Anogenital Warts

Comments from Expert Advisory Committee

  1. Anogenital warts are caused by human papilloma virus (HPV), usually types 6 and 11 which are not associated with dysplasia or malignancy
  2. Infection with HPV is common in sexually active people, most infections do not lead to visible anogenital warts and clear spontaneously
  3. Most HPV infection is acquired through sexual contact. Perinatal infection can occur and is rarely harmful to children
  4. The current HPV vaccination programme for adolescent girls is with a quadrivalent vaccine which protects against HPV 6 and 11 in addition to 16 and 18. The vaccine will be offered to adolescent boys possibly starting in September 2019.
  5. The HPV vaccine is recommended for some people living with HIV and MSM, the most up to date National Immunisation Advisory Committee vaccination recommendations are available here, https://www.hse.ie/eng/health/immunisation/hcpinfo/guidelines/.
  6. Individuals diagnosed with anogenital warts should be offered testing for other STIs including HIV, Hepatitis B, syphilis and gonorrhoea.
  7. Hepatitis C testing is recommended in MSM and in those with a history of injecting drug use in line with national Hepatitis C testing guidelines.
  8. Anogenital warts are a notifiable disease. The complete list of notifiable diseases and information on the notification process is available at HPSC

Treatment options

Small volume warts may resolve without treatment. All treatments are associated with non-response, relapse and local skin irritation.

Treatment name

Comments

Topical treatment

Podophyllotoxin cream (Warticon®) or lotion (Condylline®) applied twice daily, 3 times per week and repeated for up to 5 cycles

In general soft, non-keratinised warts respond better to podophyllotxin while cryotherapy is more useful for keratinised warts

Aldara® cream is more expensive than Warticon® and Condylline®

The choice between Warticon® and Condylline® is dictated by patient choice and ease of administration of cream or lotion to the warts

Topical treatments are not for internal use

Cryotherapy is safe in pregnancy but treatment of warts may not be necessary in pregnancy, particularly if low volume

Imiquimod 5%(Aldara®) cream 1 sachet applied nightly Monday, Wednesday and Friday for up to 16 weeks

Physical Ablation

Cryotherapy to warts, weekly for up to 4 weeks


Useful resources


Patient information

Patient information on STIs and genital conditions is available at the HSE Sexual Health and Crisis Pregnancy website

Reviewed October 2018