RISK OF ACQUIRING HUMAN PAPILLOMAVIRUS FROM THE PLUME PRODUCED BY THE CARBON-DIOXIDE LASER IN THE TREATMENT OF WARTS

Background: The documented presence of human papillomavirus DNA in the plume after carbon dioxide laser treatment of warts has raised questions about the risk of transmission of human papillomavirus to laser surgeons. Objective: We sought to define more clearly the risks to surgeons of acquiring warts from the CO2 laser plume. Methods: A comparative study was conducted between CO2 laser surgeons and two large groups of population-based control subjects (patients with warts in Olmsted County and at the Mayo Clinic from 1988 to 1992). Conclusions were drawn about the risks to surgeons of acquiring warts from the CO2 laser plume. Results: There was no significant difference (p = 0.569) between the incidence of CO2 laser surgeons with warts (5.4%) and patients with warts in Olmsted County from 1988 to 1992 (4.9%). There was a significant difference between the incidence of plantar (p = 0.004), nasopharyngeal (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 from 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 protection (p = 0.196), or full surgical gowns (p = 0.216). Finally, the incidence rates of surgeons with warts per 1000 person-years did not increase significantly (p = 0.951) as the length of time that the CO2 laser was used to treat warts increased. Conclusion: When warts are grouped together without specification of anatomic site, CO2 laser surgeons are no more likely to acquire warts than a person in the general population. However, human papillomavirus types that cause genital warts seem 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.