What is the treatment for genital warts in males?

From the Guidelines

Treatment for genital warts in males typically involves medication, procedures, or a combination of both, with cryotherapy being a highly effective option, as it destroys warts by thermal-induced cytolysis, and can be repeated every 1-2 weeks, as necessary, for up to 16 weeks 1.

Treatment Options

• Topical treatments:
  • Patient-applied options like imiquimod 3.5% or 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)
• Provider-administered treatments:
  • Trichloroacetic acid (TCA) 80-90% solution applied weekly
  • Cryotherapy with liquid nitrogen or cryoprobe

Procedural Treatments

• Surgical excision
• Electrocautery
• Laser therapy for extensive warts

Considerations

• Treatment choice depends on wart number, size, and location, with multiple sessions typically required for complete clearance
• Patients should avoid sexual contact during treatment and use condoms afterward to reduce transmission risk
• HPV vaccination is recommended for eligible males to prevent future infections
• It's essential to note that treatment eliminates visible warts but doesn't cure the underlying HPV infection, as stated in various guidelines, including those from 1993,1998,2002, and 2010 1

From the FDA Drug Label

1. 6 Patients Being Treated for External Genital Warts Dosing is 3 times per week to external genital/perianal warts. Imiquimod Cream treatment should continue until there is total clearance of the genital/perianal warts or for a maximum of 16 weeks.

The treatment for genital warts in males is Imiquimod Cream applied 3 times per week to external genital/perianal warts, for a maximum of 16 weeks or until total clearance of the warts 2.

• It is recommended that the treatment area be washed with mild soap and water 6-10 hours following Imiquimod Cream application.
• Local skin reactions such as erythema, erosion, excoriation/flaking, and edema at the site of application or surrounding areas are common.
• Uncircumcised males treating warts under the foreskin should retract the foreskin and clean the area daily.
• Imiquimod Cream may weaken condoms and vaginal diaphragms, therefore concurrent use is not recommended.
• Should severe local skin reaction occur, the cream should be removed by washing the treatment area with mild soap and water.

From the Research

Treatment Options for Genital Warts in Males

• Topical treatments include podophyllin resin, imiquimod, trichloroacetic acid, and podophyllotoxin 3
• Surgical or destructive therapies include carbon dioxide laser, surgical excision, loop excision, cryotherapy, and electrodessication 3
• Interferon can be injected locally or administered systemically to treat genital warts 3, 4
• Patient-applied, non-destructive therapies such as imiquimod 5% cream can be effective in treating genital warts 5
• The choice of therapy depends on the number, size, and location of lesions, as well as considerations of cost, effectiveness, convenience, and potential for adverse effects 3, 4

Efficacy and Safety of Treatment Options

• Podofilox 0.5% solution has been shown to be effective in treating penile warts and is well tolerated in a self-administered regimen 6
• Imiquimod 5% cream has been reported to result in complete clearance of genital warts with minor inflammatory changes and no significant pain 5
• Cryotherapy is considered a first-line destructive treatment, but surgery and electrodessication may be more effective 3
• Interferon is too expensive and trichloracetic acid is too inconsistent to be recommended as primary treatment 3

Considerations and Controversies

• There is no consensus on whether treatment of men with evidence of genital human papillomavirus infection influences the natural history of their female sex partner's cervical disease 7
• The value of treatment of genital warts in terms of clearing and curing the disease, eradicating the viruses, preventing cancer, and reducing infectivity is still uncertain 7
• Treatment of genital warts should be guided by patient preferences and considerations of expense, efficacy, convenience, and potential for adverse effects 4