From the Guidelines
Treatment for penile HPV typically involves a combination of approaches, including patient-applied medications like imiquimod 5% cream or podofilox 0.5% solution/gel, and provider-administered treatments like cryotherapy, trichloroacetic acid, or surgical excision, with the goal of removing visible warts and allowing the immune system to control the viral infection 1.
Treatment Options
- Patient-applied medications:
- Imiquimod 5% cream, applied three times weekly for up to 16 weeks
- Podofilox 0.5% solution/gel, applied twice daily for 3 days, followed by 4 days of no treatment, for up to 4 cycles
- Provider-administered treatments:
- Cryotherapy with liquid nitrogen every 1-2 weeks
- Trichloroacetic acid (TCA) 80-90% applied weekly
- Surgical excision or electrosurgery for larger lesions
Considerations
- No single treatment is universally effective, and recurrence rates of 10-30% are common regardless of the method used
- For subclinical or flat HPV lesions, treatment may not be necessary as many infections clear spontaneously within 1-2 years
- Partners should be examined for HPV lesions, though condom use provides only partial protection against transmission
- HPV vaccination is recommended for prevention but does not treat existing infections
Prevention
- HPV vaccination is recommended for adults up to 45 years old, with the 9-valent vaccine (Gardasil 9) providing protection against the most common high-risk types, as well as types that cause anogenital warts 1
- Correct and consistent use of condoms can lower the chances of giving or getting genital HPV, but is not fully protective 1
From the FDA Drug Label
In a double-blind, placebo-controlled clinical study, 209 otherwise healthy subjects 18 years of age and older with genital/perianal warts were treated with imiquimod cream or vehicle control 3 times per week for a maximum of 16 weeks.
Data on complete clearance are listed in the table below. The median time to complete wart clearance was 10 weeks
Table 14: Complete Clearance Rates (External Genital Warts) – Study EGW1 Treatment Subjects with Complete Clearance of Warts Subjects Without Follow-up Subjects with Warts Remaining At Week 16 Overall Imiquimod Cream (n=109) 54(50%) 19(17%) 36(33%) Vehicle (n=100) 11(11%) 27(27%) 62(62%) Females Imiquimod Cream (n=46) 33(72%) 5(11%) 8(17%) Vehicle (n=40) 8(20%) 13(33%) 19(48%) Males Imiquimod Cream (n=63) 21(33%) 14(22%) 28(44%) Vehicle (n=60) 3(5%) 14(23%) 43(72%)
The treatment options for human papillomavirus (HPV) of the penis include imiquimod cream, which has been shown to have a complete clearance rate of 50% in a clinical study of external genital warts 2.
- Key points:
- Imiquimod cream is applied 3 times per week for a maximum of 16 weeks.
- The median time to complete wart clearance was 10 weeks.
- Complete clearance rates were higher in females (72%) compared to males (33%) 2.
From the Research
Treatment Options for HPV of the Penis
- Destruction and excision of lesions are the main treatment options for human papillomavirus (HPV) 3
- Prophylactic HPV vaccination has proven its efficacy against cervical cancer and may also partially prevent penile cancer 4
- Therapeutic HPV vaccines, which generate T cell-mediated immunity against HPV infection, are being developed to treat existing HPV infections 5
Topical Treatments
- Imiquimod, an immune response modifier, has shown efficacy in treating HPV-related genital intraepithelial neoplasia, with complete response rates ranging from 5 to 88% 6
- Imiquimod 5% cream has been used to treat persistent HPV infection after surgical therapy for cervical or vaginal intraepithelial neoplasia, with 76.3% of patients clearing the infection 7