What is the treatment for condylomata acuminata (genital warts) on the penis?

From the Guidelines

Penile warts should be treated promptly with cryotherapy using liquid nitrogen or cryoprobe, repeated every 1–2 weeks, as it is a highly effective and recommended treatment option. The treatment of condylomata acuminata (genital warts) on the penis involves several options, including provider-administered and self-applied treatments.

• Provider-administered treatments include:
  • Cryotherapy with liquid nitrogen or cryoprobe, which is repeated every 1–2 weeks 1
  • Podophyllin resin 10%–25% in a compound tincture of benzoin
  • Trichloroacetic acid (TCA) or Bichloroacetic acid (BCA) 80%–90%
  • Surgical removal either by tangential scissor excision, tangential shave excision, curettage, or electrosurgery
• Self-applied treatments include:
  • Podofilox solution or gel, applied twice a day for 3 days, followed by 4 days of no therapy, and repeated for up to four cycles 1
  • Imiquimod cream, applied once daily at bedtime, three times a week for up to 16 weeks 1
  • Sinecatechin ointment, applied three times daily until complete clearance of warts, for a maximum of 16 weeks 1 It is essential to note that the safety of podofilox, imiquimod, and sinecatechins during pregnancy has not been established, and these treatments may weaken condoms and vaginal diaphragms 1. Regular follow-ups are crucial as recurrence is common, and getting the HPV vaccine can help prevent future infections. During treatment, it is recommended to avoid sexual contact or use condoms to prevent transmission, keep the affected area clean and dry, and complete the full treatment course even if warts disappear early.

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 condylomata acuminata (genital warts) on the penis is Imiquimod Cream applied 3 times a week for a maximum of 16 weeks or until total clearance of the warts.

• The treatment area should 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 are common at the site of application or surrounding areas.
• Sexual contact should be avoided while Imiquimod Cream is on the skin.
• Uncircumcised males should retract the foreskin and clean the area daily. 2

From the Research

Treatment Options for Condylomata Acuminata (Genital Warts) on the Penis

• The treatment for condylomata acuminata (genital warts) on the penis can be patient- or physician-administered, with the choice of treatment informed by shared decision-making 3.
• Topical treatments include podophyllin resin, imiquimod, trichloroacetic acid, and podophyllotoxin 4.
• Patient-administered therapies include podofilox (0.5%) solution or gel, imiquimod 3.75 or 5% cream, and sinecatechins (polypheron E) 15% ointment 5.
• Clinician-administered therapies include podophyllin, cryotherapy, bichloroacetic or trichloroacetic acid, oral cimetidine, surgical excision, electrocautery, and carbon dioxide laser therapy 5.

Imiquimod Treatment

• Imiquimod 5% cream applied overnight by the patient three times weekly until warts clear, for up to 16 weeks, has been shown to be an effective therapy with acceptable side-effects 6.
• The optimal dosage regimen for imiquimod is the approved three times a week regimen, as more frequent application (up to three times a day) did not improve clearance and was associated with an increase in local adverse events 7.
• Complete clearance rates for imiquimod treatment have been reported to be around 35% for men when applied three times a week 7.

Other Treatment Considerations

• The choice of treatment method should depend on the physician's comfort level with the various treatment options, the patient's preference and tolerability of treatment, and the number and severity of lesions 5.
• The comparative efficacy, ease of administration, adverse effects, cost, and availability of the treatment modality should also be taken into consideration 5.
• No single treatment has been shown to be consistently superior to other treatment modalities, and patients who do not respond to first-line treatments may respond to other therapies or a combination of treatment modalities 5.