What are the symptoms and treatment options for Condyloma acuminata (genital warts)?

From the Guidelines

Genital warts should be treated with cryotherapy, as it is a highly effective and commonly recommended treatment option. Treatment options for genital warts include patient-applied medications like imiquimod 3.5% or 5% cream (applied 3 times weekly for up to 16 weeks) 1, podofilox 0.5% solution or gel (applied twice daily for 3 days, followed by 4 days of no treatment, for up to 4 cycles) 1, or provider-administered treatments such as cryotherapy (freezing the warts with liquid nitrogen every 1-2 weeks) 1, trichloroacetic acid (80-90% solution applied weekly) 1, surgical removal, or laser therapy.

Key Considerations

• The choice of treatment should be guided by the preference of the patient, the available resources, and the experience of the health-care provider 1.
• No treatment completely eliminates the virus, and recurrence is common as the virus can remain dormant in surrounding skin.
• Prevention includes HPV vaccination (ideally before sexual activity begins), consistent condom use, and limiting sexual partners.
• It's essential to note that while most genital warts are benign, some HPV types can increase cancer risk, so regular screenings are recommended.
• Treatment should be sought promptly as warts can spread to partners and may grow larger or multiply if left untreated.

Treatment Options

• Cryotherapy: freezing the warts with liquid nitrogen every 1-2 weeks 1
• Imiquimod: applied 3 times weekly for up to 16 weeks 1
• Podofilox: applied twice daily for 3 days, followed by 4 days of no treatment, for up to 4 cycles 1
• Trichloroacetic acid: 80-90% solution applied weekly 1
• Surgical removal or laser therapy: may be considered for large or persistent warts 1

From the FDA Drug Label

1.3 External Genital Warts Imiquimod Cream is indicated for the treatment of external genital and perianal warts/condyloma acuminata in patients 12 years old and older. Podofilox Topical Solution 0.5% is indicated for the topical treatment of external genital warts (Condyloma acuminatum). The treatment for genital warts includes:

• Imiquimod cream for external genital and perianal warts in patients 12 years old and older 2
• Podofilox Topical Solution 0.5% for external genital warts (Condyloma acuminatum) 3

From the Research

Treatment Options for Genital Warts

• Imiquimod 5% cream is a topical treatment for genital warts, which has been shown to be effective in stimulating the production of interferon-alpha and various other cytokines, and has indirect antiviral activity 4.
• The cream is applied three times a week for up to 16 weeks, and has been found to result in complete clearance of warts in 37 to 50% of immunocompetent patients with genital warts 4.
• Imiquimod 5% cream has also been found to be effective in treating external genital and perianal warts in different patient populations, including males and females, and those with varying baseline wart areas and durations of current outbreak of warts 5.

Comparison with Other Treatments

• Imiquimod 5% cream has been compared to podophyllotoxin cream in the treatment of anogenital warts, and has been found to have similar efficacy, but with a wide confidence interval 6.
• The addition of quadrivalent human papillomavirus vaccine to imiquimod or podophyllotoxin cream has been found to have inconclusive cost-effectiveness, and a benefit of the vaccine was not demonstrated in one trial 6.

Use in Special Populations

• Imiquimod 5% cream has been found to be effective in treating external genital or perianal warts in human immunodeficiency virus-positive patients treated with highly active antiretroviral therapy, with a total clearance of warts observed in 32% of patients at week 16 7.
• The cream has been found to be safe and suitable for use in HIV-positive subjects with anogenital warts and successful HAART treatment 7.

Application Frequency and Local Skin Reactions

• The optimal dosage regimen for imiquimod 5% cream has been found to be three times a week, as more frequent application (up to three times a day) did not improve clearance and was associated with an increase in local adverse events 8.
• Local skin reactions, including erythema, itching, and burning, are the most commonly reported adverse events, occurring in less than or equal to 67% of patients applying imiquimod 5% cream three times a week 4.