# Anogenital Warts (Condylomata Acuminata) - Category: infectious - Review status: reviewed (every claim checked against a document named on this page) - 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 date: 2026-08 ## Verified against - 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) ## Treatment metadata - Imiquimod — topical - Referral & safety-netting (no drug therapy) - Podophyllotoxin — topical ## Complete treatment card ```text ANOGENITAL WARTS (CONDYLOMATA ACUMINATA) 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 Review status: REVIEWED against 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) (2026-08) 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 Source StatPearls "Condylomata Acuminata (Genital Warts)" - disease-level clinical article Status traced to the source above 1. IMIQUIMOD [1st line] Adult 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 Peds 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. 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. Caution 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. Egypt ALDARA 5% CREAM 12 SACHETS MEDA AB > ONE... 879.00 EGP 2. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult 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. Caution 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. 3. PODOPHYLLOTOXIN [2nd line] Adult 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) Peds Safety and efficacy have not been established in children under 18 years. Source 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." 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. Caution 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. Egypt no Egyptian brand matched - prescribe by generic name Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)