Genital warts medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Genital warts may disappear without treatment, but sometimes eventually develop a fleshy, small raised growth. There is no way to predict whether they will grow or disappear.

Medical Treatment

Depending on the size and location of the wart, and other factors, a doctor will offer one of several ways to treat them.

PID TREATMENT Preferred Regimen External genital warts(Patient applied) ▸ Podofilox (0.5% solution or gel): apply 2x/day x 3 days, 4th day no therapy, repeat cycle 4x OR ▸ Imiquimod 5% cream: apply once daily at bedtime 3x/week x up to 16 weeks External genital warts(Provider administered) ▸ Cryotherapy with liquid nitrogen; repeat q1-2 weeks OR ▸ Podophyllin resin 10-25% in tincture of benzoin. Repeat weekly as needed OR ▸ Trichloroacetic acid(TCA): repeat weekly as needed OR ▸ Surgical removal Vaginal warts ▸ Cryotherapywith liquid nitrogen OR ▸ Trichloroacetic acid Urethral warts ▸ Cryotherapy with liquid nitrogen OR ▸ Podophyllin resin 10-25% in tincture of benzoin. Anal warts ▸ Cryotherapy with liquid nitrogen OR ▸ Trichloroacetic acid or surgical removal. Advise anoscopy to look for rectal warts Skin Papillomas ▸ Topical α-lactalbumin. Oleic acid (from human milk) applied 1x/day for 3 weeks

• Imiquimod (Aldara) a topical immune response cream, applied to the affected area
• A 20% podophyllin anti-mitotic solution, applied to the affected area and later washed off
• A 0.5% podofilox solution, applied to the affected area but not to be washed off
• A 5% 5-fluorouracil (5-FU) cream
• Trichloroacetic acid (TCA)
• Pulsed dye laser
• Liquid nitrogen cryosurgery
• Electric or laser cauterization
• Condylox
• Sinecatechins (Veregen) also Polyphenon E: ointment made of several green-tea-extracted catechines and other components. Mode of action is undetermined. It is FDA-approved but very expensive

Podophyllin and podofilox should not be used during pregnancy, as they are absorbed by the skin and may cause birth defects in the fetus. 5-fluorouracil cream should not be used while trying to become pregnant or if there is a possibility of pregnancy.

Some doctors inject the antiviral drug interferon-alpha directly into the warts, to treat warts that have returned after removal by traditional means. The drug is expensive, and does not reduce the rate that the warts return.