Genital Warts (Human Papillomavirus) - Treatment Overview

Treatment Overview

Genital warts caused by the most common types of human papillomavirus (HPV) may go away on their own without treatment. For this and other reasons, experts sometimes have different approaches to treating genital warts.

• Genital warts may disappear without treatment. This is the natural course of many genital warts.
• Destroying large areas of warts is difficult and may cause scarring.
• Treatment for genital warts does not eliminate the HPV infection. You may still be able to spread the infection. Condoms can help reduce the risk of HPV infection.⁴
• Treatment of genital warts can be painful, and warts return after treatment in between 20% and 50% of people.² Warts that return after being treated usually are not treated again unless you want to be retreated. If you do, you would usually choose a different form of treatment.
• Some health professionals believe that treatment for genital warts will help prevent the spread of HPV infections and keep genital warts from returning.

Watchful waiting

After you are diagnosed with genital warts, if you do not have symptoms or cosmetic concerns, you and your health professional may observe your condition without using medical treatment. This is called watchful waiting. This period may vary from a few weeks to a few months. The length of the watchful waiting period is determined by:

• The severity of your symptoms.
• The progression of the problem if not treated.
• The risks and benefits of waiting.
• Your age and medical history.

If symptoms or cosmetic concerns develop, your health professional may recommend treatment.

Watchful waiting is usually recommended for children with warts, because most warts in children go away without treatment. Also, current treatments for warts are too painful and traumatic for children. Any child with genital warts needs to be evaluated by a health professional to determine the cause and to assess for possible sexual abuse.

Types of treatment

Treatments for genital warts include medicines, freezing, laser, or surgery.

The type of medical treatment for genital warts will depend on:

• The number, size, and location of warts.
• The side effects of treatment.
• The skill of the health professional for each treatment option.
• The cost of treatment, which varies depending on:
  • The cost of medicine.
  • Any specialized equipment used.
  • The number of treatments needed.
• The problems caused by the warts (such as blockage of the urethra).
• Your preference.

Medicines

Health professionals often recommend medicine applied to warts (topical drug treatment) as the first choice of treatment. A health professional will apply the medicines that have a high risk of causing damage to the skin around the warts; you can apply others at home.

Topical medicines applied by a health professional include:

• Podophyllin resin (Podofin).
• Trichloroacetic acid (TCA) or bichloroacetic acid (BCA).
• Intralesional (injected into wart lesion) interferon.
• Fluorouracil (Efudex, Fluoroplex).

Topical medicines that are available by prescription but can be applied at home include:

• Imiquimod (Aldara).
• Podofilox lotion or gel (Condylox).

Caution: Do not use nonprescription wart removal products to treat genital warts. These products are not intended to be used in the genital area and may cause serious burning.

Surgery and other treatment

Surgery to remove genital warts may be done when:

• Medicine treatment has failed and the removal of warts is considered necessary.
• Warts are widespread.

Surgical methods that may be used include:

• Cryotherapy
• Electrocautery.
• Laser surgery.
• Surgical excision.
• Loop electrosurgical excision procedure (LEEP).

Treatment considerations

Without treatment, external genital warts may remain unchanged, increase in size or number, or go away. Studies show that no one treatment is completely successful because there is no cure for genital warts. All treatments have advantages and disadvantages. The benefits and effectiveness of each treatment need to be compared with the side effects and cost.

Recurrence rates vary from method to method. Recurrence is most frequent in the first 3 months after treatment. People with an impaired immune system may have more frequent recurrences after treatment than other people.¹ It is difficult to know whether a recurrence of genital warts is a new infection or an unsuccessfully treated infection.

For women, an HPV infection that causes an abnormal Pap test will be treated differently than HPV that causes visible genital warts. For more information, see the topic Abnormal Pap Test.

Several choices of treatment for pregnant women have been found to be effective and safe, including trichloroacetic acid (TCA), cryotherapy, and surgery.

What To Think About

There is no standard method of treating genital warts. Very few studies have evaluated the effectiveness of combining more than one treatment.

• Treatment of warts usually requires a series of applications rather than a single treatment.
• Warts in moist areas usually respond better to treatments applied to the area, such as creams or acids.
• Warts on dry skin may respond best to freezing (cryotherapy) or surgical removal.
• Cryotherapy may be done when genital warts are visible and bothersome and are growing in a small area. Repeat treatments may be needed to remove all wart tissue.
• The success of surgery is related to the number of warts. The success rate is higher and additional treatments are less likely to be required when surgery is performed on fewer and smaller warts. However, surgery is less likely to be needed for a few small areas of warts. Surgery may require anesthesia.
• Small areas of warts can be quickly treated with removal methods, such as cryotherapy or surgical excision.
• Self-applied medicines may be used for larger areas of warts that need longer or repeated treatments.

A biopsy of warts on the vulva or penis that do not go away on their own or after treatment is often done to rule out precancerous or cancerous conditions.