Hm. Gloster et Rk. Roenigk, RISK OF ACQUIRING HUMAN PAPILLOMAVIRUS FROM THE PLUME PRODUCED BY THECARBON-DIOXIDE LASER IN THE TREATMENT OF WARTS, Journal of the American Academy of Dermatology, 32(3), 1995, pp. 436-441
Background: The documented presence of human papillomavirus DNA in the
plume after carbon dioxide laser treatment of warts has raised questi
ons about the risk of transmission of human papillomavirus to laser su
rgeons. Objective: We sought to define more clearly the risks to surge
ons of acquiring warts from the CO2 laser plume. Methods: A comparativ
e study was conducted between CO2 laser surgeons and two large groups
of population-based control subjects (patients with warts in Olmsted C
ounty and at the Mayo Clinic from 1988 to 1992). Conclusions were draw
n about the risks to surgeons of acquiring warts from the CO2 laser pl
ume. Results: There was no significant difference (p = 0.569) between
the incidence of CO2 laser surgeons with warts (5.4%) and patients wit
h warts in Olmsted County from 1988 to 1992 (4.9%). There was a signif
icant difference between the incidence of plantar (p = 0.004), nasopha
ryngeal (p = 0.001), and genital and perianal warts (p = 0.004) in the
study group and in patients with warts treated at the Mayo Clinic fro
m 1988 to 1992. No significant difference was found between physicians
who had acquired warts and those who were wart free, on the basis of
the failure to use gloves (p = 0.418), standard surgical masks (p = 0.
748), laser masks (p = 0.418), smoke evacuators (p = 0.564), eye prote
ction (p = 0.196), or full surgical gowns (p = 0.216). Finally, the in
cidence rates of surgeons with warts per 1000 person-years did not inc
rease significantly (p = 0.951) as the length of time that the CO2 las
er was used to treat warts increased. Conclusion: When warts are group
ed together without specification of anatomic site, CO2 laser surgeons
are no more likely to acquire warts than a person in the general popu
lation. However, human papillomavirus types that cause genital warts s
eem to have a predilection for infecting the upper airway mucosa, and
laser plume containing these viruses may represent more of a hazard to
the surgeon.