Introduction 4 5 25 43 9 7 45 17 15 17 23 10 Epidemiology 26 10 32 1 47 22 16 37 34 13 21 20 Aetiological and histopathological features 28 19 2 33 42 Electron microscopic analysis reveals the virion to be ∼55 nm in diameter and the capsid to be comprised of 72 pentameric capsomers. The predominant protein in the capsid consists of the L1 protein, with a smaller proportion of L2 embedded deep within the protein shell. It is this L1 protein which provides the dominant antigenic epitopes recognized by neutralizing antibodies and forms the basis for the bivalent (GlaxoSmithKline) and quadrivalent (Merck, Hohenbrumn, Germany) vaccines currently available. 11 18 30 50 8 41 3 12 36 24 27 28 14 31 46 Treatment Surgical 49 40 44 2 49 The frequent recurrence of papillomas has resulted in the use of different adjuvant treatments alongside surgical removal of macroscopically obvious in the attempt to improve outcomes. In the future, advances in the understanding of the immune response to HPV may improve our treatment modalities and prevention strategies. Adjuvant treatment 39 35 39 48 Controlled trials failed to provide sufficient evidence to draw reliable conclusions about the effectiveness of antiviral agents as adjuvant therapy in the management of RRP. Further research is required before any specific antiviral adjuvant therapy can be recommended. 6 29 38 ®