What are the treatment options for genital warts?

Genital warts, caused by certain low-risk strains of human papillomavirus (HPV)—most commonly HPV types 6 and 11—are a common sexually transmitted infection. Treatment is aimed at removing visible warts and alleviating symptoms, but it does not eliminate the underlying HPV infection or guarantee prevention of recurrence. Management should be individualized based on wart size, number, location, patient preference, cost, and provider expertise.

First-line physical modalities include cryotherapy with liquid nitrogen, which is safe, widely available, and effective for small, external lesions. For larger or recalcitrant warts, surgical excision, electrocautery, or CO₂ laser ablation may be used—particularly for intra-anal, vaginal, or extensive lesions. Podophyllotoxin 0.5% solution or gel is an FDA-approved topical agent for patient-applied treatment of external genital warts; it is contraindicated in pregnancy and must be used with strict adherence to dosing instructions to avoid toxicity.

Imiquimod 3.75% or 5% cream is another patient-applied immunomodulator approved for external anogenital warts. It works by stimulating local interferon and cytokine production, enhancing cell-mediated immunity against HPV-infected cells. It is applied three times weekly at bedtime and washed off in the morning; treatment duration is typically up to 16 weeks. Sinecatechins 15% ointment—a green tea extract with antiviral and immunomodulatory properties—is also FDA-approved for external anogenital warts and applied three times daily for up to 16 weeks.

Provider-administered treatments include trichloroacetic acid (TCA) or bichloroacetic acid (BCA), which chemically destroy wart tissue through protein coagulation. These are suitable for small, dry, non-keratinized warts but require careful application to avoid adjacent tissue damage. Intralesional interferon is rarely used today due to limited efficacy and significant side effects.

It’s important to emphasize that no therapy eradicates latent HPV, and recurrence rates remain high—up to 30% within 3 months after treatment. Therefore, counseling on transmission risk, consistent condom use, partner evaluation, and HPV vaccination (including catch-up vaccination for eligible individuals up to age 26, and shared clinical decision-making for ages 27–45) are essential components of comprehensive care. Patients should be monitored regularly for recurrence and, in women, undergo routine cervical cancer screening per current guidelines.