International Papillomavirus Society statement on reputed treatments for human papillomavirus infection and human papillomavirus-related diseases: evidence, risks, and standards for clinical evaluation.

Abstract

Human papillomavirus is the most common sexually transmitted infection and the necessary cause of cervical cancer, as well as a proportion of other anogenital and oropharyngeal cancers. Although most infections clear spontaneously, persistent oncogenic human papillomavirus infection may lead to precancer and cancer. There is therefore a need for effective and globally accessible therapies that either promote sustained clearance of human papillomavirus infection or safely treat human papillomavirus-related lesions, particularly in settings where ablative or excisional procedures are not readily available. However, no therapy has demonstrated proven and durable efficacy in eradicating human papillomavirus infection itself, although some non-ablative interventions have shown efficacy in treating specific human papillomavirus-related lesions. We conducted a narrative review of currently available and emerging interventions promoted for the treatment of human papillomavirus infection or human papillomavirus-related lesions, including approved topical agents, oral formulations, immunotherapies, therapeutic vaccines, molecular inhibitors, and widely marketed commercial products. Evidence was synthesized from clinical trials, systematic reviews, clinical guidelines, health technology assessments, and policy recommendations, and assessed using a structured evidence-evaluation framework. Some agents, including immune modulators and sinecatechins, are approved for external anogenital warts but do not reliably eliminate underlying human papillomavirus infection. Selected topical therapies, particularly 5-fluorouracil, have demonstrated efficacy in randomized trials for regression of cervical intraepithelial neoplasia in specific clinical contexts, but do not represent validated antiviral eradication therapies. Photodynamic therapy, intralesional immunotherapy, therapeutic vaccines, and molecular inhibitors remain investigational, with insufficient evidence for routine clinical use. Probiotics, nutritional supplements, vaginal gels, and other commercially promoted products also lack robust evidence. In the absence of proven therapies that eradicate human papillomavirus infection, current management relies on surveillance, evidence-based treatment of precancerous lesions, vaccination, and screening. The proposed framework may support professional societies in evaluating emerging interventions and providing clear, evidence-based guidance to health care professionals, policymakers, patients, and the public.