Condition

HPV Infection

Human papillomavirus - Most common STI

1.3B

People Affected

150

Active Trials

104M

New Cases/Year

423K

Deaths/Year

Treatment Rankings

Ranked by evidence volume first. Medicine has spent centuries ranking things by vibes. This is an improvement.

Surgical Excision / Electrocautery / Laser Ablation

95% Effectiveness• 92% Confidence• 78% Safety• 2 trials• 7.5K participants

HIGH EvidenceGood ValueDose: Surgical removal of lesions

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Comparative Safety Scale(Higher is safer)

Cyanide☠️

Meth💀

Cigarettes🚬

Chemo☢️

Alcohol🍺

Morphine💊

Antibiotics💉

Tylenol💊

Exercise🏃

Water💧

DangerousModerateSafe

Time to Effect

Immediate clearance, 1-4 weeks healing

Duration

Single procedure, 1-4 weeks healing

Response Rate

95%

Remission Rate

95%

Number Needed to Treat (NNT)

Common Side Effects:

Pain: 70%

Scarring: 40%

Infection: 10%

Bleeding: 7%

Dyspigmentation: 15%

Annual Cost of Care

Drug Cost

Monitoring

$1,700

Side Effects

$150

Total Annual

$1,850

Cost-Effectiveness

GOOD

Cost per Remission

$1,947

Cost per Responder

$1,947

Treatment Outcomes

Primary Outcomes

Complete Resolution of Visible Anogenital WartsMedian number of lesions: 5

-100% (Reduction to 0 lesions)

Histological Resolution of Cervical Intraepithelial Neoplasia (CIN2/3)Presence of CIN2/3 on biopsy at treatment site

-100% (Complete resolution of CIN2/3 on follow-up biopsy)

Reduction in 6-Month Recurrence Rate of Anogenital Warts Post-ClearanceExpected 6-month recurrence rate (untreated/conservative management): 45%

-44.4% (Reduced recurrence rate by 20 percentage points (e.g., from 45% to 25%))

Secondary Benefits

Improvement in Patient-Reported Quality of Life (HPV-Impact Profile score)HPV-Impact Profile (HIP) score: 60/100 (higher score indicates greater negative impact)

-30% (-18 points on HIP score)

Reduction in HPV-related Psychological Distress (GAD-7 score)Generalized Anxiety Disorder-7 (GAD-7) score: 12/21 (moderate anxiety)

-40% (-4.8 points on GAD-7 score)

Reduction in HPV Viral Load at Treated SiteHigh HPV viral load: 1.0 x 10^7 copies/cell

-99.99% (Reduction to <1.0 x 10^3 copies/cell (often undetectable))

Common Side Effects

Pain

+70%

Scarring

+40%

Infection

+10%

Clinical Trial Phases:

Phase 4

Trichloroacetic Acid (TCA)

80% Effectiveness• 88% Confidence• 80% Safety• 4 trials• 6K participants

HIGH EvidenceGood ValueDose: 80-90% solution, applied weekly

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Comparative Safety Scale(Higher is safer)

Cyanide☠️

Meth💀

Cigarettes🚬

Chemo☢️

Alcohol🍺

Morphine💊

Antibiotics💉

Tylenol💊

Exercise🏃

Water💧

DangerousModerateSafe

Time to Effect

1-4 weeks per session

Duration

Multiple sessions over 4-12 weeks

Response Rate

80%

Remission Rate

80%

Number Needed to Treat (NNT)

Common Side Effects:

Local pain: 80%

Burning sensation: 60%

Ulceration: 40%

Scarring: 7%

Annual Cost of Care

Drug Cost

Monitoring

$1,000

Side Effects

$50

Total Annual

$1,050

Cost-Effectiveness

GOOD

Cost per Remission

$1,312.5

Cost per Responder

$1,312.5

Treatment Outcomes

Primary Outcomes

Number of Anogenital Warts7 warts

-80% (-5.6 warts)

Total Anogenital Wart Area2.5 cm²

-85% (-2.125 cm²)

Patient-Reported Anogenital Wart Symptom Score7/10 (0-10 bother scale)

-70% (-4.9 points)

Secondary Benefits

Pain/Discomfort Score (VAS)4/10 (0-10 VAS)

-50% (-2 points)

Anogenital Wart-Related Quality of Life (QoL) Score50/100 (lower is worse QoL)

+20% (+10 points)

Self-Esteem Scale Score65/100 (lower is worse self-esteem)

+10% (+6.5 points)

Common Side Effects

Local pain

+80%

Burning sensation

+60%

Ulceration

+40%

Clinical Trial Phases:

Phase 4

Cryotherapy (Liquid Nitrogen)

70% Effectiveness• 90% Confidence• 80% Safety• 11 trials• 10K participants

HIGH EvidenceGood ValueDose: Applied for 5-30 seconds, repeated weekly/bi-weekly

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Comparative Safety Scale(Higher is safer)

Cyanide☠️

Meth💀

Cigarettes🚬

Chemo☢️

Alcohol🍺

Morphine💊

Antibiotics💉

Tylenol💊

Exercise🏃

Water💧

DangerousModerateSafe

Time to Effect

1-4 weeks per session

Duration

Multiple sessions over 4-12 weeks

Response Rate

70%

Remission Rate

70%

Number Needed to Treat (NNT)

Common Side Effects:

Pain: 85%

Blistering: 60%

Ulceration: 30%

Hypopigmentation: 20%

Scarring: 7%

Annual Cost of Care

Drug Cost

Monitoring

$1,000

Side Effects

$50

Total Annual

$1,050

Cost-Effectiveness

GOOD

Cost per Remission

$1,500

Cost per Responder

$1,500

Treatment Outcomes

Primary Outcomes

Number of Genital Warts5 warts

-80% (-4 warts)

Total Wart Area15 mm²

-85% (-12.75 mm²)

Patient-Reported Lesion Burden Score (0-10 scale)6/10

-75% (-4.5 points)

HPV DNA Viral Load in Lesions1.0 x 10^7 copies/mg tissue

-90% (-9.0 x 10^6 copies/mg tissue)

Secondary Benefits

Genital Wart-Specific Quality of Life Score (0-100 scale, higher is better)40/100

+50% (+20 points)

Pain/Discomfort Score (VAS 0-10)4/10

-75% (-3 points)

Sexual Function Index Score (0-30, higher is better)15/30

+40% (+6 points)

Common Side Effects

Pain

+85%

Blistering

+60%

Ulceration

+30%

Clinical Trial Phases:

Phase 4

Imiquimod

60% Effectiveness• 85% Confidence• 72% Safety• 11 trials• 10K participants

HIGH EvidenceGood ValueDose: 3.75% or 5% cream, 3-5 times/week

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Comparative Safety Scale(Higher is safer)

Cyanide☠️

Meth💀

Cigarettes🚬

Chemo☢️

Alcohol🍺

Morphine💊

Antibiotics💉

Tylenol💊

Exercise🏃

Water💧

DangerousModerateSafe

Time to Effect

4-16 weeks

Duration

Up to 16 weeks

Response Rate

60%

Remission Rate

60%

Number Needed to Treat (NNT)

Common Side Effects:

Local erythema: 70%

Erosion: 40%

Itching: 30%

Burning: 20%

Flu-like symptoms: 7%

Annual Cost of Care

Drug Cost

$1,200

Monitoring

$300

Side Effects

$100

Total Annual

$1,600

Cost-Effectiveness

GOOD

Cost per Remission

$2,667

Cost per Responder

$2,667

Treatment Outcomes

Primary Outcomes

Mean Number of External Anogenital Warts5 warts

-70% (-3.5 warts)

Mean Total Wart Area100 mm²

-80% (-80 mm²)

Patients with Incomplete Clearance of External Anogenital Warts100% of patients

-40% (-40 percentage points)

Secondary Benefits

HPV DNA Detection in External Anogenital Warts90% of patients

-30% (-27 percentage points)

Genital Wart Symptom and Impact Scale (GW-SIS) Score15/30 points

-50% (-7.5 points)

Itching/Discomfort Score (VAS 0-10)7/10 points

-60% (-4.2 points)

Common Side Effects

Local erythema

+70%

Erosion

+40%

Itching

+30%

Clinical Trial Phases:

Phase 4

Podofilox

55% Effectiveness• 80% Confidence• 75% Safety• 50 trials• 5K participants

HIGH EvidenceGood ValueDose: 0.5% solution or gel, applied 2x daily for 3 days, 4 days rest, repeat for 4 cycles

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Comparative Safety Scale(Higher is safer)

Cyanide☠️

Meth💀

Cigarettes🚬

Chemo☢️

Alcohol🍺

Morphine💊

Antibiotics💉

Tylenol💊

Exercise🏃

Water💧

DangerousModerateSafe

Time to Effect

2-6 weeks

Duration

Up to 4-6 weeks

Response Rate

55%

Remission Rate

55%

Number Needed to Treat (NNT)

Common Side Effects:

Local erythema: 70%

Burning sensation: 60%

Pain: 40%

Erosion: 30%

Itching: 25%

Annual Cost of Care

Drug Cost

$800

Monitoring

$200

Side Effects

$50

Total Annual

$1,050

Cost-Effectiveness

GOOD

Cost per Remission

$1,909

Cost per Responder

$1,909

Treatment Outcomes

Efficacy Outcomes

Overall Effectiveness

+55%

Response Rate

+55%

Remission Rate

+55%

Common Side Effects

Local erythema

+70%

Burning sensation

+60%

Pain

+40%

Clinical Trial Phases:

Phase 4