Beutner K R, Ferenczy A
Department of Dermatology, University of California at San Francisco, USA.
Am J Med. 1997 May 5;102(5A):28-37. doi: 10.1016/s0002-9343(97)00181-2.
Although many treatments are available for genital warts caused by human papillomavirus (HPV), none are uniformly successful in the treatment of this disease. Most current treatment options work by destroying affected tissue, either by a cytotoxic or a physically ablative mode of action. Interferons have antiviral, antiproliferative, and immunomodulatory activities, but these have not translated into a high level of cure rates against warts. With all current treatments, recurrent warts are common. Therapies currently being investigated include a 5-fluorouracil/epinephrine collagen gel that achieves high concentrations of 5-fluorouracil at the site of injection. Other new treatment modalities focus on activating the host's immune system or improving the delivery of therapeutic compounds to the affected site. Imiquimod, a novel immune-response modifier, induces interferon and a number of other endogenous cytokines. A cream formulation containing 5% imiquimod resulted in good total clearance rates and generally tolerable side effects in controlled clinical trials of patients with external genital warts. Perhaps the most effective means for managing HPV disease would be a vaccine that prevents the occurrence of genital warts. Although it is unlikely that such a vaccine will be introduced in the near future, preliminary studies indicate that it may be possible to develop suitable prophylactic and therapeutic vaccines.
虽然有多种治疗方法可用于治疗由人乳头瘤病毒（HPV）引起的尖锐湿疣，但没有一种方法能在治疗这种疾病上取得一致的成功。目前大多数治疗选择是通过细胞毒性或物理消融作用方式破坏受影响的组织。干扰素具有抗病毒、抗增殖和免疫调节活性，但这些尚未转化为针对疣体的高治愈率。对于所有当前的治疗方法，复发性疣体都很常见。目前正在研究的疗法包括一种5-氟尿嘧啶/肾上腺素胶原凝胶，它能在注射部位达到高浓度的5-氟尿嘧啶。其他新的治疗方式专注于激活宿主的免疫系统或改善治疗化合物向受影响部位的递送。咪喹莫特是一种新型免疫反应调节剂，可诱导干扰素和许多其他内源性细胞因子。在一项针对外生殖器疣患者的对照临床试验中，含5%咪喹莫特的乳膏制剂产生了良好的完全清除率，且副作用总体上可耐受。也许管理HPV疾病最有效的方法将是一种预防尖锐湿疣发生的疫苗。虽然近期不太可能推出这样一种疫苗，但初步研究表明，开发合适的预防性和治疗性疫苗或许是可行的。
