Treating Genital Warts

Evidence-based treatments and their side effects

Key points

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First steps after noticing genital warts

Seeing a wart for the first time, or seeing one come back after treatment, can be worrying. A recurrence does not necessarily mean the treatment has failed, and your doctor can decide the next step based on where the warts are, their size and how many there are.

Having warts is not, on its own, a sign that you or your partner have been unfaithful. HPV symptoms may appear months or years after the virus enters the body, and it is usually not possible to tell when it was passed on.

  • See a doctor to confirm the diagnosis and choose the right treatment.
  • Do not pick at the bump, and do not try to burn it off or remove it at home.
  • Do not use home remedies on your own, and do not trust online promises of guaranteed cures.
  • If worry or intrusive thoughts continue, talking with a doctor or a counselor can help.

Do current treatments clear warts for good?

No. Treatment can remove visible warts, but there is no medicine that directly removes the virus itself from the body.

Even so, in many people the body brings the infection under control over time. In one report, the warts of about 75% of people cleared completely within two years, even without any treatment. So treatment can be a process that includes removing the warts, time and follow-up. No single method comes with a guaranteed result.

Genital warts, HPV and high-risk types: what is the difference?

Types that cause warts

Visible warts are usually linked to low-risk types of HPV, especially HPV 6 and HPV 11. These types usually do not cause cancer, and they do not turn into HIV/AIDS or herpes.

HPV infection

The virus can be present without any symptoms. Treating warts does not mean the virus is removed straight away, and in many people the body brings it under control over time.

High-risk HPV types

Other types, such as HPV 16 and HPV 18, are linked to a higher chance of changes in the cervix. If one of these types is found (a positive result), this does not mean cancer, but the recommended follow-up is needed.

Follow-up when you have warts and a positive high-risk HPV test

Having warts and testing positive for a high-risk type can be two separate findings; one does not turn into the other. Continue your cervical follow-up plan as your doctor advises.

Genital wart treatments compared

Prescription medicines you use at home

Method
Brief description
Method

Imiquimod

Brief description

A cream that helps activate the body’s immune response against warts.

Method

Podofilox (podophyllotoxin)

Brief description

A medicine that helps destroy wart cells.

Method

Sinecatechins

Brief description

An ointment made from green tea extract, applied to the warts.

Treatments done in the doctor's office

Method
Brief description
Method

Cryotherapy (freezing)

Brief description

The wart is frozen and destroyed with liquid nitrogen.

Method

TCA (trichloroacetic acid)

Brief description

The doctor applies this acid solution directly to the wart.

Method

Surgical removal or heat treatment

Brief description

The wart is removed with methods such as electrocautery (heat), laser or cutting it out directly.

Important: never use these medicines and ointments on your own without a doctor’s prescription.

Medicines used at home: for some small, limited external warts. Which one to use and how to use it should be prescribed and explained by a doctor.

Special areas and pregnancy: warts inside the vagina, anus or mouth should be treated under a specialist’s care. Imiquimod, podofilox, podophyllin and sinecatechins should not be used in pregnancy. Warts in pregnancy are treated with safe methods such as cryotherapy (freezing).

No single method is best for everyone

The choice of treatment depends on where the warts are, how many there are and their size, your individual situation, possible side effects and your doctor’s assessment.

Why genital warts come back, and key care after treatment

Treatment day

The wart is removed, but not necessarily the virus

Treatments remove visible warts, but HPV may still remain in the surrounding skin cells.

3 to 6 months later

The highest-risk time for warts coming back (recurrence)

Warts are most likely to come back during this window, especially in the first 3 months.

19% by the third month (in studies of imiquimod cream)
23% by the sixth month

Up to about 2 years after infection

The immune system gradually controls and clears the virus

Over 1 to 2 years, the immune system controls or clears the virus in most people. As the infection settles down, warts become much less likely to come back.

Up to 75% cleared or controlled naturally by the immune system

The wart is gone. Has the virus fully cleared too?

Not necessarily. When a visible wart disappears, it does not always mean the body has fully cleared HPV or that there is no longer a risk of passing it on. That is why safer sex and keeping up with medical follow-up visits are essential.

What care is needed after genital wart treatment?

Following these steps helps you heal, but it does not completely remove the chance of warts coming back.

Home remedies, supplements and traditional medicine: a closer look

Supporting your general health

Enough sleep, a balanced diet and quitting smoking support your general health and immune system, but no food directly treats warts.

Supplements with limited evidence

AHCC (active hexose correlated compound) has been looked at in a few small, early studies on persistent high-risk HPV infection, but it has not been shown to treat genital warts, and it does not replace standard treatment or medical follow-up. Talk to your doctor before taking any supplement.

Unproven methods

Ozone therapy, plasma treatments, ganoderma (reishi mushroom), sekanjabin (a traditional vinegar-and-honey syrup) and herbal remedies that promise guaranteed results are not standard treatments for warts.

Do not use these on the genital area

Vinegar, garlic, salicylic acid, hair-removal cream or rubbing the bump may cause burns, sores and infection. Acyclovir and penciclovir are herpes medicines and do not treat warts caused by HPV. Antibiotics and antifungal medicines do not treat the warts themselves either; they are used only when a doctor prescribes them for a separate problem.

Before treatment, make sure the bump really is a wart

Confirm the diagnosis before heat removal or freezing

Skin tags, pearly papules, vestibular papillomatosis, molluscum, herpes, fungal infections and pimples can all look like warts. Diagnosis is usually made by a doctor’s examination, and if the bump looks unusual or the diagnosis is unclear, a biopsy may be needed. Freezing, heat removal or laser treatment of a bump without a correct diagnosis can damage the skin and can even make it harder to find the real cause.

Genital warts, relationships and marriage

  • HPV is very common, and having warts is not, on its own, a sign of infidelity.
  • Warts may appear months or years after the virus enters the body. It is usually not possible to tell when it was passed on or by whom.
  • Warts do not stand in the way of marriage or a healthy relationship, and they can be treated and managed.
  • Avoid sex while you or your partner have visible warts. After treatment, before having sex again, allow time for the skin to heal and follow your doctor’s instructions and your medicine’s directions. Condoms lower the chance of passing warts on but do not bring it down to zero, because they do not cover all areas of skin.

Can the HPV vaccine treat genital warts?

The vaccine does not treat warts or an HPV infection you already have. Even so, it may prevent infection with types that have not entered your body yet. Some studies have looked at whether vaccination may lower the chance of warts coming back, but this effect has not been proven. The decision about the vaccine should be made with your doctor, based on your age, vaccination history and individual situation.

5 questions to ask your doctor before genital wart treatment

Frequently asked questions about treating genital warts

Can genital warts be cured for good?

Warts can be treated, but no method can promise everyone that the virus will be removed or that warts will not come back. In one report, warts cleared in about 75% of people within two years without any treatment.

Warts may come back, especially in the first few months. Depending on the treatment method and the type of study, recurrence rates from about 13% to more than 40% have been reported, and warts are most likely to come back in the first three months. Follow up with your doctor to decide on the next step.

No. These medicines are for herpes and have no effect on warts caused by HPV.

No. These substances may cause burns, sores and infection. Topical wart medicines should be used only as prescribed and directed by a doctor.

No. Typical genital warts are mostly linked to the low-risk types HPV 6 and HPV 11, and they do not turn into another virus or disease. High-risk types of HPV are a separate matter and need cervical follow-up.

The treatment method depends on where the warts are and their size, and it should be chosen under a specialist’s care. Treating warts in these areas yourself is not appropriate.

No. Warts may appear months or years after HPV enters the body, and it is usually not possible to tell when it was passed on.

Some wart medicines should not be used in pregnancy. Your doctor will decide on the treatment and on how you give birth, based on where the warts are and their size. Do not treat them yourself.

Diagnosis is usually made by a doctor’s examination. If the bump looks unusual or the diagnosis is unclear, further tests such as a biopsy may be needed.

پرتره پروفسور مژگان کریمی‌زارچی
Author: Professor Mojgan Karimi-Zarchi
Gynecologic Oncologist

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