Genital warts in females In a pivotal clinical trial, complete clearance of lesions was observed in 72% of female patients treated with imiquimod 5% cream, three times a week for 16 weeks, or until warts cleared28. The response of a genital wart in a female patient to imiquimod treatment is shown in Figure 2. The low recurrence rate (13%)29 in patients, an obstacle with many of the other current therapies, is an encouraging benefit of this treatment modality, and may reflect the development of specific long- term cell-mediated immunity. Physicians have the choice between office- based or home-based therapies. The Centers for Disease Control and Prevention (CDC) guidelines for the treatment of genital warts recommend that a b c Figure 2 Typical response of a genital wart in a female patient following treatment with imiquimod 5% cream. Photographs were taken at the beginning of treatment (a), after 6 weeks of imiquimod treatment (b) and 4 weeks after the end of treatment (c) 152 INFECTIOUS DISEASES IN OBSTETRICS AND GYNECOLOGY Gall the choice be guided by the preference of the patient, the available resources and the experience of the healthcare provider. It is recommended that providers are knowledgeable about, and have available to them, one patient-applied and one provider-administered treatment21. Numerous different factors can influence the choice of treatment by the physician. Treatment choice is based on morphology, number, distribu- tion and the keratinization state of warts30. For example, soft non-keratinized warts respond well to podofilox and TCA, whereas keratinized lesions are better treated with physically ablative methods such as cryotherapy, excision or electrocautery30. Imiquimod is suitable for both types of lesions. The choice of treatment should be influenced by the individual patient’s preferences and con- venience. Patient-applied treatments may suit patients who desire to have a less invasive form of treatment or more control over their care. They tend to be favored by patients owing to their con- venience and ease of application. Pregnancy is an important issue in the treatment choice for genital warts, especially as their number and size tend to increase during pregnancy6. It is advocated that genital warts are removed during pregnancy if causing complications2. Therapies such as cryotherapy, laser therapy and TCA may be used in the treatment of pregnant patients; how- ever, the warts often spontaneously regress after delivery5. In addition, the cost of the treatment can influ- ence the availability of a specific treatment choice. In a recent US pharmacoeconomic analysis of therapies, it was found that imiquimod is more cost-effective than podofilox as a first-line therapy, even though the average cost of treatment is lower for podofilox. This is due to the greater sustained clearance rate of imiquimod, compared with podofilox31. KNOWLEDGE AND PREVENTION OF HUMAN PAPILLOMAVIRUS INFECTIONS Studies of college students demonstrate a very low knowledge and awareness of HPV infections and genital warts1. Even though physicians provide information about genital warts25, many patients are still misinformed and desire additional