Genital papillomavirus infections: current knowledge and future prospects.

Although much has been learned about the biology of HPV during the last decade, little progress has been made in the development of rational and effective patient management strategies. Without stronger evidence supporting a causal role for HPV in the development of genital tract and anal cancers, and without the availability of effective therapies, it is premature to recommend widespread screening for detection of HPV DNA or RNA with the molecular hybridization tests soon to be available commercially. Papanicolaou smear screening for detection of early precancerous changes of the cervix and referral for colposcopy and biopsy of areas of epithelium that are suspicious for intraepithelial neoplasia of the cervix, vagina, vulva, penis, or anus remain the cornerstones of genital tract and anal cancer prevention. The patient care implications of subclinical persistent HPV infection of the genital tract are not well understood. For this reason, and because none of the available therapies are curative, treatment of large areas of normal-appearing genital tract epithelium also cannot be recommended at this time. It is hoped that, with the growing research focus on therapies that have the potential for virologic cure, some day effective treatment for subclinical infection will be available. Until that time, patients with recalcitrant or recurring genital warts may benefit most by the sequential application of different treatment modalities.