What are the treatment options for genital warts?

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There are various treatments for genital warts on the penis, vagina or anus. They include creams and liquids to be applied directly to the affected area, and surgical procedures to remove or destroy (cauterize) the warts.

Genital warts (also known as “anogenital warts”) are one of the most common sexually transmitted infections (STIs). They are caused by human papillomaviruses (HPVs). Although they’re not dangerous, a lot of people don’t like having them and they can have a negative impact on your sex life and quality of life. They are also highly contagious.

Treatment involves applying medication to the affected area (topical medication) or having a small surgical procedure. You can talk to your doctor about suitable treatment options for you.

The warts don’t always disappear completely after treatment. So it’s a good idea to go back for a check-up. That way, if the warts start to reappear, the doctor can find them early and perhaps try a different treatment approach.

What types of topical medication are available?

The affected area can be treated using creams and liquids. You apply them externally – not inside the vagina or . 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, and soreness around the treated area.

What are the surgical options?

Removal by cutting (excision)

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.

Removal using an electric current (electrocautery)

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 . It involves evaporating the wart tissue using electrical energy. The doctor carries out the procedure through an (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.

Removal using a laser, freezing or acid

  • 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.

How do you choose?

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.

Barton S, Wakefield V, O'Mahony C et al. Effectiveness of topical and ablative therapies in treatment of anogenital warts: a systematic review and network meta-analysis. BMJ Open 2019; 9(10): e027765.

Bertolotti A, Ferdynus C, Milpied B et al. Local Management of Anogenital Warts in Non-Immunocompromised Adults: A Network Meta-Analysis of Randomized Controlled Trials. Dermatol Ther (Heidelb) 2020; 10(2): 249-262.

Feng C, Li W, Wang X et al. A systematic review evaluating the efficacy and safety of a combination of ablative treatment and self administered treatment versus ablative treatment alone for external anogenital warts. Int J Dermatol 2020; 59(10): 1210-1216.

Gilson R, Nugent D, Werner RN et al. 2019 IUSTI-Europe guideline for the management of anogenital warts. J Eur Acad Dermatol Venereol 2020; 34(8): 1644-1653.

Jung JM, Jung CJ, Lee WJ et al. Topically applied treatments for external genital warts in nonimmunocompromised patients: a systematic review and network meta-analysis. Br J Dermatol 2020; 183(1): 24-36.

Paul-Ehrlich-Gesellschaft für Chemotherapie (PEG). HPV-assoziierte Läsionen der äußeren Genitoanalregion und des Anus – Genitalwarzen und Krebsvorstufen der Vulva, des Penis und der peri- und intraanalen Haut (S2k-Leitlinie). AWMF-Registernr.: 082-008. 2017.

Robert Koch-Institut (RKI). RKI-Ratgeber Humane Papillomviren. 2018.

Werner RN, Westfechtel L, Dressler C et al. Self-administered interventions for anogenital warts in immunocompetent patients: a systematic review and meta-analysis. Sex Transm Infect 2017; 93(3): 155-161.

IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

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Created on January 2, 2023

Next planned update: 2025


Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

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