From the Guidelines
The most effective treatment for genital warts is cryotherapy with liquid nitrogen, which should be repeated every 1–2 weeks, as it provides the best balance between efficacy and safety, according to the 2010 guidelines from MMWR Recommendations and Reports 1. When considering treatment options for genital warts, it's essential to weigh the benefits and risks of each approach.
- Provider-administered treatments, such as cryotherapy, podophyllin resin, trichloroacetic acid (TCA), and surgical removal, offer various advantages and disadvantages.
- Patient-applied treatments, including podofilox, imiquimod, and sinecatechins, provide convenience but may have lower efficacy rates and potential side effects. The choice of treatment should be based on the size, location, and number of warts, as well as the patient's overall health and preferences.
- Cryotherapy, in particular, has been shown to be effective in destroying warts through thermal-induced cytolysis, with pain after application and potential necrosis and blistering being common side effects 1. It's crucial to note that no treatment can completely eliminate HPV from the body, but removing visible warts can reduce the risk of transmission.
- During treatment, patients should avoid sexual contact with the treated areas until fully healed to prevent irritation and potential transmission. Overall, the goal of treatment is to remove visible warts, reduce symptoms, and minimize the risk of transmission, while also considering the potential side effects and impact on the patient's quality of life.
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 treatment for Genital Warts includes:
- Podofilox (TOP): Apply twice daily for 3 consecutive days, then withhold use for 4 consecutive days. This cycle may be repeated up to four times until there is no visible wart tissue 2.
- Imiquimod (TOP): Indicated for the treatment of external genital and perianal warts/condyloma acuminata in patients 12 years old and older 3.
From the Research
Treatment Options for Genital Warts
- Topical treatments include podophyllin resin, imiquimod, trichloroacetic acid, and podophyllotoxin 4
- Surgical or destructive therapies include carbon dioxide laser, surgical excision, loop excision, cryotherapy, and electrodessication 4
- Interferon can be injected locally or administered systemically to treat genital warts 4, 5
- Imiquimod is a topically active immunomodulatory agent that stimulates the production of interferon-alpha and various other cytokines, and has indirect antiviral activity 6, 5
Efficacy of Treatment Options
- Complete clearance of warts occurred in 37 to 50% of immunocompetent patients with genital warts treated with imiquimod 5% cream 6
- Partial clearance of warts (defined as a reduction in wart area of > or = 50%) was observed in 76% of recipients of imiquimod 5% cream 6
- Intralesional therapy with interferon-alpha or interferon-beta, with complete response rates of 36 to 63%, is the most successful route for interferon monotherapy 5
- Cryotherapy, surgery, and electrodesiccation are more effective than other treatments, but costs differ 4
Factors Influencing Treatment Choice
- Number, size, and location of lesions 4
- Side effect profile, cost, effectiveness, and convenience (ability to attend physician's office or to undertake protracted home treatment) 4
- Patient's unique needs, including immune status, pregnancy, and ability to return for frequent injections 5