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Evidence summaries

Electrotherapy for Genital Warts

Electrotherapy is effective for clearing genital warts compared with placebo, and appears to be more effective than cryotherapy but less effective than carbon dioxide laser. Level of evidence: "A"

A systematic review 2 evaluated the clinical effectiveness and cost-effectiveness of interventions for the treatment of anogenital warts. 60 randomised controlled trials (RCTs) evaluating 19 interventions were included. Analysis by mixed-treatment comparison (MTC) indicated that ablative techniques were typically more effective than topical interventions at completely clearing warts at the end of treatment. Podophyllotoxin 0.5% solution was found to be the most effective topical treatment evaluated. Networks for other outcomes included fewer treatments, which restrict conclusions on the comparative effectiveness of interventions. Podophyllotoxin 0.5% solution first line followed by carbon dioxide (CO2) laser therapy second line if warts did not clear was most likely to be considered a cost-effective use of resources at a willingness to pay of £20,000-30,000 per additional quality-adjusted life-year gained. Probability (percentage) of complete clearance at another time point by treatment (sensitivity analysis): Placebo/no treatment 7.9, imiquimod 5% cream 44.7, cryotherapy 52.4, cryotherapy plus podophyllotoxin 0.15% cream 57.5, electrotherapy 65.5.

A topic in Clinical Evidence 1 summarizes the results of RCTs on electrosurgery. One RCT (n=230) found that electrosurgery diatermy increased clearance of warts at 6 months (82% vs 8% with no treatment, p<0.001). One RCT (n=450) found that electrosurgery increased wart clearance compared with podophyllin (94% vs 41%, p<0.05). Cryotherapy was less effective at 6 weeks (clearing warts 79% with cryotherapy vs 94% with electrosurgery, p=0.003) than electrosurgery. Electrosurgery may cause pain (17%) and dyspareunia (4%) for a median of 2 weeks.

Comment: The quality of evidence was downgraded by limited study size for each comparison.

    References

    • Buck H. What are the effects of treatments for external genital warts.? Genital warts. Clinical Evidence 2005;13:2005-2015.
    • Thurgar E, Barton S, Karner C et al. Clinical effectiveness and cost-effectiveness of interventions for the treatment of anogenital warts: systematic review and economic evaluation. Health Technol Assess 2016;20(24):v-vi, 1-486.[PubMed]

Primary/Secondary Keywords