The best systematic review of genital wart treatment was published in 2004 in the International Journal of STD & AIDS.3 Imiquimod has proven effective in many studies, including 3 randomized controlled trials in which clearance rates were 37% to 52% after 8 to 16 weeks of treatment (LOE=1a).3 One study using imiquimod found that clearance rates were twofold higher for women than for men (72% and 33%, respectively).4 This is probably because genital warts in females are less keratinized than warts on the usual site in males, the penile shaft. Similarly, clearance rates with imiquimod seem to be higher in uncircumcised men (62%) than circumcised men (33%), probably related to the degree of keratinization.3
Recurrence rates for sole therapy with imiquimod (9%–19%) are substantially lower than for most other genital wart treatments, including podophyllotoxin.3 Imiquimod may even be effective in reducing wart recurrence rates when used as an adjunct to surgical treatment.3
The Patient’s Treatment: Cryotherapy, Imiquimod Cream
The treatment options were discussed with the patient. The patient decided to have cryotherapy performed in the office and was given a prescription for imiquimod cream to be used on any remaining warts. The normal pearly penile papules on the corona were left alone and the patient tolerated the cryotherapy to the real warts with an acceptable level of temporary discomfort.
Drug Brand Names
- Imiquimod • Aldara
- Podofilox • Condylox