[Department of Dermatology and Venereology] What is the scientifically supported treatment for genital warts?

Genital warts, also known as condyloma acuminatum, are a common sexually transmitted infection caused by certain low-risk strains of human papillomavirus (HPV), most frequently HPV types 6 and 11. Effective management requires a tailored, evidence-based approach that addresses visible lesions while acknowledging the viral nature of the condition—meaning treatment targets the clinical manifestations rather than eradicating latent HPV infection.

First-line therapies include patient-applied topical agents such as imiquimod 3.75% or 5% cream, which works by stimulating local immune responses to clear infected keratinocytes; podofilox 0.5% solution or gel, a podophyllotoxin derivative that inhibits mitosis in rapidly dividing wart tissue; and sinecatechins 15% ointment, a green tea extract with antiviral and immunomodulatory properties. These are typically used for external anogenital warts in immunocompetent individuals and require strict adherence to dosing instructions to minimize irritation and optimize efficacy.

Provider-administered treatments are recommended for larger, recalcitrant, or intra-anal warts and include cryotherapy with liquid nitrogen (repeated every 1–2 weeks), application of trichloroacetic acid (TCA) or bichloroacetic acid (BCA) at concentrations of 80–90%, and surgical modalities such as electrosurgery, laser ablation (e.g., CO₂ laser), or excision. In select cases—particularly for extensive or recurrent disease—off-label use of intralesional interferon or systemic retinoids may be considered, though these carry greater risks and limited supporting evidence.

It is essential to emphasize that no treatment guarantees complete HPV eradication or prevents transmission. Therefore, counseling on safer sex practices—including consistent condom use and disclosure to partners—is integral to care. Vaccination with the quadrivalent (HPV 6/11/16/18) or nonavalent (HPV 6/11/16/18/31/33/45/52/58) HPV vaccine is strongly recommended for eligible individuals, both as primary prevention and as an adjunct to reduce recurrence after treatment. Follow-up is advised every 3 months for at least 6 months post-treatment to monitor for recurrence, which occurs in approximately 20–30% of cases within 3 months.