Cryotherapy and CO2-laser vaporization in the treatment of cervical and vaginal human papillomavirus (HPV) infections.

A series of 119 women with Human papillomavirus (HPV) infections of the uterine cervix and/or vagina were included in the present study, where the efficacy of cryotherapy and CO2-laser vaporization was assessed after a mean follow-up of 14 months (SD 6 months) after treatment, as related to the natural history of the disease. Routine Papanicolaou (PAP) smears with HPV-induced changes were the basis for patient recruitment. Patients with cervical HPV lesions (HPV-NCIN, HPV-CIN I or II) were randomly allocated into laser (55 women) and cryotherapy (42 women) groups. Women with combined lesions (HPV-CIN & HPV-VAIN) were treated by laser (22 patients). The cure rate after laser vaporization was practically identical to that of cryotherapy, 64% and 54%, respectively (difference not statistically significant). The success rate was significantly lower (40%) for the combined lesions (HPV-CIN & HPV-VAIN) (p less than 0.05). The residual disease encountered in patients after the first treatment with cryotherapy and laser was classified as HPV-NCIN in 78.9% and 37.0%, respectively. The number of patients is still too small to draw reliable conclusions on the effects of these therapy modes, as related to HPV type of lesion (HPV 6, 11, 16, 18, 31 and 33). The cure rates for both cryotherapy and laser in our treatment groups were significantly higher than the spontaneous regression rate (p less than 0.001), suggesting that treatment by either cryotherapy or CO2-laser vaporization significantly changes the natural history of genital HPV infections. More patients and longer follow-up are still needed, however, to fully establish the efficacy of the current treatment modalities in gynecological HPV infections.