Therapeutic target
Improvement of symptomatology
Therapy recommendations
- Elimination of the viruses is usually not possible.
- Optional forms of local therapy/topical therapy:
- Epigallocatechin gallate* , sinecatechins (10% ointment)/catechins (green tea extracts).
- Imiquimod (5% cream)* ; approved only for perianal condyloma and not for intraanal infestation [better recurrence rates than surgical intervention].
- Podophyllotoxin (0.5%/0.15%)* .
- Interferon ß, local gel treatment after vaporization with the CO2 laser.
- Potassium hydroxide solution (KOH), 5%.
- Polyphenon E (mixture of green tea catechins); approved only for perianal condyloma and not for intraanal infestation; dosage: 10% ointment to be applied three times daily for 16 weeks.
- Trichloroacetic acid (85%).
- 5-Fluorouracil – for therapy of extensive multifocal anal intraepithelial neoplasia when it cannot be treated primarily by ablative means.
- Mycobacteria vaccination (for anogenital warts (“warts in the area of the anus (anus) and genitals (genitals)”), vaccination reduces the HPV-6 and HPV-11 load).
- Surgical ablation of skin lesions (see under “Surgical therapy“) is usually the last therapeutic option after local therapy (see above) has been exhausted.
* Substances recommended for patient self-treatment by the major STI societies CDC and IUSTI.
Further notes
- Standardized green tea (Camellia sinensis) extract polyphenone; indications: genital and perianal warts; significantly higher healing (over 50%).
- Digoxin and furosemide as a gel (both agents inhibit potassium influx into the cell; ionic anti-viral therapy, ICVT); warts became smaller and viral load lower with few side effects
Anal carcinoma (anal cancer).
- Primary radiochemotherapy (RCT) according to Nigro’s scheme:
- Percutaneous radiotherapy/radiotherapy (50-59.4 Gy), with integrated or sequential radiation boost of 5 to 20 Gy and
- Chemotherapy with mitomycin C and 5-fluorouracil.
- After residual or recurrent (“remaining parts of the carcinoma or recurrence of the disease”) anal carcinoma (salvage therapy/(salvage = rescue): abdominoperineal rectal extirpation (removal of the sigmoid, rectum, and sphincter apparatus with the anus) with plastic surgical coverage.
