Predictors of human papillomavirus persistence or clearance after 5-aminolevulinic acid-based photodynamic therapy in patients with genital warts.

• Many factors affect the efficiency of ALA-PDT treatment in genital warts. • Patients with multiple sexual partners, recurrent HPV infection history and severe pain response during PDT were associated with high odds HPV persisting after three times of ALA-PDT and the sessions of ALA-PDT treatment in these patients should be prolonged. • Single type of HPV infection, mucosal HPV infection and subclinical infection were more likely to be cleared after three rounds of ALA-PDT treatment. • These findings contribute to improving ALA-PDT treatment efficiency in clinical practice. Numerous studies have confirmed that 5-aminolevulinic acid-based photodynamic therapy (ALA-PDT) is an effective treatment for human papillomavirus-associated diseases. In this study, we evaluated the variables associated with human papillomavirus (HPV) persistence or clearance after ALA-PDT in patients with genital warts. We performed a retrospective chart review of all patients with genital warts or subclinical HPV infection who received ALA-PDT treatment between January 2019 and December 2020 at Nanfang Hospital and Dermatology Hospital of Southern Medical University and analyzed the predictors of HPV persistence or clearance. HPV genotype and viral load assays were analyzed before treatment and after each session of photodynamic therapy. Multiple sexual partners, a history of recurrent HPV infection, and severe pain response during photodynamic therapy were associated with higher odds of viral persistence after three rounds of ALA-PDT. Infection with single strains of HPV, and mucosal and subclinical infection were more likely to be cleared after three rounds of photodynamic therapy. Our findings suggest that patients with multiple sexual partners, a history of recurrent infections, and severe pain response during photodynamic therapy should undergo close surveillance and monitoring, and may need additional photodynamic therapy sessions. Infection with a single strain of HPV, and mucosal or subclinical infections are more likely to be cleared after three courses of ALA-PDT treatment. These findings may improve the efficiency of ALA-PDT in clinical practice. [ABSTRACT FROM AUTHOR]