From the Guidelines
The management of genital warts primarily involves patient-directed therapies or provider-administered treatments, with cryotherapy with liquid nitrogen being a recommended provider-administered treatment, applied every 1-2 weeks 1. The treatment of genital warts depends on various factors, including wart size, number, location, patient preference, and provider experience.
- Patient-applied options include imiquimod 3.5% or 5% cream, applied at bedtime three times weekly for up to 16 weeks, and podofilox 0.5% solution or gel, applied twice daily for 3 days, followed by 4 days of rest, repeating for up to 4 cycles 1.
- Provider-administered treatments include cryotherapy with liquid nitrogen every 1-2 weeks, trichloroacetic acid (TCA) 80-90% applied weekly, and surgical removal via excision, electrosurgery, or laser therapy 1. It is essential to note that no treatment completely eliminates HPV, and recurrence is common, ranging from 25-67% within 3 months 1.
- Patients should be informed that warts may resolve spontaneously without treatment in some cases.
- Sexual partners should be examined for warts and other STIs, and condom use is recommended to reduce transmission risk, though it doesn't eliminate it completely since HPV can infect areas not covered by condoms 1. The choice of treatment should be based on the individual patient's needs and circumstances, taking into account the potential benefits and risks of each treatment option, as well as the patient's preferences and values 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 management modality for condyloma (genital warts) includes:
- Topical treatment with podofilox (TOP) or imiquimod (TOP)
- Application of the medication as directed by the prescriber, with podofilox applied twice daily for 3 consecutive days, then withheld for 4 consecutive days, and imiquimod applied as directed by the prescriber 2, 2, 3
From the Research
Management Modalities for Condyloma (Genital Warts)
The management of condyloma, also known as genital warts, involves various treatment options, including topical treatments, surgical or destructive therapies, and interferon therapy. The choice of therapy depends on several factors, such as the number, size, and location of lesions, as well as patient preferences, cost, convenience, adverse effects, and clinician experience 4.
Topical Treatments
Topical treatments for genital warts include:
- Podophyllin resin
- Imiquimod
- Trichloroacetic acid
- Podophyllotoxin Imiquimod 5% cream is a patient-applied therapy that has been shown to be effective in treating genital warts, with a complete clearance rate of 50% in one study 5. The optimal dosage regimen for imiquimod is 5% cream applied overnight by the patient three times weekly until warts clear, for up to 16 weeks 5.
Surgical or Destructive Therapies
Surgical or destructive therapies for genital warts include:
- Carbon dioxide laser
- Surgical excision
- Loop excision
- Cryotherapy
- Electrodessication Cryotherapy is considered a first-line destructive treatment, but surgery and electrodesiccation are more effective 6.
Interferon Therapy
Interferon can be injected locally or administered systemically to treat genital warts. However, it is considered too expensive and is not recommended as a primary treatment 6.
Treatment Outcomes
The treatment outcomes for genital warts vary depending on the therapy used. Imiquimod 5% cream has been shown to have a low recurrence rate compared to other treatment modalities, which may be due to the stimulation of the cell-mediated immune response by imiquimod 7. The cost per successful treatment course is approximately $200 to $300 for podofilox, cryotherapy, electrodesiccation, surgical excision, laser treatment, and the loop electrosurgical excision procedure 4.
Key Considerations
When choosing a treatment for genital warts, the following factors should be considered:
- Number, size, and location of lesions
- Patient preferences
- Cost
- Convenience
- Adverse effects
- Clinician experience The goal of treatment is clearance of visible warts, and some evidence exists that treatment reduces infectivity, but there is no evidence that treatment reduces the incidence of cervical and genital cancer 4.