The goal of treatment is to eradicate visible lesions and make patients comfortable. Sometimes it is not practical to eliminate all the warts. Most patients will develop a spontaneous immune response and eliminate the wart virus by the age of 30.
Isolated single lesions are best treated with liquid nitrogen spray or a light touch with the electrocautery. Lesions that are more diffuse are treated with topical medicine.
Imiquimod is available as a cream and is packaged in small individual packets. The medicine is applied every day or every other day. The warts may become inflamed and the medicine should be stopped at this point or used less frequently. Imiquimod is moderately effective and very expensive. A box of 28 packets may cost over $500.
Podofilox is applied once or twice a day 3 or 4 days a week as tolerated. Medication is used for a few weeks. Inflammation may become moderate to severe and application should be stopped at this point. Patient may be treated in the office with podophyllin resin. This medication is very effective but has the potential to cause severe inflammation. It is most effective for flat broad-based lesions. It is only applied by providers and not by patients.
The FDA has approved a special extract of green tea as a prescription drug for the topical treatment of external genital warts. The new drug, called Veregen, is to be applied three times per day to all external genital and perianal warts. It is not for oral, intravaginal, or intra-anal use. Treatment with Veregen® should be continued until complete clearance of all warts, however no longer than 16 weeks. Local skin reactions (e.g. erythema) at the treatment site are frequent. Nevertheless, treatment should be continued when the severity of the local skin reaction is acceptable.
Large bulky lesions on the genitals or in the anal area may be treated with surgical excision.
Gardasil is a human papillomavirus (HPV) vaccine that protects against HPV types 6, 11, 16, and 18. The vaccine is FDA approved for use females ages 9 to 26. Gardasil helps protect against 2 types of HPV that cause about 75% of cervical cancer cases (HPV types 16 and 18) and 2 more types (HPV type 6 and 11) that cause 90% of genital warts cases. The vaccine is also approved for use in boys and young men ages 9 to 26. Gardasil helps protect against 90% of genital warts cases.
Cervarix vaccine is used to prevent cervical cancer caused by human papillomavirus (HPV) types 16 and 18 in females ages 9 through 25. Immunization consists of 3 doses of 0.5-mL each, by intramuscular injection according to the following schedule: 0, 1, and 6 months.