Treatment modalities for genital warts

Podophyllotoxin 0.05% solution or gel and 0.15% cream (Grade A). Podophyllotoxin is a purified extract of the podophyllum plant, which binds to cellular microtubules, inhibits mitotic division, and induces necrosis of warts that is maximal 3 to 5 days after administration. Shallow erosions occur as the lesions necrotize and heal within a few days. This treatment option is generally thought to be safe, effective, and can be self-administered. Podophyllotoxin is available as a solution, cream, or gel and must be applied twice daily for three consecutive days of the week, for a maximum of four weeks. Typically, the solution is recommended for penile lesions, whereas cream or gel vehicle preparations are thought to be more comfortable for application to anal or vaginal lesions.
Randomized, placebo-controlled trials have demonstrated successful clearance rates ranging between 45 to 77 percent. Podophyllotoxin is also associated with rates of recurrence as low as 38 percent. Warts that have not resolved after four courses should be treated by alternative means. Adverse effects tend to be fairly common, especially with the first course of therapy and include pain, inflammation, erosion, burning, or itching at the application site. These are frequently thought to be the result of excessive treatment administration on the part of the patient. Despite its significantly safe drug profile, podophyllotoxin has not yet been thoroughly evaluated for teratogenecity and is not recommended for use during pregnancy.

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