Topical Treatments for Home Treatment of Genital Warts

Patient-Applied Treatment Options

The Centers for Disease Control and Prevention recommends podofilox 0.5% solution or gel and imiquimod 5% cream as patient-applied topical treatments for home treatment of genital warts, with sinecatechins 15% ointment as an additional option 1, 2
Podofilox is an antimitotic drug that destroys warts through direct cytotoxic effects 2
The total treatment area for podofilox should not exceed 10 cm² of wart tissue, and the total volume should be applied using a cotton swab (solution) or finger (gel) to visible genital warts 3
Podofilox is relatively inexpensive, easy to use, and safe for self-application, with common side effects including mild to moderate pain or local irritation 4, 2
Podofilox is not recommended during pregnancy as safety has not been established 3
Imiquimod is a topically active immune enhancer that stimulates production of interferon and other cytokines, with application protocol of three times a week for up to 16 weeks 2, 1
Imiquimod may weaken condoms and vaginal diaphragms, and is not recommended during pregnancy as safety has not been established 2, 3
Sinecatechins 15% ointment is a green tea extract with catechins as the active ingredient, with application protocol of three times daily until complete clearance of warts, but not longer than 16 weeks 1
Sinecatechins may weaken condoms and diaphragms, and is not recommended for HIV-infected or immunocompromised persons, or during pregnancy as safety has not been established 1

Patient preference should guide treatment choice, along with wart characteristics and location, according to the Centers for Disease Control and Prevention 3, 5
Warts on moist surfaces or intertriginous areas respond better to topical treatments than warts on drier surfaces 5

Treatment removes visible warts but does not eradicate HPV infection or affect its natural history, as stated by the Centers for Disease Control and Prevention 3
Untreated warts may resolve spontaneously, remain unchanged, or increase in size/number, with treatment potentially resulting in persistent hypopigmentation or hyperpigmentation, depressed or hypertrophic scars, or rare complications such as chronic pain syndromes 3, 1

Cryotherapy with liquid nitrogen destroys warts by thermal-induced cytolysis, is relatively inexpensive, does not require anesthesia, and does not result in scarring if performed properly, with efficacy ranging from 63-88% in clinical trials, and can be repeated every 1-2 weeks as necessary, according to the Centers for Disease Control and Prevention (CDC) 6, 7
Trichloroacetic acid (TCA) or bichloroacetic acid (BCA) 80-90% can be used to destroy warts by chemical coagulation of proteins, and can be neutralized with soap or sodium bicarbonate if pain is intense, with repeat applications weekly if necessary, as recommended by the CDC 8
Podophyllin 10-25% in compound tincture of benzoin can be applied only to warts, with application limited to ≤0.5 mL or ≤10 cm² per session, and is contraindicated during pregnancy, according to the CDC 6

The CDC recommends considering factors such as wart size, number, and anatomic location, patient preference and ability to comply with treatment, cost and convenience, and potential for adverse effects when selecting a treatment option 6, 7
Treatment should be changed if the patient has not improved substantially after three provider-administered treatments or if warts have not completely cleared after six treatments, as recommended by the CDC 7

The CDC notes that treatment removes visible warts but does not eradicate HPV infection or affect its natural history, and that recurrence rates are high with all treatment modalities 6
Untreated warts may resolve spontaneously, remain unchanged, or increase in size/number, with the CDC recommending consideration of this when deciding on treatment 6
Treatment complications may include persistent hypopigmentation or hyperpigmentation, depressed or hypertrophic scars, and chronic pain syndromes, according to the CDC 7

The Centers for Disease Control and Prevention recommends that for patients seeking immediate clearance, surgical removal is an option, and methods include tangential scissor excision, tangential shave excision, curettage, or electrosurgery 9

The Centers for Disease Control and Prevention suggests that podofilox 0.5% solution or gel should be applied twice daily for 3 consecutive days, followed by 4 days off therapy, and this cycle can be repeated up to 4 times as needed 9
The Centers for Disease Control and Prevention recommends that imiquimod 5% cream be applied at bedtime three times weekly for up to 16 weeks, and the treatment area should be washed with mild soap and water 6-10 hours after application 9

The Centers for Disease Control and Prevention recommends that cryotherapy with liquid nitrogen can be repeated every 1-2 weeks as necessary, and it does not require anesthesia and does not result in scarring if performed properly 9
The Centers for Disease Control and Prevention suggests that trichloroacetic acid (TCA) or bichloroacetic acid (BCA) 80-90% be applied small amount only to warts and allow to dry until white "frosting" develops, and powder with talc or sodium bicarbonate to remove unreacted acid if excess applied 9

The Centers for Disease Control and Prevention recommends that warts on moist surfaces and intertriginous areas respond better to topical treatments (TCA, podophyllin, podofilox, imiquimod) than warts on drier surfaces 9
The Centers for Disease Control and Prevention suggests that patient must be able to identify and reach warts for self-treatment, and consider patient preference for office visits versus home treatment 9

The Centers for Disease Control and Prevention recommends that treatment modality should be changed if the patient has not improved substantially after 3 provider-administered treatments or if warts have not completely cleared after 6 treatments 9
The Centers for Disease Control and Prevention suggests that the risk-benefit ratio should be evaluated throughout therapy to avoid overtreatment 9

The Centers for Disease Control and Prevention warns that persistent hypopigmentation or hyperpigmentation is common and may be permanent, and depressed or hypertrophic scars are rare but can occur, especially with insufficient healing time between treatments 9
The Centers for Disease Control and Prevention warns that disabling chronic pain syndromes (vulvodynia, hyperesthesia) can occur rarely 9