From the Guidelines
Genital warts can be effectively treated with patient-applied medications such as imiquimod 3.75% or 5% cream, podofilox 0.5% solution or gel, or sinecatechins 15% ointment, as well as provider-administered treatments like cryotherapy with liquid nitrogen, trichloroacetic acid (TCA) 80-90%, or surgical removal, with the choice of treatment depending on wart number, size, location, and patient preference, as recommended by the most recent guidelines 1. The primary treatments for genital warts include:
- Patient-applied medications:
- Imiquimod 3.75% or 5% cream, applied at bedtime 3 times weekly for up to 16 weeks
- Podofilox 0.5% solution or gel, applied twice daily for 3 days, followed by 4 days of no treatment, for up to 4 cycles
- Sinecatechins 15% ointment, applied three times daily for up to 16 weeks
- Provider-administered treatments:
- Cryotherapy with liquid nitrogen, every 1-2 weeks
- Trichloroacetic acid (TCA) 80-90%, applied weekly
- Surgical removal, or laser therapy for extensive cases These treatments work by stimulating the immune system to fight the human papillomavirus (HPV) that causes the warts or by directly destroying the affected tissue, with complete clearance requiring multiple treatment sessions, and recurrence possible since the virus can remain dormant in surrounding skin, as noted in the guidelines 1. For prevention, HPV vaccination is recommended before sexual debut, and using condoms can reduce (though not eliminate) transmission risk, as stated in the guidelines 1. Patients should avoid sexual contact when visible warts are present and should inform partners about their infection, as advised in the guidelines 1.
From the FDA Drug Label
Podofilox Topical Solution 0.5% is indicated for the topical treatment of external genital warts (Condyloma acuminatum). Imiquimod Cream is indicated for the treatment of external genital and perianal warts/condyloma acuminata in patients 12 years old and older.
The treatment for genital warts includes:
- Podofilox (TOP): applied twice daily for 3 consecutive days, then withheld for 4 consecutive days, and repeated for up to four weeks 2
- Imiquimod (TOP): for patients 12 years old and older 3 Key considerations:
- Podofilox is not indicated for perianal or mucous membrane warts 2
- Imiquimod has not been established for patients with certain conditions, such as immunosuppressed patients or those with Basal Cell Nevus Syndrome 3
From the Research
Treatment Options for Genital Warts
- Topical treatments: podophyllin resin, imiquimod, trichloroacetic acid, and podophyllotoxin 4
- Surgical or destructive therapies: carbon dioxide laser, surgical excision, loop excision, cryotherapy, and electrodessication 4
- Interferon can be injected locally or administered systemically to treat genital warts 4
Effectiveness of Treatment Options
- Cryotherapy is considered a first-line destructive treatment, but surgery and electrodesiccation are more effective 4
- Podophyllotoxin and imiquimod are considered first-line topical treatments 4
- Imiquimod 5% cream applied three times a week is an effective therapy with acceptable side-effects 5, 6
- Imiquimod 3.75% is a new agent with fewer side effects, but is not more effective than imiquimod 5% 7
Factors Influencing Treatment Choice
- Number, size, and location of lesions 4, 8
- Patient preferences, cost, convenience, adverse effects, and clinician experience 4, 8
- Cost per successful treatment course: approximately $200 to $300 for podofilox, cryotherapy, electrodesiccation, surgical excision, laser treatment, and the loop electrosurgical excision procedure 8
New and Emerging Treatments
- Sinecatechins/Polyphenon E 15%, a novel extract from green tea, can be effective against genital warts, but requires three times a day dosing and is not more effective than existing treatments 7
- Photodynamic therapy combined with other destructive modalities might increase the cure rate for genital warts 7
- Hyperthermia and immunomodulators might be positive additions to the armamentarium of clinicians 7