What are the treatments for genital warts?

Treating genital warts

A wide variety of therapies are available to treat genital warts. Treatments for genital warts are classified into provider- and patient-applied therapy groups.

Surgery for genital warts include cryotherapy, electrosurgery, surgical excision, and laser surgery.

Patient-applied nonsurgical treatments include podophyllotoxin, imiquimod, 5-fluorouracil, and cidofovir.

Surgical Treatments

Cryotherapy uses liquid nitrogen to freeze and kill genital warts. The recurrence rates with cryotherapy may be 40 –75% by 6 months after treatment.

Laser-therapy uses focused, infrared light energy to vaporize genital warts. Laser-therapy should be used by clinician specialists in this field. Some authors suggest that the clearance of warts is better when laser therapy is performed under colposcopic examination. The recurrence rates for patients enrolled in studies that used a randomized controlled design ranged from 60% to 80%

Electrosurgery uses electrical energy, in the form of thermal coagulation, to destroy genital warts. Randomized trials showed a slighty greater efficacy for electrotherapy compared with cryotherapy, that did not persist after 3 months of follow-up.

Patient-applied nonsurgical treatments

Podophyllotoxin (podofilox) destroys warts by inducing cell death. Podophyllotoxin is supplied in 0.5% gel, solution, and cream and should be applied twice daily for 3 consecutive days and repeated for 2 to 4 cycles. Clearance rates of genital warts with podophyllotoxin ranged from 45% to 77% within 6 weeks of treatment, and recurrences have been reported for up to 40% of patients followed in clinical trials.

Imiquimod (Aldara) is given as a 5% cream and has been approved for the treatment of genital warts by the United States Food and Drug Administration. Although imiquimod has no direct antiviral effect, it can induce the production of anti-inflammatory cytokines. The clearance rate in randomized placebo-controlled trials is up to 50% within 16 weeks. Imiquimod must be applied directly to the affected area at bedtime, 3 times a week for up to 16 weeks, and patients must wash the affected area with mild soap and water on awakening, to remove residual drug.

Imiquimod may be less effective on thicker, keratinized skin, and most of the studies showed that imiquimod is slighty less effective in men with genital warts than in women. Redness is systematically associated with the use of imiquimod. Side effects are localized itching and a burning sensation around the area of application. Recurrence rates have been reported in up to 20 % of patients within 3 months following the treatment with imiquimod.