Genital Warts Medication

Historically, medical treatments have been destructive in nature, although recently immunomodulators have been introduced.

Class Summary

Cause cornified epithelium to swell, soften, macerate, and then desquamate.

Podofilox (Condylox)

Topical antimitotic that can be chemically synthesized or purified from plant families Coniferae and Berberidaceae (eg, species of Juniperus and Podophyllum). Treatment of anogenital warts results in necrosis of visible wart tissue. Exact mechanism of action is unknown. Genital warts are epidemiologically associated with cervical carcinoma.

Podophyllum resin (Podocon-25)

Topical treatment for benign growths, including external genital and perianal warts, papillomas, and fibroids. Arrests mitosis in metaphase; active agent is podophyllotoxin; type of podophyllum resin used determines strength. American podophyllum contains one-fourth the amount of Indian source.

Although procedure is simple, home treatment should be avoided in most cases because patients tend to overtreat and cause excessive inflammation.

Trichloroacetic acid (TCA, Tri-Chlor)

Cauterizes skin, keratin, and other tissues. Although caustic, causes less local irritation and systemic toxicity than other drugs in the same class. However, response is often incomplete, and recurrence occurs frequently. Most clinicians use 25-50% TCA, although some use as high as 85% and then neutralize with either water or bicarbonate; tissue sloughs and subsequently heals in 7-10 d. Less destructive than laser surgery, electrocautery, or cryotherapy.

Class Summary

Stimulate the release of key factors that regulate the immune system.

Imiquimod (Aldara)

Induces secretion of interferon alpha and other cytokines; mechanism of action is unknown. May be more effective in women than in men.

Class Summary

Are naturally produced proteins with antiviral, antitumor, and immunomodulatory actions. Alpha, beta, and gamma interferons may be given topically, systemically, and intralesionally.

Interferon alfa-2b (Intron A)

Protein product manufactured by recombinant DNA technology. Mechanism of antitumor activity is not clearly understood; however, direct antiproliferative effects against malignant cells and modulation of host immune response may play important roles. For patients >18 y with genital warts refractory to other forms of treatment.

Class Summary

Inhibit cell growth and proliferation.

5-Fluorouracil or 5-FU (Efudex, Adrucil, Fluoroplex)

For management of superficial basal cell carcinomas. Interferes with DNA synthesis by blocking the methylation of deoxyuridylic acid and inhibits thymidylate synthetase, which subsequently reduces cell proliferation. For use on warts resistant to other forms of treatment.

Class Summary

An HPV vaccine is now available for prevention of HPV-associated dysplasias and neoplasia, including cervical cancer, genital warts (condyloma acuminata), and precancerous genital lesions. Immunization series should be completed in girls and young women aged 11-26 y. Also indicated for boys and men aged 9-26 years for prevention of condyloma acuminata caused by HPV types 6 and 11.

Papillomavirus vaccine (Gardasil)

Quadrivalent HPV recombinant vaccine.

First vaccine indicated to prevent cervical cancer, genital warts (condyloma acuminata), and precancerous genital lesions (eg, cervical adenocarcinoma in situ; cervical intraepithelial neoplasia grades 1, 2, and 3; vulvar intraepithelial neoplasia grades 2 and 3; vaginal intraepithelial neoplasia grades 2 and 3) due to HPV types 6, 11, 16, and 18. Vaccine efficacy mediated by humoral immune responses following immunization series.

FDA-approved for females aged 9-26 years. Currently under FDA priority review to evaluate efficacy in women aged 27-45 years. Indicated for boys and men aged 11-26 years for prevention of condyloma acuminata caused by HPV types 6 and 11.

Class Summary

Topical product that has gained FDA approval for genital warts.

Sinecatechins (Veregen)

Botanical drug product for topical use consisting of extract from green tea leaves. Mode of action unknown but does elicit antioxidant activity in vitro. Indicated for topical treatment of external genital and perianal warts (condylomata acuminatum) in immunocompetent patients. Ointment containing 15% sinecatechins, available in 15- and 30-g tubes.