亚洲尖锐湿疣治疗指南。

Asian guidelines for condyloma acuminatum.

机构信息

Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India.

出版信息

J Infect Chemother. 2022 Jul;28(7):845-852. doi: 10.1016/j.jiac.2022.03.004. Epub 2022 Mar 25.

DOI:10.1016/j.jiac.2022.03.004

PMID:35341674

Abstract

UNLABELLED

The present guidelines aim to provide comprehensive information on genital condyloma acuminata, including the epidemiology, clinical features, diagnosis and management. The guidelines provide evidence-based recommendations on the diagnosis, prevention and treatment of genital condyloma acuminata in adults in Asia, including patients with HIV co-infection.

METHODOLOGY

A PubMed search was performed, using the keywords "condyloma acuminata", "anal wart", "anogenital wart", "genital wart" and "genital HPV". A total of 3031 results were found in publications during last six years. A careful review of the titles and abstracts was done to find all the studies pertaining to epidemiology, clinical features, diagnosis, treatment and prevention of condyloma acuminata.

DIAGNOSIS

Various diagnostic procedures described are: 1. PCR (LE: 2b). 2. Serology (LE: 2b). 3. In-situ hybridization (LE: 3).

PREVENTION

Vaccination (LE: 1a): Quadrivalent vaccine reduced the frequency of anogenital warts in both vaccinated and unvaccinated contacts. According to the update Advisory Committee on Immunization Practices (ACIP) recommendations, the following protocol is recommended: (a). HPV vaccination at age 11 or 12 years for both males and females. (b). Catch-up vaccination for all persons through age 26 years. (c). Shared clinical decision-making regarding potential HPV vaccination for persons aged 27-45 years, who are at risk of new HPV infection. 2. Male circumcision (LE: 2a): conflicting evidence.

HIV AND CONDYLOMA ACUMINATA

In HIV-affected individuals, the course of HPV is more aggressive, with a greater risk of treatment resistance, increased chances of intraepithelial neoplasia as well as cancers.

TREATMENT

Physician administered. 1. Photodynamic therapy (LE: 1a). 2. Laser (LE: 2b). 3. Surgery (LE: 1a). 4. Electrosurgery (LE: 2c). 5. Cryotherapy (LE: 1b). 6. Immunotherapy (LE: 1b). 7. Podophyllin (LE: 1b). Provider administered. 1. Imiquimod 5%(LE: 1a). 2. Podophyllotoxin (LE: 1b). 3. Sinecatechins (LE: 1a). 4. Cidofovir (LE: 3). 5. 5- Fluorouracil (LE: 1a). 6. Interferon (LE: 1a).

摘要

本指南旨在提供有关生殖器尖锐湿疣的全面信息，包括流行病学、临床特征、诊断和管理。本指南提供了亚洲成人生殖器尖锐湿疣（包括 HIV 合并感染患者）的诊断、预防和治疗的循证推荐意见。

方法

使用“尖锐湿疣”、“肛门疣”、“生殖器疣”和“生殖器 HPV”等关键词，在 PubMed 上进行了检索。在过去六年的出版物中，共找到了 3031 个结果。仔细查阅标题和摘要，以找到所有与尖锐湿疣的流行病学、临床特征、诊断、治疗和预防相关的研究。

诊断

描述的各种诊断程序包括：1. PCR（证据级别 2b）。2. 血清学（证据级别 2b）。3. 原位杂交（证据级别 3）。

预防

疫苗接种（证据级别 1a）：四价疫苗减少了接种和未接种疫苗的接触者中肛门生殖器疣的发生频率。根据更新的免疫实践咨询委员会（ACIP）建议，推荐以下方案：（a）HPV 疫苗在 11 或 12 岁时为男性和女性接种。（b）26 岁以下所有人群的补种疫苗。（c）对于 27-45 岁有新 HPV 感染风险的人群，共同做出潜在 HPV 疫苗接种的临床决策。2. 男性包皮环切术（证据级别 2a）：存在矛盾的证据。

HIV 和尖锐湿疣：在 HIV 感染者中，HPV 的病程更具侵袭性，治疗耐药的风险更高，上皮内瘤变和癌症的机会增加。

治疗

医生管理。1. 光动力疗法（证据级别 1a）。2. 激光（证据级别 2b）。3. 手术（证据级别 1a）。4. 电外科（证据级别 2c）。5. 冷冻疗法（证据级别 1b）。6. 免疫疗法（证据级别 1b）。7. 鬼臼毒素（证据级别 1b）。患者管理。1. 咪喹莫特 5%（证据级别 1a）。2. 鬼臼毒素（证据级别 1b）。3. 茶多酚（证据级别 1a）。4. 西多福韦（证据级别 3）。5. 5-氟尿嘧啶（证据级别 1a）。6. 干扰素（证据级别 1a）。