Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
Genital warts are fairly common; approximately 500,000 new cases of genital warts are diagnosed each year in the U.S. A typical appearance of a genital wart may prompt the physician to treat without further testing, especially in someone who has had prior outbreaks of genital warts. Genital warts usually appear as small, fleshy, raised bumps, but they sometimes can be extensive and have a cauliflower-like appearance. They may occur on any sexually-exposed area.
Most genital warts are caused by HPV-6 and HPV-11, the so-called "low risk" HPV types.
External genital warts
There is no cure or treatment that can eradicate HPV infection, so the only currently possible treatment is to remove the lesions caused by the virus. Unfortunately, even removal of the warts does not necessarily prevent the spread of the virus, and genital warts frequently recur. None of the available treatment options is ideal or clearly superior to others.
A treatment that can be administered by the patient is a 0.5% solution or gel of podofilox (Condylox). The medication is applied to the warts twice per day for 3 days followed by 4 days without treatment. Treatment should be continued up to 3-4 weeks or until the lesions are gone. Podofilox may also be applied every other day for a total of three weeks.
Alternatively, a 5% cream of imiquimod (Aldara, a substance that stimulates the body's production of cytokines, chemicals that direct and strengthen the immune response) is likewise applied by the patient three times a week at bedtime, and then washed off with mild soap and water 6-10 hours later. The applications are repeated for up to 16 weeks or until the lesions are gone.
Only an experienced physician can perform some of the treatments for genital warts. These include, for example, placing a small amount of a 10%-25% solution of podophyllin resin on the lesions, and then, after a period of hours, washing off the podophyllin. The treatments are repeated weekly until the genital warts are gone.
An 80%-90% solution of trichloroacetic acid (TCA) or bichloracetic acid (BCA) can also be applied weekly by a physician to the lesions. Injection of 5-flurouracil epinephrine gel into the lesions has also been shown to be effective in treating genital warts.
Interferon alpha, a substance that stimulates the body's immune response, has also been used in the treatment of genital warts. Treatment regimens involve injections of interferon into the lesion every other day over a period of 8 to 12 weeks.
Alternative methods include cryotherapy (freezing the genital warts with liquid nitrogen) every 1 to 2 weeks, surgical removal of the lesions, or laser surgery. Laser surgery and surgical excision both require a local or general anesthetic, depending upon the extent of the lesions.