Date of Award


Degree Type

Selective Evidence-Based Medicine Review

Degree Name

Master of Science in Health Sciences - Physician Assistant


Physician Assistant Studies

Department Chair

Laura Levy, DHSc, PA-C


OBJECTIVE: The objective of this selective EBM review is to determine if there is a statistically significant difference in using combination therapies that include cryotherapy vs. cryotherapy alone in the clearance of genital/anogenital warts.

STUDY DESIGN: Systematic review of three peer reviewed primary studies that were published between 2009-2014.

DATA SOURCES: Review of a double-blind placebo-controlled study, a single-blinded randomized controlled study, and a randomized clinical comparative study from 2011. All sources were selected from PubMed based on the applicability to the clinical question and how accurately they answered the question regarding the patient population

OUTCOMES: The outcomes of investigation were POEMs (Patient-Oriented Evidence that Matters) that measured the overall level of clearance and partial clearance of warts.

RESULTS: On et al., showed that after 17 weeks of therapy, the combination therapy of sinecatechins 15% ointment plus cryotherapy achieved 71% partial clearance vs. 52% on cryotherapy alone with a p-value of 0.2037. Gilson et al., at week 4, saw a 60% clearance with the combination of podophyllotoxin cream plus cryotherapy vs. 45% clearance of cryotherapy alone; although, these results weren’t considered statistically significant and by week 24 the clearance rate of either therapy was the same. Mi et al., showed a 32% clearance of anogenital warts with both the ALA-PDT plus cryotherapy and cryotherapy alone. It also showed a 94% clearance of genital warts with the combination therapy and a 50% clearance with the cryotherapy alone.

CONCLUSIONS: In two of the three studies, it showed that there is a statistically significant improvement when using the combination therapies, specifically the combination of sinecatechins 15% ointment plus cryotherapy and the combination of ALA-PDT plus cryotherapy.