Anogenital warts (AGW) are benign epithelial skin lesions caused mainly by the human papillomavirus (HPV, types 6 and 11) but are sometimes associated with other oncogenic HPV types. They have a high rate of post-treatment recurrence. There are many guidelines, but they do not prioritise treatments. Therapeutics are classified as either self-administered or clinician applied. The aim of this study was to propose recommendations for the management of AGW.

These recommendations were based on a systematic review of the literature by a working group (WG) with no links of interest. The databases used were PubMed and Embase up to 1st June 2024. The risks of bias of the included studies were analysed using the PRISMA, ROBIS, AMSTAR 2, AGREE II, RIGHT and ROB grids. They were assessed by an expert review group using the GRaAL method of the French Health Authority (FHA).

A total of 204 studies were selected from 1446 (including randomised clinical trials (RCTs), systematic reviews (SR), non-randomised clinical trials involving more than 30 patients, meta-analyses (MA), and guidelines) by the working group (WG). The methodological quality of the studies varied widely. An algorithm proposing a hierarchy of treatments was developed for the general population, pregnant women, children, immunocompromised patients and for specific sites (urethral, vaginal and anal). Combination therapy has been widely adopted.

Despite a lack of data on specific populations and variability in the quality of the studies analysed, these recommendations provide a hierarchy of treatments for AGW based on a systematic review of the literature.