What topical treatments are available for home treatment of genital warts?

Topical Treatments for Home Treatment of Genital Warts

For home treatment of genital warts, podofilox 0.5% solution or gel and imiquimod 5% cream are the recommended patient-applied topical treatments, with sinecatechins 15% ointment as an additional option. 1

Patient-Applied Treatment Options

Podofilox 0.5% Solution or Gel

• Podofilox is an antimitotic drug that destroys warts through direct cytotoxic effects 1
• Application protocol:
  • Apply twice daily (morning and evening) for 3 consecutive days, followed by 4 days without treatment 2
  • This weekly cycle may be repeated up to four times until warts clear 2
  • Total treatment area should not exceed 10 cm² of wart tissue 1
  • Total volume should not exceed 0.5 mL per day 2
• Apply using a cotton swab (solution) or finger (gel) to visible genital warts 1
• Initial application should ideally be demonstrated by healthcare provider to ensure proper technique 2
• Relatively inexpensive, easy to use, and safe for self-application 1
• Common side effects: mild to moderate pain or local irritation 1
• Not recommended during pregnancy as safety has not been established 1

Imiquimod 5% Cream

• Imiquimod is a topically active immune enhancer that stimulates production of interferon and other cytokines 1
• Application protocol:
  • Apply with finger at bedtime, three times a week for up to 16 weeks 1
  • Wash treatment area with mild soap and water 6-10 hours after application 1
  • Many patients achieve clearance by 8-10 weeks 1
• Complete clearance rates: approximately 37-50% in immunocompetent patients 3
• Partial clearance (≥50% reduction in wart area) occurs in up to 76% of patients 3, 4
• More frequent application (daily or multiple times daily) does not improve clearance rates and increases side effects 5
• Common side effects: local inflammatory reactions including erythema, itching, burning, and irritation 4
• May weaken condoms and vaginal diaphragms 1
• Not recommended during pregnancy as safety has not been established 1

Sinecatechins 15% Ointment

• Green tea extract with catechins as the active ingredient 1
• Application protocol:
  • Apply three times daily using a finger to cover each wart with a thin layer 1
  • Continue until complete clearance of warts, but not longer than 16 weeks 1
  • Do not wash off after application 1
• Avoid sexual contact while ointment is on the skin 1
• Common side effects: erythema, pruritus/burning, pain, ulceration, edema, induration, and vesicular rash 1
• May weaken condoms and diaphragms 1
• Not recommended for HIV-infected or immunocompromised persons 1
• Not recommended during pregnancy as safety has not been established 1

Treatment Selection Considerations

• Patient preference should guide treatment choice, along with wart characteristics and location 1
• Warts on moist surfaces or intertriginous areas respond better to topical treatments than warts on drier surfaces 1
• Consider changing treatment if no substantial improvement after six treatments 1
• Home therapies are preferred by many patients due to comfort, dignity, and convenience 6
• Women tend to have higher clearance rates with imiquimod (approximately two-thirds) compared to men (approximately one-third) 5

Important Caveats

• Treatment removes visible warts but does not eradicate HPV infection or affect its natural history 1
• Untreated warts may resolve spontaneously, remain unchanged, or increase in size/number 1
• Recurrence rates after complete clearance range from 13-19% with imiquimod 3
• Persistent hypopigmentation or hyperpigmentation is common with treatment 1
• Depressed or hypertrophic scars are rare but can occur, especially with insufficient healing time between treatments 1
• Rare complications include chronic pain syndromes such as vulvodynia or hyperesthesia of the treatment site 1
• Diagnosis should be confirmed, particularly to differentiate warts from squamous cell carcinoma, which should not be treated with these topical agents 2

Home treatment with podofilox or imiquimod should be the first-line approach for most patients with external genital warts, with treatment selection based on patient preference, wart characteristics, and location 6.