Table 3.

Treatment options for AGW

Treatment		Mode of action	Schedule			Clearance rate (%)	Recurrence rate (%)		Advantages		Disadvantages	Refs
Ablative techniques
Cryotherapy		Liquid nitrogen freezes and destroys lesions	Applied directly to lesions; repeat for two or three cycles			46–96	18–39		Rapid results in some patients Minimal training		High recurrence rate Repeat physician visits Pain, necrosis, hypopigmentation	20, 45, 46, 47, 48, 49
CO2 and Nd:YAG laser		Laser vaporizes lesions	Under local anaesthesia, protocol depends on type of laser			23–95	2.5–77		Rapid results Effective for thick lesions		High recurrence rate; in some cases even before healing of laser treatment Repeat physician visits Costly Substantial training Expertise required Pain/scarring Smoke evacuator needed	20, 48, 50
Electrocautery		High‐frequency electrical currents cause thermal damage to infected tissue	Under local anaesthesia, base of lesion excised; repeat as required			35–94	20–25		Rapid results		High recurrence rate Repeat physician visits Expertise required Smoke evacuator needed	18, 20, 49, 51
Surgery		Scissor or scalpel excision	Under local or general anaesthesia; base of lesion excised			89–93	18–65		Rapid results Useful for large lesions		High recurrence rate Pain/scarring Expertise required	52, 53, 54
Trichloroacetic acid (33–50%)		Acid induces a chemical burn	One to three times per week; repeat as necessary			70–100	18–36		Rapid results Suitable for a few small lesions		High recurrence rate Repeat physician visits Intense burning sensation	20, 45, 47, 55
Immunotherapies
Imiquimod 5%	Immunomodulator: stimulates interferon and cytokine production		Three nights per week for up to 16 weeks or longer		35–75			6		Efficacy Simple regimen Easy self‐application Preferred by patients Lower recurrence rates than ablative techniques Inflammatory reactions extending beyond treatment area can show the infected area	Inflammatory reactions extending beyond treatment area Response may be slow Lower clearance rates than ablative techniques Rare vitiligo‐like depigmentation	20, 21, 22, 23, 24, 25, 26, 41, 56, 57, 58, 59, 60, 61, 62
Imiquimod 3.75%	Immunomodulator: stimulates interferon and cytokine production		Once daily before bedtime for up to 8 weeks		19–37			15–19		Efficacy Short treatment duration Simple regimen Easy self‐application Inflammatory reactions extending beyond treatment area can show the infected area	Inflammatory reactions extending beyond treatment area Response may be slow	20, 27, 28, 29
Sinecatechins 10% and 15%	Inflammatory response modulator		Three times daily for up to 16 weeks		40–81%			7–12		Efficacy Self‐application Lower recurrence rates than ablative techniques	Intense application site reactions Lower clearance rates than ablative techniques Repeat 3 times daily administration may affect adherence Need for sanitary pads	20, 30, 31, 32, 33, 34
Other topical therapy
Podophyllotoxin 0.5% (alcoholic solution) 0.15% (cream)	Antimitotic agent induces tissue necrosis			Twice‐daily to affected areas for 3 consecutive days per week; discontinue for 4 days; repeat for up to 4 weeks	45–94			11–100		Efficacy Easy self‐application	High recurrence rate Complicated regimen Intense application site reactions	20, 31, 35, 36, 37, 38, 39, 40, 42, 43, 44, 63
Nitric–zinc complex topical solution	Induces a caustic effect on the wart through mummification and protein denaturation/coagulation action			Once or up to four times; repeat at 2‐week intervals if needed	90–99			Not evaluated		Efficacy Easy application	Current evidence in AGW available from a limited number of patients only Investigation of recurrence rate is required	64

AGW, anogenital warts.