Patient-applied treatments |
Imiquimod 5% cream5–7 (grade B, level I)* Imiquimod 3.75% has not been evaluated for the treatment of genital warts | 51 | 22–63 | Apply with finger 3 nights/wk for 16 wk Wash off in the morning | Localized erythema, burning, inflammation; rarely, hypopigmentation Might weaken latex condoms and diaphragms | No | No; safety unknown |
Podophyllotoxin 0.5% solution or gel7 (grade B, level I)* More efficacious and less toxic than podophyllin | 56 | 2–90 | Apply with swab or finger 2 times/d for 3 d, then 4 d off, for up to 4 cycles. Limit of 10 cm2/d of skin surface or 0.5 mL/d | Localized burning, pain, itching, erosion, inflammation | No | No; it is an extract of podophyllin, which is teratogenic |
Provider-applied treatments |
Cryotherapy8–12 (grade B, level I)* | 27–88 | 25–55 | Once per wk with cotton swab, spray, or cryoprobe (not in the vagina) | Localized pain, inflammation, scarring Risk of vaginal perforation if using cryoprobe | Yes | Yes |
TCA10,11,13 (grade B, level I)* | 63–70 | 35 | Once per wk with cotton swab or toothpick | Localized pain and ulceration Can neutralize with sodium bicarbonate solution | Yes | Yes |
Excision14 (grade B, level I)† | 35–72 | 19–79 | Local anesthesia then excision of lesions | Pain, bleeding, infection | Yes | Yes |
Electrocautery14 (grade B, level II)† | 61–94 | 22 | Local anesthesia then destruction of lesions with cautery tools | Pain, bleeding, infection Operator should wear a virus-filtering mask | Yes | Yes |
Alternative treatments |
Podophyllin 25% in tincture of benzoin14–16 (grade C, level I)‡ | 23–72 | 23–65 | Once per wk with cotton swab or toothpick Limit 10 cm2 of skin surface or 0.5 mL per treatment | Localized burning, pain, itching, erosion, inflammation | Limit < 2 cm2 of skin surface | No; is teratogenic |
Sinecatechins (green tea extract) 15% ointment17,18 (grade B, level II; 2 trials)‡ | 57 | 6.5 | Apply 3 times/d for up to 16 wk | Localized erythema, burning, pain, rash, ulceration | No; not studied | No; not studied |
Fluorouracil 1% gel or 5% cream19,20 (grade C, level II)‡ Useful for large numbers of vaginal or urethral-meatal warts in which cryotherapy or TCA are not tolerated | 80–90 | No data | Insert applicatorful into vagina 3 nights/wk | Erythema, erosion, edema | Yes | No; is teratogenic |
Interferon21 (grade C, level II)‡ | 44.4 | 21.1 | One applicatorful in vagina twice daily for 5 d/wk for 4 wk | Headache, tenderness, transient fever | Yes | No; not studied |
Observation*14 | 40–60 | No data | No data | No data | No data | No data |