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Plain Language Summary

A systematic review of the use of topically applied treatment for genital warts in patients with normal immunity

First published: 01 July 2020

https://doi.org/10.1111/bjd.19183

Abstract

The aim of this paper was to analyse the results of published studies looking at the use of topically applied medications (meaning they are applied to the skin) to treat warts on the external genitalia, to see if there was enough evidence to favour one or more treatments on the basis of good results and safety.

The investigators selected 41 studies, which together involved 6371 patients. The main treatments analysed where topical podophyllotoxin (a cytotoxic agent ‐ meaning it kills cells ‐ applied to the surface of warts) in different strengths, sinecatechin (a product, again, used topically and derived from green tea extract), cidofovir gel and idoxuridine cream (both antiviral medications applied directly to warts), imiquimod (a topically applied medication used to increase immunity).

Of the two most commonly used treatments, podophyllotoxin in a 0·5% solution was more effective than imiquimod 5% cream although it also caused more side effects such a stinging and irritation. By contrast sinecatchin was not as effective as imiquimod. The antiviral medications, idoxuridine and cidofovir, produced very similar results to those seen with imiquimod and podophyllotoxin. Generally, the rates of recurrence after therapy were similar whichever treatment was applied.

The investigators concluded that there was little difference to be found between the different treatments and that selection of the most suitable in each individual case should also take into account factors such as the likelihood of irritation at the site to be treated or the length of time required to achieve cure, as some, such as imiquimod, take longer to produce results than others.