From the Guidelines
The treatment for penile warts caused by HPV typically involves topical medications, physical removal procedures, or a combination of both approaches. First-line topical treatments include patient-applied options such as imiquimod 5% cream (applied three 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 provider-administered treatments like trichloroacetic acid (TCA) 80-90% solution applied weekly 1. Physical removal methods include cryotherapy with liquid nitrogen every 1-2 weeks, surgical excision, electrosurgery, or laser therapy for extensive warts 1.
Key Considerations
- Treatment choice depends on wart number, size, location, and patient preference.
- Recurrence is common regardless of treatment method because these approaches remove the visible warts but don't eliminate the underlying HPV infection.
- Multiple treatment sessions are often required, and patients should be advised that new warts may develop even after successful treatment.
- Sexual partners should be examined, and condom use is recommended to reduce transmission risk.
- HPV vaccination is also recommended for eligible individuals to prevent future infections with certain HPV types, though it won't treat existing warts 1.
Counseling
Patients diagnosed with genital warts should be counseled about the nature of the infection, its transmission, and the available treatments. They should also be informed about the importance of regular Pap tests for women, the potential for recurrence, and the benefits of HPV vaccination for eligible individuals 1.
Treatment Approach
The most effective treatment approach should be chosen based on the individual patient's needs and preferences, taking into account the size, number, and location of the warts, as well as the patient's overall health and medical history. In general, a combination of topical treatments and physical removal methods may be the most effective approach for managing penile warts caused by HPV.
From the FDA Drug Label
Imiquimod has no direct antiviral activity in cell culture A study in 22 subjects with genital/perianal warts comparing imiquimod cream and vehicle shows that imiquimod cream induces mRNA encoding cytokines including interferon-ɑ at the treatment site. In addition HPVL1 mRNA and HPV DNA are significantly decreased following treatment.
The treatment for penile warts caused by Human Papillomavirus (HPV) is imiquimod cream, which induces mRNA encoding cytokines and decreases HPVL1 mRNA and HPV DNA at the treatment site 2.
- Key points:
- Imiquimod cream has no direct antiviral activity
- It induces cytokines, including interferon-ɑ
- HPVL1 mRNA and HPV DNA are significantly decreased following treatment
- The clinical relevance of these findings is unknown, but imiquimod cream may be used to treat external genital warts, including penile warts.
From the Research
Treatment Options for Penile Warts
- Penile warts, caused by Human Papillomavirus (HPV), can be treated with various methods, including topical creams and physician-administered therapies 3.
- Treatment options may be limited by physician skills and clinic availability, and the choice of treatment should be informed by shared decision-making 3.
Topical Treatments
- Imiquimod 5% cream is a topical immunomodulatory agent that can be used to treat genital warts, including penile warts 4, 5, 6.
- Imiquimod 5% cream has been shown to be effective in treating penile warts, with complete clearance rates ranging from 35% to 62% 4, 5, 6.
- Podofilox 0.5% solution is another topical treatment option that has been shown to be effective in treating penile warts, with complete clearance rates of 53.3% 7.
Application Frequency and Safety
- The optimal application frequency for imiquimod 5% cream is three times a week, as more frequent application has not been shown to improve clearance rates and may increase the incidence of local skin reactions 5, 6.
- Imiquimod 5% cream is generally well tolerated, with local skin reactions such as erythema, itching, and burning being the most commonly reported adverse events 4, 5, 6.
Comparison of Treatment Options
- Podofilox 0.5% solution has been shown to be more effective than imiquimod 5% cream in some studies, but may have a higher incidence of local adverse reactions 3, 7.
- Imiquimod 5% cream may be a better option for patients who prefer a self-administered treatment or have limited access to physician-administered therapies 4, 3.