Genital Warts Treatment

Whether you are trying to get rid of the genital warts completely or wanting to stop them spreading – this guide to the most effective treatment methods for genital warts should help you on your way…

There are effective methods of removing the physical aspect of the HPV virus that causes the warts – that being the wart itself but you can never truly remove the virus. That being said – most people (myself included) are more than happy if the actual wart is no longer visible.

  • With that in mind, let’s examine some of the most effective ways of treating(removing) genital warts.

Treatment Of Genital Warts

The primary reason for treating genital warts is the amelioration of symptoms (including relieving cosmetic concerns) and ultimately, removal of the warts. In most patients, treatment can induce wart-free periods. If left untreated, visible genital warts can resolve on their own, remain unchanged, or increase in size or number. Available therapies for genital warts will reduce but will not completely eradicate the HPV virus – meaning even when all the warts are gone you can still pass the virus (and associated warts) on to others.

Here are the best known methods for treating and getting rid of external genital warts:

Self Applying Creams/Gels (Do It Yourself)

The following is the actual active ingredient that has been proven to be the most effective for removing and treating external genital warts. This ingredient is found in a number of products – both available as over the counter and prescription medicine.

 

  • Podofilox 0.5% solution or gel
    • Podofilox is an antimitotic drug that destroys warts, is relatively inexpensive, easy to use, safe, and self-applied.
    • Podofilox solution should be applied with a cotton swab, or podofilox gel with a finger, to visible genital warts twice a day for 3 days, followed by 4 days of no therapy. This cycle can be repeated, as necessary, for up to four cycles.
    • The total wart area treated should not exceed 10 cm2, and the total volume of podofilox should be limited to 0.5 mL per day.
    • If possible, the health-care provider should apply the initial treatment to demonstrate the proper application technique and identify which warts should be treated.
    • Mild to moderate pain or local irritation might develop after treatment.
  • Imiquimod 5% cream

    • Imiquimod is a topically active immune enhancer that stimulates production of interferon and other cytokines.
    • Imiquimod cream should be applied once daily at bedtime, three times a week for up to 16 weeks.
    • The treatment area should be washed with soap and water 6–10 hours after the application.
    • Local inflammatory reactions, including redness, irritation, induration, ulceration/erosions, and vesicles, are common with the use of imiquimod, and hypopigmentation has also been described.
    • Imiquimod might weaken condoms and vaginal diaphragms.
  • Sinecatechins 15% ointment

    • Sinecatechin ointment, a green-tea extract with an active product (catechins), should be applied three times daily (0.5-cm strand of ointment to each wart) using a finger to ensure coverage with a thin layer of ointment until complete clearance of warts.
    • This product should not be continued for longer than 16 weeks (409–411).
    • The medication should not be washed off after use.
    • Sexual (i.e., genital, anal, or oral) contact should be avoided while the ointment is on the skin.
    • The most common side effects of sinecatechins 15% are erythema, pruritis/burning, pain, ulceration, edema, induration, and vesicular rash.
    • This medication may weaken condoms and diaphragms.
    • No clinical data are available regarding the efficacy or safety of sinecatechins compared with other available anogenital wart treatment modalities.
    • The medication is not recommended for HIV-infected persons, immunocompromised persons, or persons with clinical genital herpes because the safety and efficacy of therapy in these settings has not been established.

Provider–Administered: (The Doctor Does It)

  • Cryotherapy with liquid nitrogen or cryoprobe.
    • Cryotherapy destroys warts by thermal-induced cytolysis.
    • Health-care providers must be trained on the proper use of this therapy because over- and undertreatment can result in complications or low efficacy.
    • Pain after application of the liquid nitrogen, followed by necrosis and sometimes blistering, is common.
    • Local anesthesia (topical or injected) might facilitate therapy if warts are present in many areas or if the area of warts is large.
    • Repeat applications every 1–2 weeks.
  • Podophyllin resin 10%–25% in a compound tincture of benzoin

    • Pedophyllin resin 10%–25% should be applied to each wart and allowed to air-dry before the treated area comes into contact with clothing;
    • overapplication or failure to air dry can result in local irritation caused by spread of the compound to adjacent areas.
    • The treatment can be repeated weekly, if necessary.
    • Application should be limited to <0.5 mL of podophyllin or an area of <10 cm2 of warts per session
    • The area to which treatment is administered should not contain any open lesions or wounds.
    • The preparation should be thoroughly washed off 1–4 hours after application to reduce local irritation.

 

  • Trichloroacetic acid (TCA) or Bichloroacetic acid (BCA) 80%–90%

    • Both TCA and BCA are caustic agents that destroy warts by chemical coagulation of proteins.
    • TCA solutions have a low viscosity comparable with that of water and can spread rapidly if applied excessively; therefore, they can damage adjacent tissues.
    • A small amount should be applied only to the warts and allowed to dry before the patient sits or stands, at which time a white frosting develops.
    • If pain is intense, the acid can be neutralized with soap or sodium bicarbonate.
    • If an excess amount of acid is applied, the treated area should be powdered with talc, sodium bicarbonate (i.e., baking soda), or liquid soap preparations to remove unreacted acid.
    • This treatment can be repeated weekly, if necessary.
  • Surgical removal either by tangential scissor excision, tangential shave excision, curettage, or electrosurgery.

Surgical therapy has the advantage of usually eliminating warts at a single visit. However, such therapy requires substantial clinical training, additional equipment, and a longer office visit. After local anesthesia is applied, the visible genital warts can be physically destroyed by electrocautery, in which case no additional hemostasis is required. Care must be taken to control the depth of electrocautery to prevent scarring. Alternatively, the warts can be removed either by tangential excision with a pair of fine scissors or a scalpel, by laser, or by curettage. Because most warts are exophytic, this procedure can be accomplished with a resulting wound that only extends into the upper dermis. Hemostasis can be achieved with an electrocautery unit or a chemical styptic (e.g., an aluminum chloride solution). Suturing is neither required nor indicated in most cases if surgical removal is performed properly. Surgical therapy is most beneficial for patients who have a large number or area of genital warts. Both carbon dioxide laser and surgery might be useful in the management of extensive warts or intraurethral warts, particularly for those persons who have not responded to other treatments.

 

So What’s the Best Treatment for Genital Warts and their subsequent removal?

Get Rid of YOUR Genital Warts Today!

get rid of your genital warts today!
Because all available treatments for the removal of genital warts have shortcomings, some clinics employ combination therapy (simultaneous use of two or more modalities on the same wart at the same time). Data are limited regarding the efficacy or risk of complications associated with use of such combinations.

No one method or active medicinal ingredient has proven to be more effective than any other as each patient responds differently to various applications. The most common treatment undertaken is the cryotherapy option, with patients opting to have the warts frozen off. In most cases however the warts eventually grow back.

Alternative Genital Wart Removal Treatments

Alternative regimens include treatment options that might be associated with more side effects and/or less data on efficacy. Alternative regimens include intralesional interferon, photodynamic therapy, and topical cidofovir.
Recommended Regimen for Cervical Warts

For women who have exophytic cervical warts, a biopsy evaluation to exclude high-grade SIL must be performed before treatment is initiated. Management of exophytic cervical warts should include consultation with a specialist.

Recommended Treatments for the Removal of Vaginal Warts

  • Cryotherapy with liquid nitrogen.
    The use of a cryoprobe in the vagina is not recommended because of the risk for vaginal perforation and fistula formation.
  • TCA or BCA 80%–90% applied to warts.
    A small amount should be applied only to warts and allowed to dry, at which time a white frosting develops. If an excess amount of acid is applied, the treated area should be powdered with talc, sodium bicarbonate, or liquid soap preparations to remove unreacted acid. This treatment can be repeated weekly, if necessary.

Recommended Treatments for the Removal of Urethral Meatal Warts

 

  • Cryotherapy with liquid nitrogen
  • Podophyllin 10%–25% in compound tincture of benzoin.
    The treatment area and adjacent normal skin must be dry before contact with podophyllin.
    This treatment can be repeated weekly, if necessary.
    *Data are limited on the use of podofilox and imiquimod for treatment of distal meatal warts.

Recommended Treatments for the Removal of Anal Warts

 

  • Cryotherapy with liquid nitrogen
  • TCA or BCA 80%–90% applied to warts.
    A small amount should be applied only to warts and allowed to dry, at which time a white frosting develops.
    If an excess amount of acid is applied, the treated area should be powdered with talc, sodium bicarbonate, or liquid soap preparations to remove unreacted acid.
    This treatment can be repeated weekly, if necessary.
  • Surgical removal

Intra-anal warts should be managed in consultation with a specialist. Many persons with warts on the anal mucosa also have warts on the rectal mucosa, so persons with anal and/or intra-anal warts might benefit from an inspection of the rectal mucosa by digital examination, standard anoscopy, or high-resolution anoscopy.

Important Facts About HPV and Genital Warts

  • It’s Important that you keep the following in mind
  • Genital HPV infection is very common.
  • Many types of HPV are passed on through genital contact, most often during vaginal and anal sexual contact. HPV can also be spread by oral sexual contact.
  • Most sexually active adults will get HPV at some point in their lives, though most will never know it because HPV infection usually has no signs or symptoms.
  • In most cases, HPV infection clears spontaneously, without causing any health problems. Nevertheless, some infections do progress to genital warts, precancers, and cancers.
  • The types of HPV that cause genital warts are different from the types that can cause anogenital cancers.
  • Within an ongoing sexual relationship, both partners are usually infected at the time one person is diagnosed with HPV infection, even though signs of infection might not be apparent.
  • A diagnosis of HPV in one sex partner is not indicative of sexual infidelity in the other partner.
  • Treatments are available for the conditions caused by HPV (e.g., genital warts), but not for the virus itself.
  • HPV does not affect a woman’s fertility or ability to carry a pregnancy to term.

 

Specific counseling messages for those persons diagnosed with genital warts and their partners:

  • Genital warts are not life threatening.
  • If left untreated, genital warts might go away, stay the same, or grow in size or number.
  • Except in very rare and unusual cases, genital warts will not turn into cancer.
  • It is difficult to determine how or when a person became infected with HPV; genital warts can be transmitted to others even when no visible signs of warts are present, even after warts are treated.
  • Genital warts commonly recur after treatment, especially in the first 3 months.
  • Women should get regular Pap tests as recommended, regardless of vaccination or genital wart history.
  • Women with genital warts do not need to get Pap tests more often than recommended.
  • HPV testing is unnecessary in sexual partners of persons with genital warts.
  • Persons with genital warts should inform current sex partner(s) because the warts can be transmitted to other partners. In addition, they should refrain from sexual activity until the warts are gone or removed.
  • Correct and consistent male condom use can lower the chances of giving or getting genital warts, but such use is not fully protective because HPV can infect areas that are not covered by a condom.
  • The Gardasil vaccine, which has been approved for use in males and females aged 9–26 years, protects against the HPV types that cause 90% of genital warts (i.e., types 6 and 11).

 

Get Rid of YOUR Genital Warts Today!

get rid of your genital warts today!