Recommendations for the treatment of Trichomonas vaginalis, Mycoplasma genitalium, Candida albicans, bacterial vaginosis and human papillomavirus (anogenital warts): web annex E: evidence-to-decision framework and systematic review for the WHO treatment recommendations for anogenital warts caused by human papillomavirus
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World Health Organization
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25 p.
This web annex presents the evidence-to-decision framework and systematic review that informed WHO treatment recommendations for external anogenital warts caused by human papillomavirus (HPV). The document evaluates the benefits, harms and implementation considerations associated with available therapeutic options for adults and adolescents with uncomplicated external anogenital warts. Drawing on network meta-analyses, systematic reviews and updated randomized controlled trial evidence, it assesses outcomes including complete lesion response, adverse events, quality of life, transmission-related outcomes and cost–effectiveness. Treatments reviewed include podophyllotoxin, imiquimod, trichloroacetic acid, podophyllin, cryotherapy, electrosurgery, CO2 laser therapy and other ablative approaches. The evidence indicates that most treatments improve lesion clearance compared with no treatment, with moderate certainty of evidence, while adverse effects are generally transient and manageable. The framework also considers values and preferences, resource requirements, equity, acceptability and feasibility. Based on the balance of desirable and undesirable effects, WHO issues a conditional recommendation supporting self-applied podophyllotoxin or imiquimod as initial treatment options, with cryotherapy, trichloroacetic acid, electrosurgery or CO2 laser therapy as alternatives when treatment fails or according to local availability and clinical circumstances. The annex also identifies priorities for further research, particularly regarding quality of life, cost–effectiveness and treatment outcomes in people living with HIV and other immunocompromised populations.
This web annex presents the evidence-to-decision framework and systematic review that informed WHO treatment recommendations for external anogenital warts caused by human papillomavirus (HPV). The document evaluates the benefits, harms and implementation considerations associated with available therapeutic options for adults and adolescents with uncomplicated external anogenital warts. Drawing on network meta-analyses, systematic reviews and updated randomized controlled trial evidence, it assesses outcomes including complete lesion response, adverse events, quality of life, transmission-related outcomes and cost–effectiveness. Treatments reviewed include podophyllotoxin, imiquimod, trichloroacetic acid, podophyllin, cryotherapy, electrosurgery, CO2 laser therapy and other ablative approaches. The evidence indicates that most treatments improve lesion clearance compared with no treatment, with moderate certainty of evidence, while adverse effects are generally transient and manageable. The framework also considers values and preferences, resource requirements, equity, acceptability and feasibility. Based on the balance of desirable and undesirable effects, WHO issues a conditional recommendation supporting self-applied podophyllotoxin or imiquimod as initial treatment options, with cryotherapy, trichloroacetic acid, electrosurgery or CO2 laser therapy as alternatives when treatment fails or according to local availability and clinical circumstances. The annex also identifies priorities for further research, particularly regarding quality of life, cost–effectiveness and treatment outcomes in people living with HIV and other immunocompromised populations.