What are the treatment options for genital warts?

The affected area can be treated using creams and liquids. You apply them externally – not inside the vagina or rectum. The active ingredients are podophyllotoxin, imiquimod or green tea extract. All of these medications are only available with a prescription. Approved podophyllotoxin products come in solutions containing 0.5% of the substance and creams containing 0.15%. You can get imiquimod as a cream containing 5%. Green tea extract is available as a lotion containing 10%.

Some of these products only have to be applied a few times per week. Others have to be used several times per day. You continue the treatment until the warts have gone. If they’re still there after four months, the recommended approach is to stop the treatment and try a different option.

Treatment using creams and liquids is considered to be well tolerated. Possible side effects include itching, redness, inflammation and soreness around the treated area.

Often, genital warts are removed surgically. The doctor uses a scalpel or scissors to remove the wart tissue, or scrapes it off in a procedure known as curettage. This approach is particularly suitable for people who only have a few warts or if the warts are “pedunculated” – in other words, if they’re connected to the skin by a thin, stalk-like structure. You don’t need stitches. A local anesthetic is usually enough.

In rare cases, excision can lead to bleeding, an infected wound, scarring or damage to healthy tissue.

Doctors can also treat genital warts with a special instrument that uses an electrical current to remove them. As with excision, a local anesthetic is usually enough and you don’t need stitches.

There is a special method, called “argon plasma coagulation,” which is mainly used for warts in the rectum. It involves evaporating the wart tissue using electrical energy. The doctor carries out the procedure through an endoscope (a flexible tube with a light and camera at the end of it) inserted into the bowel. Usually, you need a general anesthetic for this procedure.

• Laser treatment involves applying heat to the wart using a device such as a CO2 laser.
• Another approach is to freeze the wart off (cyrotherapy). The doctor applies liquid nitrogen to the affected area. Typically, this has to be done several times.
• Alternatively, the wart can be dabbed with trichloroacetic acid (TCA). This treatment requires several appointments.

All three methods destroy the wart tissue, leaving a small wound, which forms a scab and usually heals completely.

Side effects are rare and only happen when the healthy skin is accidentally damaged. You might be left with a scar.

There isn’t enough reliable research to be able to say for sure which approach is most effective. You can consult a dermatologist, gynecologist, urologist or sexual health specialist to help you choose the most suitable treatment in your particular situation. For instance, if you’re not keen on the idea of surgery, you can try a podophyllotoxin solution first – especially if you only have a few, single warts. But if you think you’ll have difficulty sticking to a lengthy self-treatment schedule using a cream or liquid, you can ask for information and advice on the other options.