Genital Warts
Canadian Guidelines on Sexually Transmitted Infections - Genital Human Papillomavirus Infections
- Differential diagnosis:
- condyloma acuminata (HPV)
- molluscum contagiosum
- epidermoid cysts
- pearly penile papules
- condylomata lata (secondary syphilis)
- tumours
- Refer to specialist if:
- large/extensive warts
- resistant lesions
- internal lesions: vaginal, cervical, anal, urethral, meatal warts
- neoplasia suspected:
- pigmented lesions
- bleeding
- persistent ulceration
- persistent pruritus
- recalcitrant lesions
- Recommend testing for chlamydia, gonorrhea, hepatitis B&C, syphilis and HIV.
- No therapy guarantees eradication of HPV.
- Discuss HPV vaccination with patient.
- Therapy is primarily to reduce lesion size - may reduce risk of transmission.
Condyloma acuminata
Usual PathogensHuman Papilloma Virus (HPV)
Patient-applied
| Therapy | Dose | Duration |
|---|---|---|
| Imiquimod 3.75% cream | Apply to warts daily, wash off in morning or 6-8 hours later | Up to 8 weeks |
| or | ||
| Podofilox 0.5% solution | Apply to warts (not contiguous skin) bid | 3 days (4 days off). May repeat 3 day cycle up to 6 times |
Provider-applied
| Therapy | Dose | Duration |
|---|---|---|
| Bi or tri chloracetic acid 50-80% | Apply to warts (not contiguous skin) weekly | Once per week until resolved (6-8 weeks) |
| or | ||
| Podophyllin 10-25% | Apply to warts (not contiguous skin) 1-2 times per week, wash off 1-4 hours later | Until resolved |
Other options
| Therapy | Dose | Duration |
|---|---|---|
| Cryotherapy | ||
| Electrocautery | ||
| Laser therapy |