HPV: An Updated Guide to Treatment and Prevention

Jennifer A. Wilson, PharmD, BCACP; Rashi C. Waghel, PharmD, BCACP


US Pharmacist. 2015;40(9):HS-22--24. 

In This Article

Treatment of HPV Infections

External Genital Warts

There are multiple treatment options for external and perianal genital warts. Some therapies can be self-administered by patients, while other treatments require administration by healthcare providers. Per the CDC's 2015 sexually transmitted diseases treatment guidelines, there are three recommended options for self-administration by patients: podofilox 0.5% solution or gel, imiquimod 3.75% or 5% cream, and sinecatechins 15% ointment.[1] The provider-administered options include cryotherapy, trichloroacetic acid (TCA) 80%-90%, bichloroacetic acid (BCA) 80%-90%, and surgical removal.[1,4] Podophyllin resin was previously included as a provider-administered option in the 2010 guidelines;[4] the 2015 update does not generally recommend its use because of systemic toxicities.[1] Table 1 lists the currently recommended treatment options.[1]

Podofilox 0.5% solution or gel (Condylox) should be applied two times daily for 3 days, followed by a period of 4 days without therapy. This dosing cycle can be repeated up to four times. The solution should be applied using a cotton swab or provided applicator, and the gel should be applied with a finger. No more than 0.5 mL of podofilox should be applied per day. Patients should be counseled that mild-to-moderate local pain or irritation may occur.[1,2,4,5]

Imiquimod 5% cream (Aldara) should be applied at bedtime three times per week for a maximum of 16 weeks. Imiquimod is also available as a 3.75% cream (Zyclara), which is applied every night at bedtime. Regardless of dosage strength used, patients should wash the area 6 to 10 hours after applying the medication. Patients should be counseled to expect local reactions such as redness and irritation. Hypopigmentation of the skin may also occur. It is important to educate patients that imiquimod can weaken condoms and vaginal diaphragms.[1,2,4,6]

Sinecatechins 15% ointment (Veregen) should be applied three times daily for a maximum of 16 weeks. Unlike imiquimod, sinecatechins ointment should not be washed off after administration. Patients should be counseled to avoid sexual contact while the ointment is on the skin. Common adverse effects include local reactions such as redness, irritation, burning, or pain. Sinecatechins is not recommended for immunocompromised patients (e.g., HIV-positive) or those with genital herpes.[1,2,4,7]

Provider-administered options recommended by the CDC include cryotherapy, TCA 80%-90% (Tri-Chlor 80%), BCA 80%-90%, and surgical removal.[1,3,8–10] Cryotherapy involves freezing off the warts using liquid nitrogen or a cryoprobe. TCA and BCA are widely used agents to chemically remove warts. These treatments may also be used on a weekly basis as needed. Surgical removal typically only requires one office visit and is preferred in patients with many lesions. Some providers will use a combination of methods due to the failure rate of these treatments.[1,4] Alternative, less common methods include intralesionally administered interferon, laser surgery, photodynamic therapy, and topical cidofovir.[2,3]

Internal Vaginal, Anal, and Urethral Meatus Warts

All therapies for internal vaginal and anal warts should be administered by a healthcare provider. Cryotherapy using liquid nitrogen or application of TCA or BCA 80%-90% are options for vaginal or anal warts. Additionally, surgical excision can be used for anal warts.[1,3,4]

As with vaginal and anal warts, treatment for urethral meatus warts is limited to provider-administered options. These options include cryotherapy with liquid nitrogen or surgical removal.[1,3,4]