Effective Treatments for Genital Warts: What You Need to Know

Cauliflower treatment

In April of this year, I discovered that I had warts in my genital area.
I went to a gynecologist who referred me to an external clinic, and they could only prescribe me a topical ointment (Podophyllotoxin).
A few days later, I visited a clinic in Taoyuan that specializes in treating warts, and the doctor mentioned two options: 1) topical medication plus oral medication, and 2) electrosurgery.
When I decided to go for electrosurgery, the doctor suggested that I take medication first, then consider electrosurgery after some time.
Unfortunately, after taking the medication and using the ointment for two full months (even though there were a few days when the warts were completely gone, they reappeared after a week), the doctor recommended that I receive the nine-valent HPV vaccine, but the warts still returned.
The situation worsened.
The ointment from the first gynecologist did not cause any pain or itching, but the ointment from the Taoyuan clinic started to cause severe itching and was much less effective.
The first ointment (Podophyllotoxin) worked quickly and with minimal sensation, while the ointment from the Taoyuan clinic was extremely itchy.
One night, due to the intense itching, I unconsciously scratched the area, and by morning, I experienced pain and itching, along with skin breakdown.
When applying the ointment, I noticed white patches of broken skin, and there was an odor along with discharge.
I saw the doctor again, who advised me to continue taking the medication and using the ointment.
Each time I picked up the medication, it cost over 3000 TWD, and I felt like I was being taken advantage of, especially since my condition had not improved.
What should I do now? My genital area feels like my hands do after being in water for too long; the skin is breaking down, and I have several warts that are itchy and painful.
Neither the medication nor the ointment has improved my condition.
Should I switch clinics for a check-up? I've already been seeing this clinic for a while, and I have fully paid for the nine-valent vaccine, with the next shot scheduled for August.
Should I continue treatment there, or switch clinics for treatment while still receiving the vaccine there? I am scared of taking more medication and desperately want to get better.
Are there any other treatment options available? Can warts really be completely cured? I haven't had children yet, and I am very worried and distressed.
I kindly ask for your advice.
Thank you.

Zhen, 20~29 year old female. Ask Date: 2017/07/15

Dr. Huang Jianzhong reply Obstetrics and Gynecology

In April of this year, I discovered that I had genital warts and went to a gynecologist for a check-up.
However, the gynecologist referred me to an external clinic and could only prescribe a topical ointment (Podophyllotoxin) for me to apply at home.
A few days later, I visited a clinic in Taoyuan that specializes in treating warts, where the doctor mentioned two treatment options: 1) topical medication plus oral medication, and 2) electrosurgery.
When I decided to go for electrosurgery, the doctor suggested that I first take medication and then consider electrosurgery after some time.
Unfortunately, after taking the medication and applying the ointment for two full months (although there were a few days when the warts were completely gone, they reappeared after a week), the warts did not improve and instead became more severe.
The ointment prescribed by the first gynecologist did not cause any pain or itching, but after switching to the ointment from the Taoyuan clinic, I started experiencing severe itching and the effectiveness was much lower than the first ointment.
The first ointment (Podophyllotoxin) worked quickly without much sensation, while the ointment from the Taoyuan clinic caused unbearable itching.
One night, due to the intense itching, I unconsciously scratched the area, and by morning, I began to experience pain and itching, along with skin breakdown.
When applying the ointment, I noticed white broken skin, and there was a smell and discharge.
I saw the doctor again, who advised me to continue taking the medication and applying the ointment.
Each time I obtained medication, it cost over 3000 TWD, and I felt seriously taken advantage of, as I was still not improving.

What should I do now? My genital area feels like the skin is breaking down, and I have several warts that are itchy and painful.
Neither the oral medication nor the topical ointment has improved my condition.
Should I switch clinics for a check-up? I have already been seeing this clinic for a while, and I have fully paid for the nine-valent vaccine, with the next injection scheduled for August.
Should I continue treatment there or switch clinics for treatment while still getting the vaccine there? I am already afraid of taking more medication and just want to get better quickly.
Are there other treatment options available? Can genital warts really be completely cured?
Answer:
1.
Destructive Treatments:
- Surgical Excision: Under local anesthesia, excision can be performed for isolated lesions, especially for larger lesions (>1cm) or those resistant to treatment.
Pathological examination can confirm the diagnosis.
In adult studies, the clearance rate ranges from 36-100%, with recurrence rates between 8-65%, depending on the extent of the lesions.
Extensive lesions may require general anesthesia.
A downside is the potential for scarring.
- Electrosurgery: This is a commonly used method where the lesions are directly cauterized under local anesthesia.
In adult studies, the clearance rate is between 64-94%, with recurrence rates as high as 50%.
Multiple treatments may be necessary, and post-treatment pain can occur.
HPV DNA can aerosolize during treatment, so protective masks and equipment are necessary to prevent infection.
- Cryotherapy: Liquid nitrogen is applied directly to the lesions, causing cell death.
It is most effective for small, keratinized warts and is relatively inexpensive, but may take several weeks to achieve clearance.
In adult studies, the clearance rate is 54-88%, with recurrence rates of 21-40%.
Young children may find cryotherapy painful, and topical anesthetics like lidocaine may be used beforehand.
Side effects include pain, local skin irritation, and post-healing pigmentation changes.
- Laser Treatment: Carbon dioxide lasers are effective for treating anal and genital warts but can cause pain and scarring, are expensive, and require skilled operation.
The clearance rate ranges from 40-100%, with variable recurrence rates from 4-77%.
2.
Cytotoxic Agents:
- Trichloroacetic Acid (TCA): A white liquid that is applied directly to the lesions weekly, causing protein coagulation and cell death (80-90%).
Care must be taken to avoid surrounding skin to prevent ulceration.
In adult studies, the clearance rate is 70-81%, with a recurrence rate of 36%.
- Podophyllotoxin: Derived from the roots of a plant, it has less toxicity than its predecessor, podophyllin.
The 0.5% gel has antiviral properties and can be used in children.
Literature shows a clearance rate of 45-88% in children with a recurrence rate of 12-60%.
Side effects include burning sensations and, less commonly, pain, skin breakdown, swelling, itching, and bleeding.
- Cidofovir: An antiviral drug that blocks DNA polymerase of several viruses, preventing replication.
It can be administered intravenously for certain viral infections or as a topical cream.
Reports indicate effectiveness in treating resistant warts in children.
3.
Immunomodulators:
- Imiquimod: The most commonly used immunomodulator, available as 5% and 3.75% creams.
It induces cytokine production, particularly interferon, to clear warts.
In studies, the clearance rate is around 47.8%, with recurrence rates of 8.8% after three months.
- Catechins: The main component of green tea, Sinecatechins, is FDA-approved for patients over 18.
In studies, a 15% ointment applied three times daily showed a clearance rate of 54.9%.
- Polyphenon E: A green tea extract with >85% catechins, FDA-approved for genital wart treatment.
In studies, the complete clearance rate was 61% for males and 56.8% for females.
- Cimetidine: An H2 receptor antagonist used for gastric ulcers, it also has immunomodulatory effects.
Reports indicate successful treatment of warts in children after other methods failed.
Prevention: There are two vaccines available to prevent HPV-related genital warts, both containing virus-like particles (VLPs) but no live virus.
The quadrivalent (Gardasil) vaccine is effective against HPV types 6, 11, 16, and 18 and is recommended for females aged 9-26.
The vaccine is most effective when administered before sexual activity begins.
In conclusion, no single method guarantees complete eradication of genital warts, and recurrence rates are high due to the latent nature of HPV.
Some treatments require hospital settings, while topical treatments like 0.5% podophyllotoxin or 5% imiquimod can be self-administered.
Cidofovir is reserved for cases where other treatments have failed.
The best prevention is vaccination, especially with the quadrivalent vaccine, which may reduce the incidence of genital warts.

Reply Date: 2017/07/15

More Info

Genital warts, caused by certain strains of the human papillomavirus (HPV), can be a distressing condition for many individuals. The treatment options available for genital warts vary in effectiveness and can depend on the severity and location of the warts, as well as the patient's overall health. Here’s a comprehensive overview of effective treatments for genital warts and what you need to know.

Treatment Options for Genital Warts
1. Topical Treatments:
- Imiquimod (Aldara): This is an immune response modifier that helps the body fight the virus. It is applied directly to the warts and can take several weeks to show results.

- Podophyllin and Podofilox: These are plant-derived compounds that can be applied to the warts to destroy them. Podophyllin is usually applied by a healthcare provider, while Podofilox can be self-administered.

- Trichloroacetic Acid (TCA): This chemical is applied by a healthcare provider to burn off the warts. It is effective but may require multiple treatments.

2. Cryotherapy: This involves freezing the warts with liquid nitrogen. This method is often effective and can be performed in a doctor's office. It may require several sessions for complete removal.

3. Electrosurgery: This technique uses electrical currents to burn off the warts. It is typically used for larger warts or those that do not respond to other treatments.

4. Laser Treatment: For extensive or resistant warts, laser therapy may be an option. This method uses focused light to destroy the warts.

5. Surgical Removal: In some cases, warts may need to be surgically excised, especially if they are large or causing significant discomfort.

6. Vaccination: The HPV vaccine (such as Gardasil 9) can help prevent future infections with the types of HPV that cause genital warts. However, it does not treat existing warts.

Considerations and Recommendations
- Consultation with a Specialist: Given your ongoing issues with genital warts and the discomfort you are experiencing, it may be beneficial to seek a second opinion or consult a specialist in dermatology or a sexual health clinic. They may offer more tailored treatment options and a fresh perspective on your condition.

- Monitoring and Follow-Up: It’s essential to have regular follow-ups with your healthcare provider to monitor the progress of your treatment. If the current treatment is not effective, your doctor may suggest alternative therapies.

- Avoid Irritation: Since you mentioned experiencing itching and irritation, it’s crucial to avoid scratching the area, as this can lead to further irritation or infection. Gentle hygiene practices and avoiding harsh soaps or irritants can help.

- Emotional Support: Dealing with genital warts can be emotionally taxing. Consider seeking support from counseling or support groups where you can share your experiences and feelings.

Can Genital Warts Be Cured?
While genital warts can be treated effectively, they may not always be completely eradicated. The HPV virus can remain dormant in the body, and warts may recur even after successful treatment. However, many individuals find that with appropriate treatment, they can manage the condition effectively.

Conclusion
In summary, there are multiple effective treatments for genital warts, ranging from topical applications to surgical options. Given your current situation, it may be wise to consult with a specialist for a comprehensive evaluation and treatment plan. Additionally, consider the emotional aspects of dealing with this condition and seek support if needed. Remember, while genital warts can be a challenging issue, with the right approach, you can manage and treat them effectively.

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