Condyloma Acuminatum (Genital Warts) Medication

Updated: Oct 22, 2018
  • Author: Delaram Ghadishah, MD; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
  • Print
Medication

Medication Summary

Various topical and systemic treatments are available for the treatment of condyloma acuminatum, including options for home use by the patient (eg, purified podophyllotoxin, imiquimod, sinecatechins). Other treatments that are administered in the physician’s office or emergency department may include acetic acid applications or interferon injections.

An important preventive therapy for condyloma acuminatum and other dysplasias is the human papillomavirus vaccine (9vHPV, Gardasil 9). The FDA has expanded the age to receive the vaccine through age 45 years. [7]

Next:

Cytotoxic agents

Class Summary

Inhibit proliferation of cells at various stages of the cell cycle.

Podophyllum resin (Podocon-25, Pod-Ben-25)

Extract of various plants, which are cytotoxic. Effective in arresting mitosis in metaphase. Expect cure rate of 20-50% if used as single agent.

Podofilox (Condylox)

Purified podophyllotoxin that is antimitotic, cytotoxic, and available for patient's home use. While exact mechanism of action on condyloma is unknown, podofilox results in necrosis of genital condyloma acuminatum. Condylox is one agent containing podofilox. Slightly higher cure rates can be expected with podofilox than with podophyllin. Additionally, useful for prophylaxis.

Trichloroacetic acid topical

At various concentrations (up to 80%), these agents rapidly penetrate and cauterize skin, keratin, and other tissues. Bichloracetic acid is one such agent. Although caustic, this treatment causes less local irritation and systemic toxicity. Additionally, has low cost. Response is often incomplete, and recurrence is frequent.

5-Fluorouracil (Adrucil, Efudex, Fluoroplex)

No longer recommended for routine use.

Has antimetabolic and/or antineoplastic and immunostimulative activity. Useful in prevention of recurrence after condyloma ablation if started within 4 wk, especially in immunocompromised patients.

Bleomycin (Blenoxane)

Composed of cytotoxic glycopeptide antibiotics, which appear to inhibit DNA synthesis with some evidence of RNA and protein synthesis inhibition to a lesser degree; used in management of several neoplasms as a palliative measure; may cause a variety of adverse effects; observe patients frequently and carefully during and after treatment.

Imiquimod (Aldara)

Induces interferon production and is a cell-mediated immune response modifier. Has minimal systemic absorption but causes erythema, irritation, ulceration, and pain. Burning, erosion, flaking, edema, induration, and pigmentary changes may occur at application site.

Imiquimod 5% cream comes in single-use packets.

Previous
Next:

Miscellaneous topical ointment

Class Summary

Another topical product that has gained FDA approval for genital warts includes kunecatechins.

Kunecatechins (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.

Previous
Next:

Interferons

Class Summary

Interferons are not recommended as a primary treatment modality. [3]

Naturally produced proteins with antiviral, antitumor, and immunomodulatory actions. Alpha, beta, and gamma interferons exist and may be administered topically, systemically, and intralesionally. Topical, systemic, and intralesional interferons are not efficacious.

Interferon alfa-n3 (Alferon N)

Alpha interferon has been approved by FDA for injectional use in refractory condyloma acuminatum with some possible benefit. Alferon N is interferon alpha-n3, which has been used effectively for this purpose.

Recurrence rate of 20-40% exists with intralesional interferon, but recurrence rate after successful treatment is lower than with other treatment modalities. Additionally, intralesional interferon is expensive and requires repeat office visits.

Furthermore, numerous adverse reactions may occur, including myalgias, fever, chills, GI symptoms, transient leukopenia, thrombocytopenia, LFT abnormalities, serum lipid abnormalities with intramuscular interferon, and theoretical risk of viral transmission with natural interferon products. Viral symptoms do abate with time, and all adverse effects resolve once therapy is stopped. Viral symptoms can be treated with acetaminophen or NSAIDs in the interim.

Previous
Next:

Vaccines

Class Summary

One human papillomavirus (HPV) vaccine (9vHPV, Gardasil 9) is available in the United States for the prevention of HPV-associated neoplasias and dysplasias, including genital warts (condylomata acuminata). [7]

Human papillomavirus vaccine, nonavalent (Gardasil 9)

Recombinant vaccine that targets 9 HPV types (6, 11, 16, 18, 31, 33, 45, 52, 58). It is indicated for females and males aged 9-45 years to prevent genital warts and also dysplasias and neoplasia (eg, cervical, vulvar, vaginal, and anal cancers).

Previous