Genital Warts

Canadian Guidelines on Sexually Transmitted Infections - Genital Human Papillomavirus Infections


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- Differential diagnosis:

  • condyloma acuminata (HPV)
  • molluscum contagiosum
  • epidermoid cysts
  • pearly penile papules
  • condylomata lata (secondary syphilis)
  • tumours

- Refer to specialist if:

  • large/extensive warts
  • resistant lesions
  • internal lesions: vaginal, cervical, anal, urethral, meatal warts
  • neoplasia suspected:
    • pigmented lesions
    • bleeding
    • persistent ulceration
    • persistent pruritus
    • recalcitrant lesions

- Recommend testing for chlamydia, gonorrhea, hepatitis B&C, syphilis and HIV.

- No therapy guarantees eradication of HPV.

- Discuss HPV vaccination with patient.

- Therapy is primarily to reduce lesion size - may reduce risk of transmission.

Condyloma acuminata

Usual Pathogens

Human Papilloma Virus (HPV)


Therapy Dose Duration
Imiquimod 3.75% cream Apply to warts daily, wash off in morning or 6-8 hours later Up to 8 weeks
Podofilox 0.5% solution Apply to warts (not contiguous skin) bid 3 days (4 days off). May repeat 3 day cycle up to 6 times


Therapy Dose Duration
Bi or tri chloracetic acid 50-80% Apply to warts (not contiguous skin) weekly Once per week until resolved (6-8 weeks)
Podophyllin 10-25% Apply to warts (not contiguous skin) 1-2 times per week, wash off 1-4 hours later Until resolved

Other options

Therapy Dose Duration
Laser therapy