Treatment modalities for genital warts
Sinecatechins 15% ointment (Grade A). Sinecatechins is a botanical extract approved in 2006 by the United States Food and Drug Administration (FDA) for the treatment of genital warts, making it the first botanical to officially receive medical approval. The active ingredient is a green tea extract containing sinecatechins, which is thought to possess antioxidant, antiviral, and antitumor effects. Although the precise mechanism of action remains unclear, sinecatechins is thought to modulate the inflammatory response through the inhibition of transcription factors AP-1 and NF-κB, both of which are induced by reactive oxygen species. They have also been shown to downregulate the expression of cyclooxygenase-2, which has been linked to activation of the prostaglandin E2 system and subsequent epithelial dysplasia.
Sinecatechins 15% cream is applied topically to warts three times a day for up to four months. Typically, if an improvement is not seen within a few weeks, the treatment is stopped and another option is tried. Several randomized, double-blind, placebo-controlled trials have shown sinecatechins to be significantly more effective than placebo in the treatment of genital warts, with clearance rates as high as 58 percent. Recurrence rates are also relatively low, ranging between 6 to 9 percent at 12 weeks follow up.
This botanical extract is associated with a number of adverse effects that are thought to occur in approximately 20 percent of users. These events are generally quite mild and typically include redness, burning, itching, and pain at the site of application. More severe reactions associated with this topical product’s use, such as lymphadenitis, vulvovaginitis, balanitis, and ulceration are extremely rare, but have been reported .