Treatment for Genital Warts

Genital warts may be new, recurrent or have been present for many years.

Treatment for genital warts is optional. Even though there are many good treatments for genital warts, most genital wart infections will clear up spontaneously sooner or later. However, many people want to have them treated as the warts can be unsightly and/or uncomfortable.

The goal of treatment should be to remove visible genital warts and relieve annoying symptoms.

There are several available treatments, and no one treatment is ideal for all people or all warts.

Factors that might influence the choice of treatment include size, location and number of warts, changes in the warts, patient preference, the cost of treatment, convenience, possible adverse effects and the health care provider's expertise.

All treatment options involve some drawbacks, such as pain, possible scarring, and expense. Additionally, some of the warts which were cleared initially may, in some people, have recurrences which means going back for further treatment.

If there is no significant response to the HPV treatment within 4–6 weeks, an alternative diagnosis, change of treatment modality, or onward referral should be considered.

Whatever the treatment option is, here are some important points to remember:

It is advisable to seek medical advice before starting treatment for genital warts.
Ask the doctor for an explanation of the treatment, including the costs and likely benefits as well as any side effects.
Be sure to understand the follow-up instructions, such as what to do about discomfort and when to seek help.
Be patient – treatment often takes several visits and a variety of approaches.
If pregnant, tell the doctor so they can choose the right treatment.
Don’t use over-the-counter treatments which are not specifically for genital warts (for example remedies for warts on the feet or hands). These are not meant for sensitive genital skin and can do more damage to your skin.
It is recommended to avoid sexual contact with the infected area during treatment, to protect the treated area of skin from friction and help it heal.

Salt water baths help soothe and heal the genital area during treatment. Two handfuls of plain salt per bath or two tablespoons in a large bowl, preferably twice daily.
Xylocaine (2% lignocaine gel) is a useful local anaesthetic to put on raw areas two minutes prior to passing urine or having a bowel motion.
Thrush (yeast) infection is common, especially when the genital area is raw, and it is often helpful to treat the thrush at the same time as the warts are being treated.

Options for removing genital warts

Remember that not all of these treatment options may be available, and a treatment plan needs to be discussed with the doctor or health care specialist.

Whatever the choice, remember that weekly treatments are usually needed, and it may be some time before the warts clear. No treatment at present can guarantee that warts are gone forever. Also keep in mind that warts would usually go away over time without treatment.

Podophyllotoxin (Condyline™) solution is a patient-applied treatment for external genital warts, recommended for external penile skin only as it can irritate if applied to skin folds such as under the foreskin on the penis or vulval skin (the area around the vaginal opening). It is contraindicated in pregnancy.
Imiquimod (Aldara™) cream is a patient-applied treatment for external genital and perianal warts. It is easy to use and safe if instructions are followed. If other treatments are unsuitable, Aldara is available by fully subsidised prescription from your doctor. Not recommended in pregnancy.
Cryotherapy (freezing off the wart with liquid nitrogen) can be done by a trained health practitioner.
Trichloroacetic acid (TCA) is a chemical applied to the surface of the wart by a trained health practitioner. It is unavailable in some DHBs.
Laser therapy (using an intense light to destroy the warts) or surgery (cutting off the warts) has the advantage of getting rid of the warts in a single visit. Laser treatment can be expensive and the health care provider must be well trained in these methods. It is only available in a few centres. Recurrences may occur.

Follow-up after treatment

After visible genital warts have cleared, a follow-up evaluation is not necessary.

Recurrences (a return of the warts) occur most frequently during the first 3 months. A follow-up evaluation 3 months after treatment may be useful for reassurance that there are no persistent or new warts. Regular cervical screening is recommended for everyone with a cervix, regardless of whether they have genital warts or not.

Anyone with genital warts should discuss with their doctor the possibility of other sexually transmitted infections being present, and take the opportunity to have a full sexual health check.