infectious

Anogenital Warts (Condylomata Acuminata)

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources5 sources

Warticon Cream (podophyllotoxin 0.15% w/w) SmPC section 4.2 (eMC product 1507): "Using a fingertip, the cream should be applied twice daily morning and evening (every 12 hours) for 3 consecutive days using only enough cream to just cover each wart. The cream should then be withheld for the next 4 consecutive days. ... Residual warts should be treated with further courses of twice daily applications for three days at weekly intervals, if necessary for a total of 4 weeks of treatment." · BASHH National Guideline for the Management of Anogenital Warts in Adults 2024 for the indication, with the schedule from Aldara 5% Cream (imiquimod) SmPC section 4.2 (emc-aldara-5pct-imiquimod.txt): "Imiquimod cream should be applied 3 times per week (example: Monday, Wednesday, and Friday; or Tuesday, Thursday, and Saturday) prior to normal sleeping hours, and should remain on the skin for 6 to 10 hours. Imiquimod cream treatment should continue until the clearance of visible genital or perianal warts or for a maximum of 16 weeks per episode of warts." · BASHH National Guideline for the Management of Anogenital Warts in Adults 2024 · Aldara (imiquimod) 5% Cream SmPC, electronic Medicines Compendium · Warticon (podophyllotoxin) 0.15% Cream SmPC, electronic Medicines Compendium

Verified against4 documents

Warticon Cream (podophyllotoxin 0.15% w/w) SmPC section 4.2 (eMC product 1507): "Using a fingertip, the cream should be applied twice daily morning and evening (every 12 hours) for 3 consecutive days using only enough cream to just cover each wart. The cream should then be withheld for the next 4 consecutive days. ... Residual warts should be treated with further courses of twice daily applications for three days at weekly intervals, if necessary for a total of 4 weeks of treatment."
BASHH National Guideline for the Management of Anogenital Warts in Adults 2024 for the indication, with the schedule from Aldara 5% Cream (imiquimod) SmPC section 4.2 (emc-aldara-5pct-imiquimod.txt): "Imiquimod cream should be applied 3 times per week (example: Monday, Wednesday, and Friday; or Tuesday, Thursday, and Saturday) prior to normal sleeping hours, and should remain on the skin for 6 to 10 hours. Imiquimod cream treatment should continue until the clearance of visible genital or perianal warts or for a maximum of 16 weeks per episode of warts."
BASHH National Guideline for the Management of Anogenital Warts in Adults 2024
Anogenital Warts (Condylomata Acuminata) - disease-level clinical article (anogenital-warts-clinical.txt)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (3)

Warts may itch, redden, burn, cause more moisture in the area, or produce unusual vaginal discharge or discomfort [itching · vaginal discharge]
In most cases the wart itself is the only sign or symptom of the HPV infection
Oropharyngeal HPV disease can cause a persistent sore throat, chronic cough, hoarseness, painful chewing, enlarged lymph nodes, or earache [cough · ear pain · hoarseness · lymphadenopathy · sore throat]

Signs — what you find (5)

Warts range from separate lesions to clusters, on the penile shaft, scrotum, vagina, labia majora, or vaginal and anal mucosa
Individual warts are often small, 5 mm or under, but they commonly merge into larger masses in the area
Color ranges from skin-colored to darker, and lesions can bleed spontaneously
Warning signs of malignancy include bleeding, flat blue-brown neoplasms, irregular pigmentation, a nonhealing ulcer, palpable dermal infiltration, penile rash, or small crusty bumps [bleeding · rash]
On exam, warts rise above the skin surface and show parakeratosis with the typical HPV nuclear enlargement and perinuclear clearing

Tests (6)

Diagnosis is mainly clinical; biopsy may be used to confirm
Because low-risk HPV types cause the warts, HPV DNA testing is not generally used for diagnosis; all patients should be screened for STIs
Acetowhite test: 3-5% acetic acid applied for 5 to 10 minutes turns HPV-infected cells white
The acetowhite test is sensitive but not specific, with many false positives, so it is not used for routine screening
Biopsy is advised when the diagnosis is uncertain, the patient is immunocompromised, or the lesion is pigmented or ulcerated
If the glans is involved, or there are lower urinary tract or notable urethral symptoms, cystoscopy is worth considering

If not this — what else fits (10)

Condyloma lata of secondary syphilis can look like genital warts
Small warts can be mistaken for molluscum contagiosum
Buschke-Lowenstein tumor is a giant condyloma variant on the differential
Pearly penile papules can be mistaken for warts
Malignancy of the anal, cervical, oropharyngeal, penile, or vulvar sites should be considered
Herpes simplex infection starts as small, painful blisters before breaking down into ulcers and sores
Chancroid causes painful ulcers with soft edges
Granuloma inguinale (donovanosis) causes beefy-red, open sores
Lymphogranuloma venereum starts as a small, painless sore; syphilis causes a single, painless ulcer
Benign lesions such as acrochordons, benign familial pemphigus, or benign nevi can mimic genital warts

SourceStatPearls "Condylomata Acuminata (Genital Warts)" - disease-level clinical article

Presentation findings are traced to the source above.

IMIQUIMOD

1st line

Formtopical

Adult dose and duration

Apply 5% cream in a thin layer directly to wart tissue 3 times weekly, prior to normal sleeping hours, and wash off with mild soap and water after 6-10 hours - Continue until visible warts clear, or for a maximum of 16 weeks per episode; consider switching treatment if there is less than 50% reduction in wart volume after 8 weeks

Paediatric dose

Paediatric use is not recommended (not established). Anogenital warts in a child should prompt specialist referral, including consideration of non-sexual transmission (vertical transmission or autoinoculation) alongside safeguarding assessment.

Dose source

BASHH National Guideline for the Management of Anogenital Warts in Adults 2024 for the indication, with the schedule from Aldara 5% Cream (imiquimod) SmPC section 4.2 (emc-aldara-5pct-imiquimod.txt): "Imiquimod cream should be applied 3 times per week (example: Monday, Wednesday, and Friday; or Tuesday, Thursday, and Saturday) prior to normal sleeping hours, and should remain on the skin for 6 to 10 hours. Imiquimod cream treatment should continue until the clearance of visible genital or perianal warts or for a maximum of 16 weeks per episode of warts."

Why

Chosen as line 1 here because it is stocked in Egypt (ALDARA 5% cream); BASHH 2024 lists imiquimod and podophyllotoxin as self-applied options of comparable standing, with the choice between them normally guided by wart morphology and patient preference rather than a strict hierarchy.

Cautions

Salicylic acid (used for cutaneous/plantar warts) must NOT be applied to anogenital skin - imiquimod and podophyllotoxin are the appropriate topical agents for this site.
May weaken latex condoms and diaphragms - advise an alternative contraceptive method during treatment.
Not recommended in pregnancy or breastfeeding - no self-applied topical agent is licensed for use in pregnancy; refer for a clinician-applied ablative treatment (e.g. cryotherapy) if pregnant.
Use with caution in solid-organ transplant recipients and in those with autoimmune disease - may exacerbate inflammatory skin conditions.
Local inflammatory skin reactions (redness, erosion, itching, burning) at the application site are common and expected.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
ALDARA 5% CREAM 12 SACHETS	MEDA AB > ONE PHARMA TECH	879.00 EGP

REFERRAL & SAFETY-NETTING (NO DRUG THERAPY)

1st line

Dose source

Anogenital Warts (Condylomata Acuminata) - disease-level clinical article (anogenital-warts-clinical.txt)

Why

Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.

Cautions

RED FLAG - Biopsy is recommended for uncertain diagnosis, immunocompromised patients, or pigmented/ulcerated lesions.
RED FLAG - Cystoscopy is recommended for glans involvement, lower urinary tract symptoms, or urethral symptoms.

PODOPHYLLOTOXIN

2nd line

Formtopical

Adult dose and duration

Apply 0.15% cream twice daily (morning and evening) for 3 consecutive days, using only enough cream to cover each wart, then withhold for 4 days. Repeat this weekly cycle if residual warts remain, for a maximum of 4 weeks - Up to 4 weeks (four 3-days-on/4-days-off cycles)

Paediatric dose

Safety and efficacy have not been established in children under 18 years.

Dose source

Why

BASHH 2024 lists the 0.5% solution as preferred for efficacy, with the 0.15% cream as an off-license alternative used where solution application is difficult (e.g. perianal warts); listed for completeness, but no Egyptian brand is registered under any of podophyllotoxin, podofilox, or podophyllin - confirm import availability before prescribing, or use imiquimod instead.

Cautions

CONTRAINDICATED in pregnancy and in women of childbearing potential not using reliable contraception - antimitotic agents such as podophyllotoxin are embryotoxic.
Not established or licensed for use in children under 18 years.
Apply only enough cream to cover each wart and avoid contact with surrounding healthy skin; do not cover with an occlusive dressing.
For lesions larger than 4 cm2 in total area, treat only under the direct supervision of a healthcare professional.
No Egyptian brand is registered for this drug - verify local/import availability before prescribing.

Egyptian brands

No Egyptian brand matched — prescribe by generic name.

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.