In high-risk patients, including those who are immunosuppressed or have abnormal findings on Pap smears, immunoperoxidase studies for HPV typing are helpful. These can determine whether the patient is infected with one of the strains of HPV associated with a high risk of oncogenesis. If such a strain is found, close follow-up for the development of possible malignant transformation is essential. A number of treatment methods are available. Cryotherapy with liquid nitrogen works quite well for small penile and exocervical lesions.
Some discomfort is involved but is usually transient.
These medications can be used to shrink larger lesions to a size more easily treated with destructive therapy. Acid preparations, including trichloroacetic acid, are effective in treating vaginal warts, but multiple treatment sessions are usually required. When condylomata involve larger areas, carbon dioxide laser ablation is probably the most effective treatment, since it permits precise destruction of warty papules and plaques. This method is superior to electrocautery in that it does not injure sur-rounding tissue. Intralesional injections of interferon can be used, but most patients are unwilling to undergo the necessary series of treaments.