Treatment of Genital Penile Warts

Diagnosis

• The Centers for Disease Control and Prevention recommends that diagnosis of genital warts is primarily clinical, made through visual inspection 2
• Biopsy is indicated only in specific circumstances: uncertain diagnosis, lesions unresponsive to standard therapy, worsening during therapy, atypical lesions, immunocompromised patients, or pigmented/indurated/fixed/bleeding/ulcerated warts 2, 3

Patient-Applied Treatment Options

• The Centers for Disease Control and Prevention recommends podofilox 0.5% solution or gel, applied by patient twice daily for 3 days, followed by 4 days of no therapy; cycle may be repeated up to 4 cycles 1, 4
• The total treatment area should not exceed 10 cm², with total volume not exceeding 0.5 mL per day 1, 4

Provider-Administered Treatment Options

• Cryotherapy with liquid nitrogen destroys warts by thermal-induced cytolysis, and is a relatively inexpensive option that does not require anesthesia and does not result in scarring if performed properly 1, 5, 6
• Trichloroacetic acid (TCA) or bichloroacetic acid (BCA) 80-90% are caustic agents that destroy warts by chemical coagulation of proteins, and can be neutralized with soap or sodium bicarbonate if pain is intense 1

Treatment Selection Considerations

• The Centers for Disease Control and Prevention recommends that factors influencing treatment choice include wart size, number, anatomic site, morphology, patient preference, cost, convenience, adverse effects, and provider experience 2, 4

Important Caveats

• Treatment removes visible warts but does not eradicate HPV infection or affect its natural history, and recurrence rates are high (approximately 25-30%) with all treatment modalities 2, 4, 6
• Untreated warts may resolve spontaneously (20-30% within 3 months), remain unchanged, or increase in size/number 2, 6