Treatment is directed on the alleviation of signs and symptoms with traditional treatment modalities focusing on the destruction of infected tissue. This includes cryotherapy, imiquimod, podophyllin resin, podophyllotoxin, salicylic acid, trichloroacetic acid, laser and surgical techniques. Despite the fact that patients with HIV infection tend to have larger or more numerous lesions, and might not show good response to therapy, data do not support altered approaches to treatment for persons with HIV infection.[57] 43 Antiretroviral therapy does not seem to reduce the incidence or persistence of genital warts in this population.{/ref}
Immunomodulatory compounds with antiviral properties have demonstrated superior efficacy with clearance rates up to 77% and low recurrence rates in some recent studies.[58] Topical imiquimod 5% has however been proven to be safe and effective and is recommended for those with CD4 cell counts of more than 200 cells/μL or who are on ART. Best outcomes have been with application three times a week for 6-10 hours until visible inflammation occurs and the warts disappear. Side effects can be controlled by decreasing the frequency of application.[59] Recently, topical cidofovir has been demonstrated to be effective in treating anogenital warts in patients with HIV infection. However, its cost limits its widespread use. Combining surgical and medical therapies may have a beneficial effect on treatment outcomes.[60]
The management and monitoring of cervical intraepithelial neoplasia and anal intraepithelial neoplasia are described in section Oncological conditions.