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Genital warts - Treating genital warts

NHS Choices Medical Reference

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There are two main types of treatment for genital warts:

  • topical treatment, where a cream, lotion or chemical is applied directly to the wart or warts
  • physical ablation, where the tissue of the wart is destroyed using external forces, such as lasers or electricity

Different people respond to treatments for genital warts in different ways.

However, topical treatments tend to work better on softer warts, and physical ablation tends to work better on harder and rougher feeling warts. Sometimes, a combination of topical treatment and physical ablation can be used.

Either type of treatment can take several months to remove the warts, so it is important to be patient and persevere with the treatment.

Topical treatment

There are several topical treatments that can be used to treat genital warts. These are described below.

Podophyllotoxin

Podophyllotoxin is usually recommended to treat clusters of small warts. It comes in liquid form and works by having a toxic (poisonous) effect on the cells of the warts.

A special application stick is used to draw up the correct dosage of the liquid, which is then dripped onto the wart. You may experience some mild irritation when you apply the liquid to the wart.

Treatment with podophyllotoxin is based on cycles. The first treatment cycle involves applying the medication twice a day for three days. This is then followed by a rest cycle where you have four days without treatment. Most people require four to five treatment cycles separated by rest cycles.

Imiquimod

Imiquimod is a type of cream usually recommended to treat larger warts.

Imiquimod works by helping stimulate your immune system into attacking the warts. You apply the cream to the warts and then wash it off after six to ten hours. This should be done three times a week.

It can often take several weeks of treatment before you notice an improvement in your symptoms. Common side effects of imiquimod include:

  • hardening and flakiness of the skin
  • swelling of the skin
  • a burning or itching sensation after applying the cream
  • headache

These side effects are usually mild and should pass within two weeks of stopping treatment with imiquimod.

Trichloroacetic acid (TCA)

Trichloroacetic acid (TCA) may be recommended to treat small warts that are very hard. TCA is also recommended for use by pregnant women because it is thought to be the safest of all the topical treatments to use during pregnancy.

TCA works by destroying the proteins inside the cells of the wart. However, if it is not applied correctly, TCA can damage healthy skin. Therefore, it is not recommended you apply TCA yourself. Instead, you will be asked to visit your local GUM clinic once a week so a doctor or nurse can apply the medication.

After TCA is applied, some people experience an intense burning sensation for around five to ten minutes.

Physical ablation

There are four main methods used in the physical ablation of genital warts. They are:

  • cryotherapy
  • excision
  • electrosurgery
  • laser surgery

These treatments are given by a health professional.

Cryotherapy

Cryotherapy is usually recommended to treat multiple, small warts, particularly those that develop on the shaft of the penis or on, or near, the vulva.

Cryotherapy involves freezing the wart using liquid nitrogen. Freezing helps to kill the cells of the wart by splitting their outer membranes. After being frozen, the wart is allowed to thaw out and, if necessary, it can be frozen and thawed again.

During cryotherapy treatment, you will experience a mild to moderate burning sensation. Once the treatment has finished, it is likely you may develop skin irritation, blistering and pain at the site of the wart. Your skin will take between one and three weeks to heal.

Avoid having sex until the area of skin around the wart has fully healed.

Excision

Excision, in which warts are cut away, is sometimes recommended to treat small, hardened warts, particularly where this is a combination of smaller warts that have joined together to form a sort of cauliflower shape.

At the start of the procedure you will be given a local anaesthetic to numb the area of skin around the wart. The wart will then be cut away with a surgical scalpel, and the remaining incision sealed with stitches.

Excision can cause scarring so it may not be suitable for very large warts. The area of skin from where the wart was removed will be sore and tender for around one to three weeks.

You should avoid having sex until the area of skin around the wart has fully healed.

Electrosurgery

Electrosurgery is often combined with excision to treat large warts that develop around the anus or vulva that have failed to respond to topical treatments.

First, excision is used to remove the outer bulk of the wart. A metal loop is then pressed against the wart. An electric current is passed through the loop in order to burn away the remaining part of the wart.

Removing a large number of warts in this way can be quite painful, so you may be given a regional anaesthetic (where everything below your spine is numbed, similar to an epidural during pregnancy) or a general anaesthetic.

Laser surgery

Laser surgery may be recommended to treat large genital warts that cannot be treated using other methods of physical ablation because they are difficult to access, such as deep inside your anus or urethra (the tube that connects the bladder to the penis or vulva, through which urine passes).

Laser surgery may also be recommended for pregnant women who fail to respond to treatment with trichloroacetic acid (TCA).

During the procedure, a surgeon will use a laser to burn away the warts. Depending on the number and size of the warts, laser surgery can be performed under either a local or general anaesthetic.

As with other types of ablation treatment, you should expect soreness and irritation at the site where the warts were removed. This should heal within two to four weeks. 

Medical Review: May 28, 2012
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