TABLE 2.

Treatment modalities for genital warts

TREATMENT TYPE	MECHANISM OF ACTION	ADMINISTERED BY	PREGNANCY SAFETY	LEVEL OF EVIDENCE	CLEARANCE %	RECURRENCE %	COMMENTS
TOPICAL
Podophyllotoxin	Anti-wart lignans	Patient	Unknown	A	45-7734,36	38-6538	Cost-effective home treatment
Imiquimod 5% cream	Induces secretion of cytokines that reduce HPV DNA viral load	Patient	Unknown	A	5645	1345	Lengthy duration and sporadic dosing frequency can affect compliance
Imiquimod 3.75% cream	Induces secretion of cytokines that reduce HPV DNA viral load	Patient	Unknown	A	28-3348	1548	New formulation with more intuitive dosing regimen
Sinecatechins 15% ointment	Possess antitumor, antiviral, antioxidant effects	Patient	Unknown	A	5855	6-955	Can often take 16 weeks to elicit positive response
Podophyllin	Anti-wart lignans	Patient	No	C	42-5067	46-6058	Not generally recommended for EGW treatment
5-FU	Inhibits key enzyme in DNA replication	Physician	No	C	10-5048	5048	Sometimes used for urethral warts
DESTRUCTIVE AND SURGICAL
TCA	Chemically destructive acids	Physician	Yes	B	7049	18 50,51	High clearance rates with relatively low morbidity
Cryotherapy	Dermal damage induced by cold temps initiate immune response	Physician	Yes	B	79-8812	25-4012	Treated areas can take several weeks to heal, requires multiple treatments
Electrosurgery	Thermal coagulation	Physician	Yes	B	9458	2258	Long-term effectiveness comparable to cryotherapy
Scissor excision	Physical removal of diseased tissue	Physician	Yes	B	7260	19-2960	Outdated treatment modality, utilized with large lesions causing obstruction
CO2 laser	Infrared light energy vaporizes lesions	Physician	Yes	B	23-5212	60-7712	Treatment of choice in immunocompromised
SYSTEMIC
Interferon	Interferes with viral replication	Physician	No	C	17-6756,57,58	9-6956,57,58	Topical use has higher clearance rates versus placebo; systemic use has comparable clearance rates versus placebo

HPV=human papillomavirus, BCA=bichloroacetic acid, TCA=trichloroactetic acid; A=one double-blind, randomized, controlled trial; B=well-conducted clinical studies, no randomized, controlled trial; C=Evidence from expert committee reports/options and/or clinical experience of respected authorities, indicated absence of directly applicable studies of good quality