How are genital warts treated?

There is no specific antiviral medication or vaccine available for the treatment of genital warts. Conventional treatments will remove the warts using surgical techniques, but the virus usually remains in the infected area and may cause recurrences even if the whole growth or wart is removed. Unfortunately there is little evidence that removing the visible lesion (the wart) reduces the risk of transmission. The treatment of genital warts is usually for cosmetic reasons and sometimes because large lesions cause physical problems. Recurrences occur in 1/3 to 2/3 people, whatever treatment is used. On the other hand, visible genital warts can spontaneously disappear in up to 1/3 of people, without treatment, within a few months of their appearance.


Non-prescription remedies should not be used for genital warts. The genital area is too sensitive for these drugs and they can damage the skin. The warts can also be confused with other sexually transmitted diseases that need to be treated properly.
Good nutrition, adequate vitamin intake, avoiding smoking, proper sleep and stress reduction may strengthen your immune system so that it can bring the virus under control.


•    Podophyllin may be applied every two to four days; the solution should be applied only to the lesions, since normal skin will otherwise burn (normal skin should be protected by applying Vaseline around the wart prior to placing the podophyllin to the wart).
•    Tri or Bi-chloroacetic acid can be applied weekly.
•    Imiquimod is a cream that stimulates the local immune system to cause clearance of HPV and is used for treating mild to moderate warts.
•    5 Fluorouracil is no longer recommended
These agents should not be used if you are pregnant, as they are absorbed by the body and may harm the unborn baby.
•    Alpha-interferon, an immune-stimulating medication, may be injected into the lesions in severe cases which have not responded to other treatment. The immune system consists of cells and proteins that attack and destroy infections and foreign cells. When the immune system is working well, it can keep the virus under control, but otherwise virus growth can become unchecked. Interferon cannot eradicate the viruses, but may help to treat some manifestations of the infection. In some studies, the drug cleared warts in half the subjects. Interferon can be used when lesions recur despite other treatments.
•    Recently, a new anti-viral drug known as cidofovir has shown promising results in the treatment of papillomavirus infections, notably for recurring laryngeal papillomas in babies and children.


When lesions are large, treatment with medication may not be effective. Large genital warts may be treated with cryotherapy. In this procedure, lesions are frozen with liquid nitrogen or solid carbon dioxide (dry ice). A laser can also be used. When the diagnosis is not clear, surgical excision is required and a pathologist examines the lesion.


The outcome depends largely on immune system competence: in up to a third of people the lesions disappear within three to four months; in others there is persistence and spread. While the various treatment options may be initially successful, recurrences are common. Fortunately, genital warts very rarely pose a significant health risk.

(Reviewed by Professor Lynette Denny, Gynaecology Oncology Unit, Department Obstetrics & Gynaecology, University of Cape Town/Groote Schuur Hospital, August 2008)


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