Choosing equipment for treating genital warts in genitourinary medicine clinics.

Anogenital warts represent a major therapeutic problem in genitourinary medicine. A wide range of treatment modalities is available (the usual indication that none is ideal). This therapeutic problem is not new; in the sixth century, Dionysius graphically described treatment of genital warts: "The surgeons spared neither iron nor fire, and were not moved to pity by the cries of the patients". Both of these treatment modalities remain in existence today, although fortunately they have been modified since the sixth century! The long-term natural history of genital wart lesions has been poorly studied, but it is the experience of most clinicians that the majority of patients with genital warts are managed easily with simple chemo-destructive measures such as trichloracetic acid or podophyllin. A significant minority of patients will, however, fail to respond to such simple measures. Keratinised warts on dry skin, such as the shaft of the penis or perianal area, may often respond poorly; there may be virological and immunomodulatory reasons for this which are, at present, poorly understood. Patients with recalcitrant warts generally require