**3.1 Histology**

Acanthosis, epidermal hyperplasia, papillomatosis, compact orthokeratosis, hypergranulosis, tortuous dermal papillary capillaries, and vertical tiers of parakeratotic cells are the typical histological findings of warts. In the granular layer, cells have coarse keratohyalin granules and vacuoles surrounding wrinkledappearing nuclei. Koilocytes are pathognomonic.

### **3.2 Immunohistochemistry or immunocytochemistry using type-common and type-specific antibodies**

### *3.2.1 DNA in situ hybridization*

In situ hybridization is a direct signal detection assay. It preserves the morphological context with HPV DNA signals. It has low sensitivity; however, in recent years, using improved signal-detecting method, sensitivity increased. It is becoming a valuable screening tool for women of age more than 30 years.

## **3.3 Polymer-based enzyme-linked immunosorbent assay (ELISA) for immunoglobulin G (IgG) antibody (Ab) against HPV 16 capsid**

### *3.3.1 PCR for HPV DNA*

Patients who are diagnosed with condylomata need a Papanicolaou (Pap) test of the cervix in accordance with the guidelines of the American College of Obstetricians and Gynaecologists

Computed tomography (CT) or magnetic resonance imaging (MRI) can be used to determine the extent of spread of cervical carcinoma and extensive anogenital papillomatosis that has spread into the pelvis.

**33**

*4.1.1 Surgery*

*Human Papillomavirus Infection: Management and Treatment*

Warts are usually self-limiting. Large studies have shown complete spontaneous remission in 42% of patients after 2 months; in 53%, after 6 months; and in 65%, after 2 years [2]. The intact immune system plays the most important role for preventing HPV infection. This can be seen in patients with primary immunodefi-

HPV-induced warts are the most common skin disorder in organ transplant recipients [3]. Children with recalcitrant extragenital wart may suffer from primary immunodeficiency. It has been shown that immunosuppressed patients experience resolution of treatment-refractory warts once their immune status has improved [4]. The known spontaneous remission of HPV-induced warts, which is attributed to cellbound mechanisms, underscores the role of the immune system, including an increase

Guidelines for the management of cutaneous warts have been prepared for dermatologists on behalf of the British Association of Dermatologists [6]. The guideline highlighted the ideal aims of treatment of warts as follows: (i) Removal of wart without recurrence. (ii) Treatment should result with no scars. (iii) Immunity that induced by treatment should be lifelong [5]. The general principles observed in the treatment of warts are the following: (1) There is no need to treat all warts. (2) Treatment indications are pain, interference with function, cosmetic embarrassment and risk of malignancy. (3) All the treatments have success rate not very high (average 60 ± 70% clearance in 3 months). (4) An immune response is usually essential for clearance. Immunocompromised individuals may never show wart clearance. (5) Younger individuals with short duration of illness usually have the

There is a high rate of spontaneous remission, especially in children, so 'wait-andsee' approach is feasible in many cases. Regular filing or paring down the hyperkeratotic layer makes the lesion thin and comfortable. Simple measure to limit the spread of lesion should be encouraged. The treatment of warts can be broadly classified into destructive, antimitotic, virucidal, immunotherapy, and some folk and alternative

The goals of wart treatment are to resolve all or a maximum number of warts, make it painless, need only one or a part of a wart treated, only need minimum number of treatments, leave no scar, offer lifetime HPV immunity and be easily available for all patients [7]. The criteria for wart treatment, developed by the American Academy of Dermatology in 1995, [7] include (1) the patient's desire for therapy; (2) symptoms of pain, bleeding, itching or burning; (3) disabling or disfiguring lesions; (4) large numbers or large sizes of lesions; (5) the patient's desire to prevent the spread of warts to unblemished skin of self or others; and (6)

The lesions are damaged or removed by different procedures followed by clinical cure. The destructive therapies include surgical removal by curettage and cautery, chemical cautery, cantharidin, cryotherapy, electrocautery, radiocautery ablation,

Curettage followed by cautery was an early and still widely practiced method of surgical removal of warts. A success rate of 65–85% has been reported in surgical

, CD8+

) around the diseased tissue [5].

*DOI: http://dx.doi.org/10.5772/intechopen.92397*

ciency or in immunosuppressed patients.

in Th1 cytokines and infiltration of T cells (CD4+

highest clearance rates for various treatments [5].

therapies which have recently become popular again.

infrared coagulation, photodynamic therapy, and lasers.

an immunocompromised condition [6].

**4.1 Destructive therapy**

**4. Treatment**
