Therapie der Infektion mit humanen Papillomviren: Optionen bei benignen und präinvasiven Erkrankungen assoziiert mit humanen Papillomviren

Background: Human papillomavirus (HPV) infection causes various benign, premalignant and invasive diseases of the genital tract. Since no antiviral HPV therapy is available as yet, treatment is focused on HPV-related lesions such as anogenital warts and vulvar (VIN) or cervical intraepithelial neoplasia (CIN). Objectives: This article gives a review of the literature on established as well as innovative therapeutic methods and gives advice on treatment based on evidence as well as national and international guidelines. Material and methods: A literature search using the search terms “HPV”, “cervical intraepithelial neoplasia”, “vulvar intraepithelial neoplasia”, “genital warts” and “treatment” was performed on PubMed. Results: In over 95% of cases, there was no evidence of residual or recurrent dysplasia 12 months after surgical CIN therapy. The available surgical methods do not differ significantly. There is only scant evidence for conservative CIN treatment. Recurrence rates of VIN are high (21%–58%) at 12 months following surgery or laser therapy. There are no significant differences between these options. Complete remission is seen in 58% of cases at 6 months after VIN treatment using Imiquimoda. For anogenital warts there is a large variety of topical and ablative treatment options, the former having cure rates of about 30%–70%, the others 70%–100%. Conclusions: Surgery is the standard treatment for CIN and VIN. Conservative CIN therapy is experimental. Imiquimod may be used for the treatment of a VIN in special cases. The treatment of anogenital warts consists primarily of topical self-treatment. However, the best cure rates are achieved with laser therapy.