From the Guidelines
Genital warts can be effectively treated with cryotherapy, which is a recommended first-line treatment due to its high efficacy and safety profile, as evidenced by the 2010 guidelines 1. The treatment of genital warts depends on various factors, including the number, size, and location of warts, as well as the patient's preference and the healthcare provider's experience.
- Topical medications like imiquimod 5% cream (applied 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), or sinecatechins 15% ointment (applied three times daily for up to 16 weeks) are commonly prescribed for visible warts.
- Office-based treatments, such as cryotherapy (freezing the warts with liquid nitrogen every 1-2 weeks), trichloroacetic acid (80-90% solution applied by a healthcare provider), surgical removal, or laser therapy, may be recommended for larger or numerous warts. The choice of treatment should be guided by the patient's preference, available resources, and the healthcare provider's experience, as there is no definitive evidence that any single treatment is superior to others 1. It is essential to complete the full treatment course, even if warts disappear early, as the virus may still be present, and sexual partners should be informed to reduce transmission risk 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): Apply twice daily for 3 consecutive days, then withhold use for 4 consecutive days. This cycle may be repeated up to four times until there is no visible wart tissue 2.
- Imiquimod (TOP): Indicated for the treatment of external genital and perianal warts/condyloma acuminata in patients 12 years old and older 3.
From the Research
Genital Wart Treatment Options
- Imiquimod is a topically active immunomodulatory agent that has been shown to be effective in treating genital warts 4, 5, 6, 7
- It is formulated as a 5% cream for application by the patient, and has indirect antiviral activity by stimulating the production of interferon-alpha and various other cytokines 4
- Clinical trials have demonstrated complete clearance of warts in 37 to 50% of immunocompetent patients with genital warts treated with imiquimod 5% cream 3 times a week for up to 16 weeks 4, 5
Efficacy and Safety of Imiquimod
- Imiquimod 5% cream has been shown to be generally well tolerated by immunocompetent and HIV-infected patients, with local skin reactions (mainly mild or moderate) being the most commonly reported adverse events 4, 5
- The incidence of adverse events is lower in patients applying the cream 3 times a week than with daily application 8
- Recurrence rates of genital warts after treatment with imiquimod 5% cream have been reported to be around 13 to 19% 4, 6
Comparison of Treatment Regimens
- A study comparing different application frequencies of imiquimod 5% cream found that the optimal dosage regimen was the approved three times a week regimen, with more frequent application (up to three times a day) not improving clearance and being associated with an increase in local adverse events 8
- Another study found that 5% imiquimod treatment was significantly more effective than vehicle, with 50% of patients experiencing clearing of all baseline warts 6
Immunotherapy for Genital Warts
- Immunotherapy for genital warts has been investigated, with interferon and imiquimod being two potential therapies 7
- Intralesional therapy with interferon-alpha or interferon-beta has been shown to be effective, with complete response rates of 36 to 63% 7
- Imiquimod has been shown to be an efficacious and well tolerated patient-controlled measure for wart therapy, with complete response rates ranging from 37 to 54% in controlled trials 7