M Pharmaceuticals and Stiefel who
have sponsored his attendance at scientific meetings. He has also
conducted clinical trials for 3M and Perstorp. Dr Fox has received
sponsorship to attend scientific meetings and has participated in
research sponsored by 3M Pharmaceuticals. Dr Nathan has conducted
clinical trials for 3M Pharmaceuticals and has received sponsorship for
attendance at scientific meetings. Dr D. Rowen has conducted clinical
trials for 3M and Steifel. Dr Sonnex has conducted clinical trials for
Stiefel and acted as an adviser to 3M pharmaceuticals. Dr Lacey has
conducted clinical trials for Stiefel and acted as an adviser to 3M
pharmaceuticals. Dr Gilson has conducted clinical trials for Stiefel.

#### GUIDELINE STATUS

This is the current release of the guideline.

This guideline updates a previously released version: Association for
Genitourinary Medicine (AGUM), Medical Society for the Study of Venereal
Disease (MSSVD). 2002 national guideline for the management of
anogenital warts. London: Association for Genitourinary Medicine (AGUM),
Medical Society for the Study of Venereal Disease (MSSVD); 2002. Various
p. \[43 references\]

#### GUIDELINE AVAILABILITY

Electronic copies: Available from the [British Association for Sexual
Health and HIV Web site](http://www.bashh.org/guidelines).

#### AVAILABILITY OF COMPANION DOCUMENTS

The following are available:

-   UK national guidelines on sexually transmitted infections and
    closely related conditions. Introduction. Sex Transm Infect 1999
    Aug;75(Suppl 1):S2-3.

-   Revised UK national guidelines on sexually transmitted infections
    and closely related conditions 2002. Sex Transm Infect 2002;78:81-2

Print copies: For further information, please contact the journal
publisher, [BMJ Publishing Group](http://sti.bmjjournals.com/).

#### PATIENT RESOURCES

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#### NGC STATUS

This summary was completed by ECRI on December 8, 2000. The information
was verified by the guideline developer on January 12, 2001. This
summary was updated on August 5, 2002. This NGC summary was updated by
ECRI Institute on December 13, 2007. The updated information was
verified by the guideline developer on February 7, 2008.

#### COPYRIGHT STATEMENT

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### DISCLAIMER

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Date Modified: 11/10/2008