Treating genital warts 

Treatment for genital warts depends on the type of warts you have and where they are located. You do not need treatment if there are no visible warts.

There are two main types of treatment for genital warts:

  • applying a cream, lotion or chemical to the warts (topical treatment)
  • destroying the tissue of the warts by freezing, heating or removing them (physical ablation)

Most topical treatments tend to work better on softer warts, and physical ablation tends to work better on harder and rougher-feeling warts. Sometimes, a combination of topical treatments is recommended.

For some people, treatment can take several months to remove the warts, so it is important to persevere.

You may be advised to avoid perfumed soap, bath bubbles or lotions while you are having treatment for warts as these can sometimes irritate the skin.

Topical treatment

There are several topical treatments that can be used to treat genital warts. Some creams can weaken latex condoms, diaphragms and caps. Remember to check this with the doctor or nurse, who can advise you.

Topical treatments are described below.

Podophyllotoxin

Podophyllotoxin is usually recommended to treat clusters of small warts. It comes in liquid form and works by having a toxic (poisonous) effect on the cells of the warts.

A special application stick is used to draw up the correct dosage of the liquid, which is then dripped on to the wart.

You may experience some mild irritation when you apply the liquid or cream to the wart. Cream is usually advised for areas where applying liquid is difficult.

Treatment with podophyllotoxin is based on cycles. The first treatment cycle involves applying the medication twice a day for three days.

This is then followed by a rest cycle where you have four days without treatment. Most people require four to five treatment cycles separated by rest cycles.

Podophyllotoxin should not be used if you are pregnant.

Imiquimod

Imiquimod is a type of cream usually recommended to treat larger warts.

It works by helping stimulate your immune system into attacking the warts. You apply the cream to the warts and then wash it off after 6 to 10 hours. This should be done three times a week.

You may experience skin irritation after you apply the cream. Usually this is mild, but contact the doctor or clinic if it does not improve.

It can often take several weeks of treatment before you notice an improvement in your warts.

Imiquimod is not usually used if you are pregnant.

Trichloroacetic acid

Trichloroacetic acid (TCA) may be recommended to treat small warts that are very hard. 

It works by destroying the proteins inside the cells of the wart. But if it is not applied correctly, TCA can damage healthy skin.

TCA is thought to be safe to use during pregnancy.

It is not recommended that you apply TCA yourself. Instead, you will be asked to visit your local GUM clinic once a week so a doctor or nurse can apply the medication.

After TCA is applied, some people experience an intense burning sensation for around 5 to 10 minutes.

Physical ablation

There are four main methods used in the physical ablation of genital warts. They are:

  • cryotherapy
  • excision
  • electrosurgery
  • laser surgery

These treatments are performed by a trained doctor or nurse.

Cryotherapy

Cryotherapy involves freezing the wart using liquid nitrogen and is usually recommended to treat multiple small warts, particularly those that develop on the shaft of the penis or on, or near, the vulva.

During cryotherapy treatment, you will experience a mild to moderate burning sensation.

Once the treatment has finished you may develop skin irritation, blistering and pain at the site of the wart. Your skin will take between one and three weeks to heal.

Avoid having sex until the area of skin around the wart has fully healed.

Excision

Excision, where warts are cut away, is sometimes recommended to treat small hardened warts, particularly where this is a combination of smaller warts that have joined together to form a sort of cauliflower shape.

At the start of the procedure, you will be given a local anaesthetic to numb the area of skin around the wart. The wart will then be cut away with a surgical scalpel and the remaining incision sealed with stitches.

Excision can cause scarring, so it may not be suitable for very large warts. The area of skin where the wart was removed will be sore and tender for around one to three weeks.

You should avoid having sex until the area of skin around the wart has fully healed.

Electrosurgery

Electrosurgery is a specialist treatment. It is often combined with excision to treat large warts that develop around the anus or vulva that have failed to respond to topical treatments.

Excision is first used to remove the outer bulk of the wart. A metal loop is then pressed against the wart. An electric current is passed through the loop to burn away the remaining part of the wart.

Removing a large number of warts in this way can be quite painful, so you may be given a regional anaesthetic (where everything below your spine is numbed, similar to an epidural during pregnancy) or even a general anaesthetic.

Laser surgery

Laser surgery is also a specialist treatment. It may be recommended to treat large genital warts that cannot be treated using other methods of physical ablation because they are difficult to access, such as warts deep inside your anus or urethra (the tube that connects the bladder to the penis or vulva, which urine passes through).

During the procedure, a surgeon will use a laser to burn away the warts. Depending on the number and size of the warts, laser surgery can be performed under either a local or general anaesthetic.

As with other types of ablation treatment, you should expect soreness and irritation at the site where the warts were removed. This should heal within two to four weeks.

Genital warts and sex

It is recommended you do not have sex, including anal and oral sex, until your genital warts have fully healed.

This will help prevent you passing the infection on to others. It will also help your recovery, as the skin friction that occurs during sex can cause treated skin to become irritated and inflamed.

Even after the warts have gone, there may still be traces of human papillomavirus (HPV) in your skin cells. It is therefore recommended you use a condom during sex for the first three months after the warts have cleared up.

Smoking

For reasons that are still unclear, many treatments discussed on this page are more effective in non-smokers than in smokers.

If you are a smoker, quitting smoking may help speed up the healing process after treatment for genital warts.

Quitting smoking will also bring a range of other important health benefits, such as significantly reducing your risk of developing lung cancer and heart disease.

The NHS Smokefree website provides support and advice for people who want to stop smoking. Your GP will also be able to prescribe medication that can help you quit.

See treatment for quitting smoking for more information.

Page last reviewed: 22/08/2014

Next review due: 22/08/2016