The CO2 laser utilizes focused infrared light energy. This energy is absorbed by the tissues, making the tissue water to vaporize. The target area gets void of water, is not viable any longer, so the lesion gets destroyed. Laser allows precise tissue ablation by spatial limitation of thermal damage and effective vaporization.

CO2 laser therapy is a useful treatment method, especially for extensive warts and can be used at difficult anatomical sites. It is typically performed in an office. In some particular cases (large lesions, pediatric patients) anesthesia may be required and therefore this procedure should be done in hospital under general anesthesia. The CO2 laser is very precise and therefore it spares normal tissue, probably it eliminates the infective agent and also has a good cosmetic effect. However, it is considerably more expensive than other destructive methods used for GW treatment (cryotherapy, electrosurgery or surgical excision).

In most of the cases, healing is rapid. The risk of scaring is small but is greater than of cryotherapy. Other side effects are similar to those of surgery. It has been shown that the plume of smoke resulting form laser technique may contain papilloma virus DNA, with contagious potential for operating personnel (infection of the respiratory tract). However, if appropriate equipment is used, the risk for contamination is basically null (Garden JM, 1988; Scheinfeld NS, 2005; Weynandt GH, 2011).
Efficacy and Recurrence
Overall, the clinical studies have shown clearance rates between 23% and 52%, whereas the recurrence rates varied from 60% to 77% over a follow-up period of 3-18 months (International Collaborative Study Group, 1993; Duus BR, 1985; Reid R, 1992; Petersen C, 1991).

A study comprising 208 patients (135 women and 73 men) with vaginal and external anogenital warts was designed to compare the outcomes of electrosurgery and laser therapy. To avoid selection bias, in each patient half of the lesions measuring 2 cm2 or greater total linear area were treated with electrosurgery, and the other half were treated with laser excision. The follow-up was at least 6 months after the last treatment received. Clearance was achieved in 95% of patients with a lesional area of 5 cm2 or less, and 100% of patients with 5 cm2 or larger by the third and sixth postoperative week, respectively. Similar side effects occurred in both groups: severe discomfort (12% of patients), and delayed complications, including vitiligo and scarring (4% of patients). Complete clearance of warts after a single session (51% vs 38%) and multiple treatments (75% vs 64%) were similar for electrosurgery and CO2 laser. In vaginal and external GW electrosurgery and continuous wave CO2 laser seems to be equally effective especially if the lesions are limited to a 5 cm2 or less area (Ferenczy A, 1995).

Another randomized trial in patients with refractory GW also found the carbon dioxide laser did not offer any advantages over traditional surgery, including electrocautery (Duus BR, 1985). No difference between the two treatments was seen in numbers of recurrences, postoperative pain, healing time, and rate of scar formation.
One-hundred-six patients treated with CO2 laser for GW were followed for 6 months. At one month follow-up, clearance was found in 81.2% of cases, recurrence in 12.6% and persistence in 6.6%. Ninety-three percent of patients in remission at one month were still in remission at three months. At six months, 83% of patients were in remission after 1.4 laser treatments. (Aynaud O, 2008).

A case-control study was performed on pregnant women with GW treated with CO2 laser. Two-hundred-eighty women received treatment during pregnancy and 256 women were treated three months after delivery. Recurrence rates over a 2 year follow-up were higher in the women treated in postpartum (p < .01) than in the group treated during gestation (p < .005). Clinical HPV infections treated during the second trimester of pregnancy were associated with a decrease in recurrence rate of infection (Frega A, 2006).

Another study evaluated the complication rate and patient satisfaction in male patients with extensive GW treated with laser or electrosurgery. Questionnaires were used retrospectively in 64 consecutive men (answer rate 60% or 64/107 addressed persons). The mean follow-up was 25 months (range 7-75). The overall clearance rate after 1 session of treatment was 67%. The clearance and recurrence rates were similar for both HIV-positive and HIV-negative groups. However, the cure rate was influenced by localization: endoanal versus perianal: 56 versus 84% (odds ratio = 4.06; p = 0.03). After a second treatment session, the cure rate increased to 79% or higher in all subgroups. Painful defecation for an average of 4-5 weeks was the main postoperative complaint. (Carroza PM, 2002).

It appears that administration of interferon alpha-2b subcutaneously following laser therapy in patients with resistant GW is beneficial. Interferon was fairly well tolerated in a trial and significantly improved the clearance rates: 14/27 patients (52%) cured in the group treated with laser plus interferon, vs 5/22 (23%) patients in laser plus placebo group (Petersen CS, 1991).
In conclusion, laser surgery is as effective as surgical excision at clearing and preventing recurrence of genital warts. Even it was considered at one time the method of choice for treating GW, it has not be proven to be superior to other therapy options.

References

Aynaud O, Buffet M, Roman P, Plantier F, Dupin N. Study of persistence and recurrence rates in 106 patients with condyloma and intraepithelial neoplasia after CO2 laser treatment. Eur J Dermatol. 2008 Mar-Apr;18(2):153-8.
Condylomata International Collaborative Study Group. Randomized placebo-controlled double-blind combined therapy with laser surgery and systemic interferon-alpha 2a in the treatment of anogenital condylomata acuminatum. J Infect Dis 1993;167:824-9.
Duus BR, Philipsen T, Christensen JD, Lundvall F, Søndergaard J. Refractory condylomata acuminata: a controlled clinical trial of carbon dioxide laser versus conventional surgical treatment. Genitourin Med. 1985 Feb;61(1):59-61.

Frega A, Baiocco E, Pace S, Palazzo A, Iacovelli R, Biamontil A, Moscarini M, Stentella P. Regression rate of clinical HPV infection of the lower genital tract during pregnancy after laser CO2 surgery. Clin Exp Obstet Gynecol. 2006;33(2):93-5.
Garden JM, O’Banion MK, Shelnitz LS, Pinski KS, Bakus AD, Reichmann ME, Sundberg JP.: Papillomavirus in the vapor of carbon dioxide laser-treated verrucae. JAMA. 1988;259:1199-202.

Surgical excision usually requires adequate anesthesia (local, regional, or general) and surgical instruments for hemostasis, because large genital warts are very vascular and can heavily bleed.
The side effects of procedure include pain, bleeding/ hematoma, infection, scarring.
Efficacy and Recurrence

Two trials comprising 97 patients found no significant difference between surgical excision and podophyllin in terms of wart clearance (16/18 [89%] with surgical excision v 15/19 [79%] with podophyllin; RR 1.13, 95% CI 0.85 to 1.50 (Khawaja HT, 1989); and 28/30 [93%] with surgical excision v 23/30 [77%] with podophyllin; P = 0.20 (Jensen SL, 1985). However, the recurrence rates over 6–12 months were significantly reduced by surgery compared with podophyllin (19% with surgical excision v 60% with podophyllin, P = 0.05 (Khawaja HT, 1989), and 29% with excision v 65% with podophyllin, P < 0.01 (Jensen SL, 1985). More patients receiving surgical excision than receiving podophyllin had pain (11/18 [61%] with excision v 5/19 [26%] with podophyllin (Khawaja HT, 1989); 25/30 [83%] with excision v 7/30 [23%] with podophyllin (Jensen SL, 1985). More people receiving surgical excision than receiving podophyllin had bleeding (13/30 [43%] with excision v 11/30 [37%] with podophyllin) (Jensen SL, 1985). The statistical significance of the differences was not assessed by these trials.

Overview research to medicine:

Another trial compared surgical excision versus carbon dioxide laser (Duus BR, 1985). The two treatment had similar outcomes, with no significant difference in wart clearance (43 people; RR 1.2, 95% CI 0.6 to 2.4), and no significant difference in recurrence rates. The trial also found no significant difference in postoperative pain, healing time, and rate of scar formation (p > 0.1-0.2), although fewer people having surgical excision developed scars (9% had scars with surgical excision v 28% with laser surgery; P > 0.2).

Excision of extensive anal warts has a high probability of recurrences. However, the risk of developing anal stenosis was low in a study of 41 patients undergoing excision of large anal warts with an average follow-up of 6 months. Recurrent warts developed in 19 patients (46.3%). Bleeding was a complication in 22% of the cases. None of the patients developed postoperative stricturing or anal stenosis at follow-up (Klaristenfeld D, 2008).
A randomized controlled study was carried out in 261 patients with anal warts allocated to surgical excision alone (control group; n = 122) and surgical excision plus postoperative immunostimulation for 30 days with a natural product (STET; study group; n = 139). Six months after surgery, recurrence occurred in 7.2% (10/139) in the study group and in 27.1% (33/122) in the control group (P < 0.0001), suggesting that immunostimulation using a natural product may be used to reduce the incidence of recurrence of anal warts in patients undergoing surgical excision Mistrangelo M, 2010).
Surgical excision was safely and successfully used in a pregnant woman to remove an obstructive urethral wart causing difficulty in urine voiding. (Parnell BA, 2010).

In conclusion, surgical excision is as effective as laser surgery at clearing and preventing recurrence of genital warts, and is more effective than podophyllin at preventing recurrence after 6–12 months. Surgical excision of external GW may cause pain, bleeding and scaring.

References

Duus BR, Philipsen T, Christensen JD, Lundvall F, Søndergaard J. Refractory condylomata acuminata: a controlled clinical trial of carbon dioxide laser versus conventional surgical treatment. Genitourin Med. 1985 Feb;61(1):59-61.

Jensen SL. Comparison of podophyllin application with simple surgical excision in clearance and recurrence of perianal condylomata acuminata. Lancet. 1985 Nov 23;2(8465):1146-8.

Khawaja HT. Podophyllin versus scissor excision in the treatment of perianal condylomata acuminata: a prospective study. Br J Surg. 1989 Oct;76(10):1067-8.

Klaristenfeld D, Israelit S, Beart RW, Ault G, Kaiser AM. Surgical excision of extensive anal condylomata not associated with risk of anal stenosis. Int J Colorectal Dis. 2008 Sep;23(9):853-6.

Mistrangelo M, Cornaglia S, Pizzio M, Rimonda R, Gavello G, Dal Conte I, Mussa A. Immunostimulation to reduce recurrence after surgery for anal condyloma acuminata: a prospective randomized controlled trial. Colorectal Dis. 2010 Aug;12(8):799-803.
Parnell BA, Geller EJ, Jannelli ML. Urethral condyloma accuminata causing bladder outlet obstruction in pregnancy: a case report. J Reprod Med. 2010 Nov-Dec;55(11-12):514-6.

As Denavir is an antiviral medication, some patients have used it to treat another virus-infected disease of an almost similar nature, which are genital or venereal warts. To examine whether Denavir is effective in treating genital warts, one needs to first develop an understanding about the two diseases including their symptoms and complications before arriving at any conclusion.

Like herpes, genital or venereal warts is a contagious disease that can be transmitted during sexual intercourse. They are both sexually transmitted diseases (STD), and unfortunately cannot be cured.

There are distinct differences between venereal warts and herpes. For one, genital warts are caused by a different virus known as human papillomavirus (HPV) instead of herpes simplex virus which is the virus responsible for herpes.

Another major difference between herpes and HPV lies in their outward symptoms, symptom locations and conditions. Symptoms of genital herpes are the appearances of blisters or sores on the genitals, buttocks and anal area, whereas symptoms of oral herpes are blisters and sores around the lips and face. Blisters and sores caused by herpes are often itchy, swollen and sometimes, painful and they often break out when the patient’s immune system is affected such as during stressful situations or when the body is weakened due to lack of sleep or illness.

HPV on the other hand does not often produce any outward symptoms and if they do, they are known as genital warts which are hard or soft flesh cauliflower-shaped lumps around the genital areas. Due to its general lack of symptoms, patients with HPV sometimes do not realize they are infected.

Can Denavir treat Genital Warts?
Genital warts can be either removed surgically or treated with antiviral cream application. There are currently several antiviral cream products in the market that can be used for herpes as well as genital warps.

So far Denavir has not been proven to treat genital warts. It is an antiviral cream which is manufactured for external application on cold sores caused by the herpes simplex virus; there has not been any claim by its manufacturer that it can treat HPV. Secondly, it is also specifically recommended only for external application on the lips and on the face, and not to be applied inside the mouth, the nose, near the eyes or on genital areas. The latter could cause skin irritation or other side effects.

By following its recommended dosage, Denavir can reduce and contain the outbreak of swollen painful sores caused by herpes simplex virus within a matter of days. However, it can only contain and limit the outbreak of sores but cannot cure or prevent the transmission of the virus. Similarly, Denavir is unlikely to treat or prevent the transmission of HPV virus. Furthermore, genital warts caused by HPV are normally not painful but only cause discomfort and itch. In some cases, they often go away on its own even though no treatment is applied.

Therefore, one should seek medical advice before using Denavir on genital warts as the medication is not meant to fight HPV virus in the first place. However, there may be instances when symptoms are similar and it is essential to receive the right diagnosis in order to receive the right treatment.

Pathology: What’s a Wart?

A wart is a typically benign tumor that appears as the result of contracting a virus known as the Human Papilloma Virus or HPV. HPV is normally transmitted through open cuts or scabs on the skin, and once inside, begins to produce the tumors. In most cases, HPV is simply a cosmetic annoyance. But in rarer cases, HPV can cause certain types of cancer. In order to reduce the risk of contracting a severe case, doctors usually remove the warts with liquid nitrogen or lasers. Not only that, but there has recently been a vaccine that reduces the risk of contracting HPV.

In the case of genital warts, someone who has contracted HPV has sexual intercourse with a non afflicted partner. If unprotected, skin contact with a wart can result in the Human Papilloma Virus spreading to the genital areas. The result is warts in or near the anus, perineum, and the sexual organs.

How Does Condylox Work?

Condylox is a prescription gel-lotion that contains roughly .5% podofilox, a chemical found in rhizome tubers. Seeing that warts are simply cells reproducing at a rapid rate, the goal of the gel is to prevent the cells from dividing. The anti-mitotic agent in Condylox is podofilox, which when applied on the wart, prevents the cells from multiplying, causing them to die.

Note: Condylox is prescribed only for use on genital and perennial warts. Condylox also simply acts as a treatment for when warts appear; it is not a cure.

Benefits

Using Condylox offers a plethora of benefits. These include:

Non-invasive treatment: Instead of removing warts via freezing, electricity, or burning, all of which can be very painful, especially in the sensitive genital areas, Condylox is a simple topical gel that offers the same treatment with little pain. Not only that, but Condylox does not require one to return to their doctor to remove every wart. They must only obtain a prescription from them and visit for check-ups.

Immune Strengthening Method: Condylox appears as a simple topical cream, but when applied, the anti-mitotic chemical podofilox alerts the immune system that there are cells appearing to divide rapidly. This extra “heads up” allows the body to remove the warts quickly and reduces the amount of outbreaks one has.

Side Effects

Although Condylox appears to be the best method for treatment of genital warts, it should be noted that the medication does not work for everyone. Several side effects have known to occur from people using Condylox. These include:

-Itching
-Redness
-Burning sensations at site of application
-Headaches
-Stinging pain
-Inflammation

Fortunately these side effects are relatively mild and are usually caused by an over-application of the gel.

In rarer cases, people who are allergic to Condylox can experience more severe side effects which include:

-Rash
-Hives
-Wheezing/Difficulty breathing
-Tightness in chest
-Swollen face, throat, lips, and tongue
-Severe bleeding and irritation at application site
-Extreme burning sensation found at the application site

Note that these are very rare side effects that occur only if patient is allergic.

Results have shown that Imiquimod helps to get rid of warts in about half the people who use it for four months. But one study found it didn’t help people who had HIV.

Imiquimod cream is supplied in single-use sachets. Each gram of the 5% cream contains 50 mg of imiquimod in a cream base. According to the US Center for Disease Control recommendations imiquimod 5% cream be applied by the patient once daily at bedtime, 3 times per week. The treatment area should be washed with mild soap and water 6-10 hours after the application. With more frequent applications (up to 3 times daily), the rate of success does not improve significantly. However, an increase in local adverse events, such as erythema, vesicle formation, ulceration, and excoriation may occur. The treatment is usually applied for up to 16 weeks, but is well tolerated for up to 32 weeks. This duration is longer than that of any other Genital Warts treatment.

Imiquimod can also help to reduce the chance of the warts coming back two to four months after you stop using it. It doesn’t seem to matter whether you use imiquimod once, twice or three times a day. It’s just as likely to work however often you use it.

Imiquimod cream can make your skin red, swollen and itchy. Using it twice a day causes more side effects than using it less often.

You shouldn’t use imiquimod if you’re pregnant.

Detailed Overview

New warts may develop during therapy, as imiquimod is not considered a cure. Recurrences appear in up to 20 % of patients. The safety of imiquimod during pregnancy is not established and thus its use is contraindicated in pregnancy.

The side effects of imiquimod are generally mild or moderate. Erythema, erosion, swelling, changes in skin color, itching, burning, pain/ tenderness, thickening/ hardening of the skin, peeling/ flaking/ scabbing/ crusting may occur with this treatment. In some few cases in which the skin reaction is severe (bleeding, formation of sores/ blisters/ ulcers), imiquimod may need to be temporarily stopped so that the skin can heal. Other side effects may include headache, loss of appetite, dizziness, diarrhea, nausea or back pain.
Imiquimod acts by stimulating a cell-mediated response against human pappiloma virus.

Efficacy and Recurrence

Several randomized controlled trials demonstrated that imiquimod 5% cream is an efficacious treatment for external anogenital warts when applied 3 times per week for up to 16 weeks. Complete clearance of warts occurred in up to 50% of patients, and recurrence rates ranged from up to 19% after 3 months and 23% after 6 months (Garland SM, 2001). Because the recurrence rates were similar at both 3- and 6-month follow-up, it appears that after 3 months, the risk of developing recurrence is low (Vexiau D, 2005). Similar results have been reported by other studies as well.

In a prospective, double-blind, placebo-controlled, clinical trial with 108 patients, imiquimod 5% cream was applied 3 times daily for up to 8 weeks. Complete wart clearance was achieved in 37% of the imiquimod treated patients and 0% of the placebo group. A 50% reduction in baseline wart area was noted in 76% of imiquimod-treated patients compared with 8% of the placebo group. For patients whose warts cleared completely, 19% experienced recurrences after a 10-week follow-up period. Side effects were predominantly mild or moderate in severity and included itching (54%), erythema (33%), burning (31%), irritation (17%), tenderness (13%), ulceration (10%), erosion (10%), and pain (8%) (Beutner, 1998).

Imiquimod 1% or 5% significantly increased the proportion of people with complete clearance and no recurrence at 10–16 weeks after treatment compared with placebo (Moore RA, 2001). In patients whose warts completely cleared, recurrence during the 10–16 weeks after the end of the treatment was similar with imiquimod 1% and placebo, but higher with imiquimod 5%.

Another study has found that imiquimod 5% cream (3 times a week for 12 weeks) significantly increased the proportion of patients with completely healed or improved genital warts compared with placebo, regardless of gender, initial wart size, duration of current outbreak of warts, previous wart treatment, and smoking status (Syed TA, 2000).

An open-label phase IIIB trial consisting of 943 patients recruited in 20 countries, imiquimod 5% cream was found to be 47.8% effective for overall complete clearance after 16 weeks of treatment. Recurrence rates at the end of 3- and 6-month follow-up were 8.8% and 23%, respectively. The sustained clearance rates after 3 and 6 months were 41.6% and 33%, respectively. The study also found that a greater proportion of female patients (75.5%) experienced complete clearance than did male patients (56.9%). (Garland 2001). Higher efficacy rates in female patients (71% – 77%) have also been reported by other investigators (Edwards L, 1998; Sauder DN, 2003). At least one adverse event was reported in 42% of patients; the majority of reactions were mild to moderate in severity. Local erythema was the most common local skin reaction, occurring in 67% of patients.

Another RCT consisting of 311 patients was randomized to 3 arms (109: 102: 100): imiquimod 5% cream, imiquimod 1% cream, or vehicle 3 times per week for a maximum of 16 weeks. Complete clearance of lesions was achieved in 50% of patients who received the imiquimod 5% cream, 21% of those who received imiquimod 1% cream, and 11% of those treated with the placebo. After a 3-month follow-up, the study found a recurrence rate of at least 1 wart in 13% of patients who receive imiquimod 5% cream. The complete clearance mean time ranged from 8 weeks for women to 12 weeks for men. Twelve weeks after the treatment was stopped, the recurrence rate of at least one wart was 13%. The side effects reported during this study included mild or moderate erythema, erosion, excoriation. (Edwards L, 1998).

In another prospective, multicenter, double-blind, RCT with 279 patients (Beutner KR, 1998), 94 patients used imiquimod 5% cream once-daily for up to 16 weeks. Complete wart clearance occurred in 52% of patients treated with imiquimod 5% cream, with 19% wart recurrence at a 3-month follow-up. These results were similar to those obtained with 3 applications per week. This regimen with 3 times per week treatment is preferable because it is associated with a lower rate of side effects. (Perry CM, 1999; Chang YC, 2005; Gupta AK, 2004).

Even in a lower concentration (3.75%) and applied daily for up to 8 weeks imiquimod was well tolerated and superior to placebo in a cohort of women with external anogenital warts. (Baker DA, 2011).

Longer duration of treatment seems to have no additional benefit. A one-month therapy with imiquimod 5% cream applied 3 times weekly in women with genital warts had similar efficacy to a 4-month treatment (Garland SM, 2001). The difference in complete clearance rates were not statistically significant (40% after 1 month and 51.6% after 4 months, p > 0.05).
Recent studies have found that imiquimod can be succesfully used even in children (Brandt HR, 2010; Masuko T, 2011).
However, in immunosuppressed (HIV-positive) patients it seems that imiquimod is less effective (Gilson, 1999).
Imiquimod 5% cream has had similar beneficial effects of GW as podophyllotoxin 0.5% solution. Also side effects were mild and comparable with both treatments (Komericki P, 2011).

Several studies have found that treatment with imiquimod 5% cream pre- or post surgical excision of warts resulted in a lower recurrence rate compared with surgery alone (Carrasco D, 2002; Kaspari M, 2002). Association of imiquimod to surgical treatment may provide long-term clearance of anogenital warts in patients for whom monotherapy is insufficient.

In conclusion, patient-applied imiquimod 5% cream is a first line topical treatment for anogenital warts that is both safe and efficacious. Further longer follow-up studied are needed to evaluate the efficacy and recurrence rate of different combination regimens.

Getting adequate treatment to take care of genital & venereal warts is very important. One of the products you will find out there is called Aldara. It is a type of topical cream that you will have to apply to the area for several days. Keep in mind that there is no cure for genital or venereal warts. Instead, you have to find a treatment that works well for you. Here is one that you may have heard of. Before you consider it though, get the facts.

Pros

There are many benefits to using Aldara to treat genital & venereal warts. This type of infection can be very itchy and painful. With the use of this medication, the itching and pain can be reduced. It can take action quickly and offer you relief. This particular medication is offered as a topical cream.

For those that take medications for various health concerns, that is important. They don’t want to risk the medication they take to treat genital & venereal warts to interfere with medications they take for other needs. This topical product is affordable too which is important. Not everyone has health insurance or has the money to pay for expensive prescriptions.

The use of Aldara can help to boost your immune system. This means that you are less likely to suffer from future outbreaks of genital and venereal warts. This is definitely a benefit because such breakouts can be very stressful as well as embarrassing.

There have been numerous studies with the use of Aldara. The findings are that it does work to help clear up genital and venereal warts for most individuals. These studies also so that there is very little risk involved with the use of this particular type of medication.

Cons- SIDE EFFECTS

Some individuals experience irritation in the genital area after they have used Aldara. For about 11% of users, there will be the development of some type of fungal infection. If you do experience that, you need to discontinue the use of Aldara right away. Make sure you consult with your doctor so that other forms of treatment can be considered. You will also need treatment to destroy the fungal infection.

Approximately 5% of people that use Aldara will develop symptoms that are very similar to the flu. However, most of the time they don’t make the connection. The symptoms should go away within a couple of days. If they don’t it is a good idea to consult with your doctor about alternative forms of treatment.

It is important to note that the use of Aldara is only to be for external warts. Don’t use it for anything that has developed inside of the body. It shouldn’t be used for anyone under the age of 12. You should only use it for the number of days your doctor tells you to. Applying too much or using it for too long can increase your chances of developing a very serious skin reaction.

It can take up to 16 weeks of use though to get the warts to clear up from a single outbreak. It can also be difficult to remember when to apply it since it should only be applied three times per week.

Consult with your Doctor

Never use Aldara for genital or venereal warts without first talking to your doctor. It isn’t a good idea to use a prescription medication given to someone else. Don’t be embarrassed to talk to your doctor about the situation and the use of this medication. Understanding the pros and cons of Aldara can help you to decide if it is a type of medication you are willing to try or not.

References

Baker DA, Ferris DG, Martens MG, Fife KH, Tyring SK, Edwards L, Nelson A, Ault K, Trofatter KF, Liu T, Levy S, Wu J. Imiquimod 3.75% cream applied daily to treat anogenital warts: combined results from women in two randomized, placebo-controlled studies. Infect Dis Obstet Gynecol. 2011;2011:806105.
Beutner KR, Tyring SK, Trofatter KF, Jr., et al. Imiquimod, a patient-applied immune-response modifier for treatment of external genital warts. Antimicrob Agents Chemother 42(4):789-94 (1998 Apr).

Beutner KR, Spruance SL, Hougham AJ, et al. Treatment of genital warts with an immune-response modifier (imiquimod). J Am Acad Dermatol 38(2 Pt 1):230-9 (1998 Feb).
Brandt HR, Fernandes JD, Patriota RC, Criado PR, Belda Junior W. Treatment of human papillomavirus in childhood with imiquimod 5% cream.An Bras Dermatol. 2010 Aug;85(4):549-53.
Carrasco D, vander Straten M, Tyring SK. Treatment of anogenital warts with imiquimod 5% cream followed by surgical excision of residual lesions. J Am Acad Dermatol. 2002;47(4 Suppl):S212-6.

Chang YC, Madkan V, Cook-Norris R, Sra K, Tyring S. Current and potential uses of imiquimod. South Med J. 2005 Sep;98(9):914-20.
Diamantis ML, Bartlett BL, Tyring SK. Safety, efficacy & recurrence rates of imiquimod cream 5% for treatment of anogenital warts. Skin Therapy Lett. 2009 Jun;14(5):1-3, 5.
Edwards L, Ferenczy A, Eron L, et al. Self-administered topical 5% imiquimod cream for external anogenital warts. HPV Study Group. Human PapillomaVirus. Arch Dermatol 1998;134:25–30.

Garland SM, Sellors JW, Wikstrom A, et al. Imiquimod 5% cream is a safe and effective self-applied treatment for anogenital warts–results of an open-label, multicentre Phase IIIB trial. Int J STD AIDS 12(11):722-9 (2001 Nov).

Gilson RJ, Shupack JL, Friedman-Kien AE, Conant MA, Weber JN, Nayagam AT, Swann RV, Pietig DC, Smith MH, Owens ML. A randomized, controlled, safety study using imiquimod for the topical treatment of anogenital warts in HIV-infected patients. Imiquimod Study Group. AIDS. 1999 Dec 3;13(17):2397-404.

Gupta AK, Cherman AM, Tyring SK. Viral and nonviral uses of imiquimod: a eview. J Cutan Med Surg. 2004 Sep-Oct;8(5):338-52.

Kaspari M, Gutzmer R, Kaspari T, Kapp A, Brodersen JP. Application of imiquimod by suppositories (anal tampons) efficiently prevents recurrences after ablation of anal canal condyloma. Br J Dermatol. 2002;147(4):757-9.
Komericki P, Akkilic-Materna M, Strimitzer T, Aberer W. Efficacy and safety of imiquimod versus podophyllotoxin in the treatment of anogenital warts. Sex Transm Dis. 2011 Mar;38(3):216-8
Masuko T, Fuchigami T, Inadomi T, Inamo Y, Hashimoto K. Effectiveness of imiquimod 5% cream for treatment of perianal warts in a 28-month-old child. Pediatr Int. 2011 Oct;53(5):764-6.
Moore RA, Edwards JE, Hopwood J, Hicks D. Imiquimod for the treatment of genital warts: a quantitative systematic review. BMC Infect Dis. 2001;1:3.

Perry CM, Lamb HM. Topical imiquimod: a review of its use in genital warts. Drugs. 1999 Aug;58(2):375-90.

Sauder DN, Skinner RB, Fox TL, et al. Topical imiquimod 5% cream as an effective treatment for external genital and perianal warts in different patient populations. Sex Transm Dis2003;30:124–128

Syed TA, Hadi SM, Qureshi ZA, Ali SM, Kwah MS. Treatment of external genital warts in men with imiquimod 2% in cream. A placebo-controlled, double-blind study. J Infect. 2000 Sep;41(2):148-51.

Vexiau D, Decuypère L, Moyse D, et al. [Efficacy and safety of 5% imiquimod cream in external genital warts: a 6 month follow-up evaluation]. Ann Dermatol Venereol 132(11 Pt 1):845-51 (2005 Nov).

Two RCTs found that cryotherapy worked about as well as treatment with acid. After six weeks of either treatment, about two-thirds of people had gotten rid of their warts.22 Warts came back in about one-third of people two months later, whichever treatment they had.

It isn’t clear whether cryosurgery works better than using an electrical current (electrosurgery) to get rid of the warts.

Cryotherapy can sometimes cause an infection, but this is rare.

It is safe to have cryotherapy if you’re pregnant.

CRYOTHERAPY

Cryotherapy is a procedure to treat anogenital warts by freezing. It involves application of nitrous oxide or liquid nitrogen (-196°C) to warts. This very low temperature induces dermal and vascular damage and edema, leading to cellular necrosis in both epidermal and dermal layers of the skin.
Discomfort of the procedure is mild, so anesthesia is not needed. However, a mild topical pain reliever may be administered before the procedure. There are several ways to perform cryotherapy. Liquid nitrogen can be poured into a container with a long, pointed device (cryoprobe). It is then sprayed directly onto the wart. Liquid nitrogen can also been applied with a cotton-tipped swab. Either way, freezing of the wart is done for 10-60 seconds, until it is completely covered with ice. A halo of the surrounding tissue is common. The subsequent thaw is followed by cell death. Treated area dries up and falls off in several days or weeks. If necessary, the freezing and thawing cycle can be repeated several times, although trials have not established the optimal number of applications. This depends on the size of the wart and the area being affected.
Cryotherapy causes little scarring after re-epithelialization. The treatment does not have systemic side effects and only affects tissue to which it is directly applied. Color changes may occur, but they are usually short term.
Efficacy and Recurrence
Cryotherapy was applied in a trial to 64 patients, using a fine needle-spray technique (Damstra RJ, 1991). Warts resolved in 83% within 4 weeks and 96% after 6 weeks. The results were significantly better compared with the control group of 70 patients (13% and 45% after 4 weeks and 6 weeks, respectively). Other studies have found clearance rates of 54-88 % and recurrence rates of 21-40 % (Handley JM, 1991; Eron LJ, 1993; Abdullah AN, 1993; Godley MJ, 1987). ). Most warts cleared with fewer than three treatments. It has been suggested that the recurrence occurs often at sites of previous GW, as a result of the reactivation of virus (Ho GY, 1998). Conversely, if the tissue containing the virus is completely destroyed, the risk of recurrence on the same site is much less. Recurrences in other sites may be explained by re-exposure to HPV or from reactivation of a latent virus.
It seems that cryotheraphy is as effective as trichloroacetic acid (TCA) or podophyllin in terms of clearance rates.

Two trials found no significant difference between trichloroacetic acid and cryotherapy in wart clearance after 6 or 10 weeks of treatment (Abdullah AN, 1993; Godley MJ, 1987). The success rates at 6 weeks were: 21/33 (64%) with trichloroacetic acid v 37/53 (70%) with cryotherapy, RR 0.91, 95% CI 0.67 to 1.25. At 10 weeks the rates were: 43/49 (88%) with trichloroacetic acid v 46/57 (81%) with cryotherapy, RR 1.08, 95% CI 0.92 to 1.24). One of the studies found no significant difference in recurrence at 2 months after the end of 10 weeks of treatment (36% with trichloroacetic acid v 39% with cryotherapy; RR 0.91, 95% CI 0.51 to 1.61) (Godley MJ, 1997).
A randomised, double-blind, multicentre controlled trial (Gilson RJ, 2009) has found that initial combination of 0.15 % cream podophyllotoxin and cryotherapy may be more beneficial in some patients, compared with cryotherapy alone, although overall the clearance rates were similar in both groups. By intention-to-treat analysis, clearances at 4 and 12 weeks were higher in the combination group than with cryotherapy alone, although not statistically significant (RR 1.31, 95% CI 0.95 to 1.81). By week 24 there was no difference between the groups (68.6% and 64.3%, respectively; RR 1.07, CI 0.84 to 1.35). Wart clearance was significantly higher in men (p = 0.001) and those with a past history of warts (p = 0.009) at week 4, but these differences were not longer noted at week 12. The group receiving cryotherapy alone was more prone to relapse.
Two trials compared cryotherapy plus interferon (IFN) injection versus cryotherapy alone. Subcutaneous IFN alpha 2a combined with cryotherapy was no more effective than cryotherapy alone in the treatment of GW (Handley JM, 1991). At 8 weeks 60.7% (17/28 patients) of the IFN group and 67.9% (19/28 patients) of the placebo group were clinically wart-free (not statistically significant); at 12 weeks, the differences between the 2 groups were, again, not significant. Similar response rates were not influenced by gender. In patients cleared of warts at 8 weeks, the recurrence rate at three months was 50% (8/16) and 37.5% (6/16) in the IFN and placebo groups respectively (not significant). Systemic side effects were significantly more common in the IFN than in the placebo group, 50% versus 10.7% of patients (p < 0.01). The presence of multiple warts and perianal/anal canal warts were factors of adverse prognostic.
Recurrence of GW following cryotherapy seems not to be prevented by systemically administered interferon (Eron LJ, 1993). A number of 49/97 patients with recurrent GW were treated with cryotherapy plus subcutaneously administered interferon alpha-2a. The rest (48 patients) received cryotherapy plus placebo. The recurrences occur in 10 (28%) interferon recipients and 16 (43%) placebo recipients by completion of IFN therapy. At six months follow-up, 25 (69%) interferon and 27 (73%) treated patients experienced recurrences.
In a single blind study, 42 male patients with ano-genital warts were randomly allocated to either cryotherapy or electrocautery. Patients undergoing cryotherapy required a mean of 2-6 sessions, while those receiving electrocautery required a mean of 1-4 treatments. There was no significant difference in wart clearance at 3 month follow-up between cryotherapy and electrosurgery (10/18 [56 %] with cryotherapy v 10/24 [42%] with electrosurgery; RR 1.33, 95% CI 0.71 to 2.50). Cryotherapy was qualitatively much more acceptable to the patients, as it did not require injections of local anesthetic. This treatment seems particularly suited to patients with widely scattered warts who are unable to attend for regular treatment. (Simmons PD, 1981).
A recent study (Mi X, 2011) has found that cryotherapy plus photodynamic therapy may be more efficient than cryotherpay alone in treating GW. After two treatments, the complete response rates in the combined group were 32.4% (36/111) and 32.6% (43/132) in the cryotherapy group. The recurrence rates in the combined group and cryotherapy group were 24.3% (27/111) and 31.1% (41/132). The adverse effects in each group included mild to moderate pain, edema, erosion and skin discoloration.
Cryotherapy for treatment of GW was safely and successfully used in pregnant women. (Bergman A, 1984). Thirty-four pregnant women in the second (4 cases) and third (30 cases) trimesters of pregnancy underwent cryosurgery. No fetal, maternal or neonatal complications occurred during or following treatment. No recurrences were observed before or six weeks following delivery. Cryotherapy eliminated the need for elective cesarean section in many patients with GW. It appears that cryotherapy can be safely used in pregnancy, irrespective of the gestational age.
In a 3-month follow up period, cryotherapy was also efficient in children aged 1-11 years of age (Stefanaki C, 2011).
Overall, the advantages of cryotherapy include ease of application and rapid destructive effect. It may have special benefit in treating bulky lesions, grouped lesions, and lesions on hair-bearing areas. With no systemic side effects and only minor local ones, cryotherapy is an effective method for treating GW.

References
Abdullah AN, Walzman M, Wade A. Treatment of external genital warts comparing cryotherapy (liquid nitrogen) and trichloroacetic acid. Sex Transm Dis. 1993 Nov-Dec;20(6):344-5.
Bergman A, Bhatia NN, Broen EM. Cryotherapy for treatment of genital condylomata during pregnancy. J Reprod Med. 1984 Jul;29(7):432-5.
Buck H Jr. Warts (genital). Clin Evid (Online). 2007 Aug 1;2007. pii: 1602
Damstra RJ, van Vloten WA. Cryotherapy in the treatment of condylomata acuminata: a controlled study of 64 patients. J Dermtol Surg Oncol. 1991 Mar;17(3):273-6.
Eron LJ, Alder MB, JM OR, Rittweger K, DePamphilis J, Pizzuti DJ. Recurrence of condylomata acuminata following cryotherapy is not prevented by systemically administered interferon. Genitourin Med. 1993 Apr;69(2):91-3.
Gilson RJ, Ross J, Maw R, Rowen D, Sonnex C, Lacey CJ. A multicentre, randomised, double-blind, placebo controlled study of cryotherapy versus cryotherapy and podophyllotoxin cream as treatment for external anogenital warts. Sex Transm Infect. 2009 Dec;85(7):514-9
Godley MJ, Bradbeer CS, Gellan M, Thin RN. Cryotherapy compared with trichloroacetic acid in treating genital warts. Genitourin Med. 1987 Dec;63(6):390-2
Handley JM, Horner T, Maw RD, Lawther H, Dinsmore WW. Subcutaneous interferon alpha 2a combined with cryotherapy vs cryotherapy alone in the treatment of primary anogenital warts: a randomised observer blind placebo controlled study. Genitourin Med. 1991 Aug;67(4):297-302.
Ho GY, Bierman R, Beardsley L, Chang CJ, Burk RD. Natural history of cervicovaginal papillomavirus infection in young women. N Engl J Med. 1998 Feb;338(7):423-8.
Mi X, Chai W, Zheng H, Zuo YG, Li J. A randomized clinical comparative study of cryotherapy plus photodynamic therapy vs. cryotherapy in the treatment of multiple condylomata acuminata. Photodermatol Photoimmunol Photomed. 2011 Aug;27(4):176-80.
Rasi A, Soltani-Arabshahi R, Khatami A. Cryotherapy for anogenital warts: factors affecting therapeutic response. Dermatol Online J. 2007 Oct 13;13(4):2.
Scheinfeld N, Lehman DS. An evidence-based review of medical and surgical treatments of genital warts. Dermatol Online J. 2006 Mar 30;12(3):5. Review.
Simmons PD, Langlet F, and Thin RN. Cryotherapy versus electrocautery in the treatment of genital warts. Br J Vener Dis. 1981 August; 57(4): 273–274.
Stefanaki C, Barkas G, Valari M, Bethimoutis G, Nicolaidou E, Vosynioti V, Kontochristopoulos G, Papadogeorgaki H, Verra P, Katsambas A, Katsarou A. Condylomata Acuminata in Children. Pediatr Infect Dis J. 2011 Dec 23.
Wiley DJ. Genital warts. Clin Evid. 2002 Dec;(8):1620-32.

During electrosurgery, doctors use an electrical current to heat up your genital warts to get rid of them. It is also called diathermy or a loop electrosurgical excision procedure (LEEP).

One study found that, after six months, warts had cleared up in 8 in 10 people who had electrosurgery.

It isn’t clear whether electrosurgery works better than freezing the warts off (cryotherapy).

Electrosurgery can cause scarring, swelling, pain generally and pain during sex.

It’s safe to have electrosurgery if you’re pregnant.

In Depth

Electrosurgery is another destructive treatment used for the treatment of genital warts. It uses electrical energy to destroy HPV-affected areas and is applied by doctor only. Local anesthesia is needed to perform electrosurgery.

A few types of electrosurgery are available.

Electrocautery consists in burning of the affected site and surrounding tissue by means of a electrocautery (an instrument for directing a high-frequency current through a local area of tissue).
Electrofulguration is another type of electrosurgery. It results in a superficial dessication of tissue with little dermal damage.
Monopolar surgery uses different waveforms, allowing desiccation, cutting, or coagulation. This leads to a cleaner cut and less damage to surrounding tissue.
The loop electrosurgical excision procedure (LEEP) uses a thin, low-voltage electrified wire loop to cut out affected tissue. It removes only a small amount of normal tissue at the edge of the abnormal area.
It is recommended to leave skin bridges between treatment sites to help healing and keeping scarring to minimum. All electrosurgical techniques result in a plume of smoke which has been shown to contain HPV DNA. Because of this infectious potential, mask should be worn by provider during procedure.

Electrosurgery side effects include infection, bleeding, pain, temporary or permanent nerve damage, not healing wound, scarring.

Efficacy and Recurrence

A retrospective 5-year study of 213 patients with extensive anogenital warts treated by day case electrosurgery was undertaken to determine clearance and recurrence rates. One hundred and seventy-six patients underwent single procedures, 35 underwent repeat procedures and two (1%) spontaneously cleared before surgery. Clearance of the warts was found by 3 months in 57% of the single procedure cases, 78% of the repeat procedure patients and 61%, [95% confidence interval [CI] 52.4-68.8%]) of the whole sample. Recurrence rates were 24%, 23% and 24%, [95 CI 16.9-31.2%]) respectively (Challenor R, 2002).

In a 203 patient cohort randomly assigned to intramuscular or subcutaneous recombinant interferon alfa-2b; and no treatment, electrosurgery significantly increased clearance of warts at 6 months after treatment compared with no treatment (82% with electrosurgery v 8% with no treatment; P < 0.001) (Benedetti P, 1989).

Few studies compared electrosurgery against IFN, cryotherapy, and podophyllin resin (Beutner KR, 1999; Beutner K, 1997; Stone K, 1990; Benedetti P, 1989; Simmons PD, 1981). Overall, 61%–94% of electrosurgery-treated patients showed clearance in these comparative trials within 3–6 weeks of treatment. Electrosurgery was found to be 3 times more effective than intramuscular interferon (IFN) and 6 times more effective than subcutaneously injected IFN (Wiley DJ, 2000).

Other study found that systemic recombinant interferon alpha-2b is active in treating patients with primary condyloma lesions and does so as well as cauterization (Benedetti P, 1989).Compared with podophyllin resin, electrotherapy was about twice as effective initially but equally effective 3 months after therapy (Stone KM, 1990). When comparing electrosurgery with cryotherapy, there was slightly greater efficacy for electrotherapy, but only short term, as after 3 months of follow up, results were similar for the 2 methods (Stone KM, 1990; Simmons PD, 1981).

The efficacy of electrodesiccation was compared with that of podophyllin and cryotherapy in a 450 patient trial (Stone KM, 1990). Complete clearance of warts was observed in 41%, 79%, and 94% of patients who received up to six weekly treatments of podophyllin, cryotherapy, and electrodesiccation, respectively. Relapses were found in 25% of all patients, yielding 3 month clearance rates of 17%, 55%, and 71% for podophyllin, cryotherapy, and electrodesiccation, respectively. Wart volume and duration did not influence treatment outcome. Women showed a greater response rate than men. Although electrodesiccation and cryotherapy were more effective than podophyllin, none of these treatments were highly successful for the treatment of GW.
The loop electrosurgical excision procedure (LEEP) has been compared with laser treatment for genital warts (Schoenfeld A, 1995). In a group of 28 women, 86 % of lesions treated with LEEP and 75 % of lesions treated with a laser showed no HPV DNA within a 20-mm circumference of the treated lesion.
Electrosurgery appears to be as effective as continuous wave CO2 laser for treating vaginal and external anogenital warts, especially those limited to a 5 cm2 or less area (Ferenczy A, 1995).
The two methods (electrosurgery and laser therapy) can be used in case of giant warts (Madrigal de la Campa MA, 2000).
Clinical trials reported recurrences in 14-22 % of patients undergoing electrosurgery (Schonefeld A, 1995; Stone KM, 1990). Interferon significantly reduced recurrence rates at 6 months, but not at 12 months, compared with electrosurgery (Benedetti P, 1989).

The most common adverse effect after electrosurgery was slow cicatrisation, found in 9/51(18 %) people, and lasting for 30–50 days (Benedetti P, 1989). Other adverse effects after electrosurgery included moderate local edema and pain (17/51 [33%]), and dyspareunia (2/51 [4%]), which persisted from 1–8 weeks (median 2 weeks).
Below is a summary of trials involving electrosurgery, cryotherapy and combination therapy of GW (Scheinfeld N, 2006). These studies were detailed in previous sections.

Reference
Patients
Design
Clearance
Recurrence/side effects
Stone KM, 1990
450
Randomized Control
Surgical excision showed complete clearance of warts in 94% and 71% after 6 weeks and 3 months
Recurrence
Simmons, PD 1981
42
Randomized Control
No significant difference over 3 months follow-up comparing cryotherapy versus electrocautery
No data
Eron et al, 1993
97
Randomized control, double blind
Interferon alpha-2a had no benefit as an adjuvant to cryotherapy.
28% of interferon recipients and 43% of placebo recipients experienced recurrences. At six months follow-up, 69% interferon and 73% placebo recipients experienced recurrences.
Handley et al,1991
91
Randomized control
At eight weeks subcutaneous IFN alpha 2a combined with cryotherapy showed 60.7% clearance versus 67.9% clearance with cryotherapy alone.
Recurrence at three months was 50% and 37.5% of patients in the IFN and placebo groups respectively
Abdullah et al, 1993
86
Randomized controlled
86% clearance of warts in patients who received cryotherapy vs 70% of patients who received TCAA.
No data on recurrences. Ulcerations at the site of application developed in 30% of the TCAA treated patients
Damstra et al, 1991
134
Clinical trial
Showed clearance in 83% within 4 weeks and 96% after 6 weeks with cryotherapy versus 13% and 45% after 4 weeks and 6 weeks, respectively in the control
No data
Godley et al, 1987
130
Randomized Control
Showed clearance in 88% of patients treated with cryotherapy versus 81% of those treated with TCAA
Recurrence found in 36% of patients treated with TCAA and in 39% of those treated with cryotherapy.

TCAA= tricholoroacetic acid

In conclusion, in terms of clearance of genital warts, electrosurgery is superior to sham treatment. It is as effective as laser ablation and cryotherapy after 3 months and may be as effective as intramuscular or subcutaneous interferon after 6 months. Overall, the clearance rates were up to 94% at the end of treatment and 78-91% 3 month after therapy.
As for the wart recurrence, electrosurgery may be more effective than intramuscular or subcutaneous interferon at preventing recurrence of warts after 6 months, but the benefit may be limited to this period of time. The recurrence rate reported in studies was as high as 24%.

References
Benedetti Panici P, Scambia G, Baiocchi G, Perrone L, Pintus C,Mancuso S. Randomized clinical trial comparing systemic interferon with diathermocoagulation in primary multiple and widespread anogenital condyloma. Obstet Gynecol 1989;74:393-7.
Beutner KR, Wiley DJ, Douglas JM. Genital warts and their treatment. Clin Infect Dis 1999;28(Suppl 1):S37-56.
Beutner K, Wiley D. Recurrent external genital warts: a literature review. Papillomavirus Report 1997;8:69-74.
Challenor R, Alexander I. A five-year audit of the treatment of extensive anogenital warts by day case electrosurgery under general anaesthesia. Int J STD AIDS. 2002 Nov;13(11):786-9.
Ferenczy A, Behelak Y, Haber G, Wright TC Jr, Richart RM. Treating vaginal and external anogenital condylomas with electrosurgery vs CO2 laser ablation. J Gynecol Surg. 1995 Spring;11(1):41-50.
Madrigal de la Campa MA, Ruiz Moreno JA, Palacios Ochoa J. Treatment of giant vulvar condylomata acuminata combining CO2 laser and electrosurgery. Ginecol Obstet Mex. 2000 Jan;68:27-30.
Simmons PD, Langlet F, Thin RN. Cryotherapy versus electrocautery in the treatment of genital warts. Br J Vener Dis 1981;57:273-4.
Scheinfeld N, Lehman DS. An evidence-based review of medical and surgical treatments of genital warts. Dermatol Online J. 2006 Mar 30;12(3):5. Review.
Schoenfeld A, Ziv E, Levavi H, Samra Z, Ovadia J. Laser versus loop electrosurgical excision in vulvar condyloma for eradication of subclinical reservoir demonstrated by assay for 2′5′ oligosynthetase human papillomavirus. Gynecol Obstet Invest 1995;40:46-51.
Stone KM, Becker TM, Hadgu A, Kraus SJ. Treatment of external genital warts: a randomised clinical trial comparing podophyllin, cryotherapy, and electrodesiccation. Genitourin Med 1990;66:16-9
Wiley DJ, Beutner KR. Genital warts. Clin Evidence 2000;3:764-74.

Eight RCTs found that using podofilox for four months helped to get rid of genital warts. But up to a third of people got their warts back.

Continuing to use podofilox after it has gotten rid of your genital warts probably won’t stop them from coming back.

Six studies have also compared podofilox with podophyllin. Most of these studies found that the two treatments worked equally as well for clearing up warts and keeping them from coming back.

Podofilox can irritate and burn your skin, causing pain and itching.6 It can occasionally make the foreskin and head of the penis inflamed in men who aren’t circumcised.

You should not use podofilox if you’re pregnant.

The bad news is that there’s no known cure for HPV, but the good news is that there are certain products that have been proven to help reduce the breakout/symptoms of personal warts and help aid in spacing the time between attacks. Since it is currently impossible to completely cure the HPV virus that causes warts, most doctors aim at treating the symptoms instead of chasing the pot of gold that is a permanent solution.

However, there are homeopathic warts treatments that can ease the symptoms of warts. Wartrol is a homeopathic herbal treatment that many people are responding positively to.

Therefore, many people think that the Wartrol products are successful in easing their suffering. Only time will be able to tell if people stay breakout free, but even 6-9 months between breakouts is equal to and higher than some medical treatment options. Thus making the choice to use Wartrol for personal warts fairly tempting and obvious.

One thing that is for sure, is that although Wartrol may not cure the HPV virus from your system, its constant use makes it one of the best products available to treat them in terms of breakout to breakout. The very worst part of genital warts is not the actual virus, even if that is why you breakout, but actually the breakout itself. Personal wart breakouts burn, itch, and are hideous to look at especially since they are in your private areas.