Genital Warts Treatment
At the moment, there is no treatment for HPV, but there are treatments to get rid of genital warts. Warts may be removed by applying a chemical treatment, freezing them or removing them surgically, depending on the size and location of the warts. Some of these treatments may take up to three months, or longer, and because the virus may still be in your body, warts often come back even after treatment.
Chemical treatments, solutions and creams
Podophyllin
Podophyllin is a chemical treatment derived from a plant extract. It is applied as a mild solution directly to genital warts. Podophyllin is poisonous to human cells and stops warts from growing by interrupting the natural growth process of the body’s skin cells. It must only be applied by a trained healthcare professional, and a petroleum jelly should be applied to the skin around the warts to protect it from irritation or burns. The treatment must be washed off four hours after application or it will burn your skin.
Podophyllin treatment may need to be applied, at a clinic, several times over a 2 to 3 week period and is only appropriate for external warts. If after a few weeks the treatment is unsuccessful, an alternative treatment should be considered to avoid side effects. Podophyllin, while applied locally, can affect your whole body if you are exposed to too much of it, and side effects may include severe skin irritation, dizziness, confusion and damage to the nervous system. Some experts have recommended Podophyllin no longer be used to treat genital warts.
It is not safe for use during pregnancy.
Studies show that the recurrence rate of warts following podophyllin treatment may be as high as 40% to 60%.
Podophyllotoxin
Podophyllotoxin, the active ingredient in podophyllin (above), is available in a preparation that is safe for self-application and does not need to be washed off.
Podophyllotoxin is only for use on small external warts and is available on prescription. It is applied, at home, usually twice a day for three days. If the warts have not disappeared after four ‘rest days’ following treatment, the three-day-on/four-day-off treatment may be repeated for up to four weeks. You should be given detailed instructions with your prescription.
Podophyllotoxin may cause soreness and mild skin irritation. If you have questions about how to use the treatment, talk to the chemist, your GP or nurse practitioner, or contact your local GUM clinic.
Podophyllotoxin should not be used during pregnancy.
Information on recurrence rates varies greatly. It may be anywhere between 10% and 90%.
Trichloroacetic acid (TCA)
Trichloroacetic acid works more quickly than podophyllin and has no systemic (far-reaching) side effects. It works by chemically burning away the warts and must be carefully applied by a trained healthcare professional. As with podophyllin, using vaseline may help protect the surrounding skin. You may feel a painful burning sensation for 5 to 10 minutes while the acid destroys the warts.
There is conflicting information about whether TCA is safe for use during pregnancy.
Warts have been found to recur in about 35% of cases treated with TCA.
Interferons
Interferons are antiviral drugs that may be applied as a cream or may be injected directly into warts. Interferon treatments are rarely used because there are issues around safety, efficacy and expense.
Imiquimod
This is a relatively new treatment that stimulates (boosts) the body’s immune system to fight the wart virus. It comes as a cream to be applied to the affected skin and should not be used internally on vaginal, anal or cervical warts. Imiquimod does not boost your entire immune system; it only affects the area of skin it is applied to.
Imiquimod may take up to four months to work and can be self-applied at home. The cream is used three times weekly but must be washed off after 6 to 10 hours. It may cause skin irritation in some people, so if you have a severe skin reaction to the cream, stop using it and see your GP or go to a GUM clinic.
Imiquimod should not be used during pregnancy.
Recurrence rates appear to be relatively low, between 13 and 20%, but additional studies are needed to confirm this data.
5-Flourouracil
This cream has been found to cause severe side effects, including vulval burning, and is no longer commonly used to treat genital warts.
Freezing Treatment
Cryotherapy (cryosurgery)
Cryotherapy involves putting very cold liquid nitrogen, nitrous oxide or carbon dioxide directly onto the warts. This freezes the wart tissue and destroys it. Cryotherapy can be used to treat internal warts (vaginal, cervical and anal) as well as external warts. The procedure generally takes 5 to 15 minutes, depending on the number and size of warts. It can be painful, both during and after the procedure, so you may want to ask your doctor about a local anaesthetic to ease the pain.
If you have cryotherapy for vaginal, cervical or anal warts, you may notice a discharge for a few weeks after treatment. This is a sign that your body is healing. Avoid using tampons or having penetrative sex for 2 to 4 weeks or until the discharge has stopped.
Cryotherapy may be one of the safest treatment options for removing warts during pregnancy.
Recurrence rates after cryotherapy range from 10% to 40%.
Surgical treatments
Sometimes large warts, or warts that won’t go away with other treatments, may need to be removed surgically. All surgical treatments involve mild to moderate pain and will require either local or general anaesthetic. Some surgical treatments may need to be done in hospital on an outpatient basis.
Warts may be surgically removed by:
Excision: cutting warts away. This is usually offered as a final option or if you have few, but large, warts that are easily accessible. Sutures or stitches are generally not necessary and diathermy (heat/burning) may be used to stop any bleeding. There may also be some scarring and the area may be tender and sore for a day or two after treatment. If the area doesn’t seem to heal, or becomes more painful, it may be infected. See your doctor or go to a GUM clinic as soon as you can.
Warts return after surgical excision in about 20% of patients.
Diathermy or electrocautery: destroying the wart tissue with heat from an electric current. This procedure literally burns warts off, causing a smell of burning skin that may be distressing for some people.
Wart recurrence rate following traditional electrosurgery is about 25%.
A newer procedure, called LEEP (Loop Electrosurgical Excision Procedure) uses a hot looped wire to remove rather than burn tissue. LEEP may also be called LLETZ (Large Loop Excision of the Transformation Zone) when used to remove abnormal cells (CIN) from the cervix.
Laser treatment: vapourising warts. Laser treatment is very precise and can be used to treat warts in difficult to reach areas. Laser treatment also has a low risk of damage to surrounding tissue. During the procedure, smoke created from the vapourising tissue is extracted by a machine. This can be quite loud and may be alarming if you haven’t been warned.
Recurrence rates of warts after laser treatment range between 10% and 40%.
After surgery
It is generally advised to avoid sex for 2 to 4 weeks after surgical treatment. If you have had treatment for internal warts, you may notice a weeping or discharge for a few weeks after surgery. You should not use tampons during your next period and should wait until the discharge has stopped before having sex again.
If you feel unwell after treatment or the treated area becomes inflamed or painful, you may have a secondary infection and should go to your GP or GUM clinic as soon as possible.
What if I’m pregnant and have warts?
Warts tend to grow rapidly during pregnancy and may become numerous and large. This may be due to a weakened immune system, but there is some evidence to suggest that HPV is influenced by progesterone, which is high during pregnancy. In most cases warts will not interfere with pregnancy or birth but if the warts are very large, they may need to be removed.
The safest treatments during pregnancy are cryotherapy and surgery. In severe cases, if large warts cannot be removed, it may be necessary to have a caesarean section.
Although rare, HPV may be passed on to a baby through warts in the birth canal. This is not a serious condition, but it is possible for the baby to develop warts in the throat if exposed to the wart virus. Known as laryngeal papillomatosis, this can cause breathing problems in the baby, but the risk of this happening is extremely low and therefore is not, on its own, a reason to perform a caesarean section.