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Condylomata acuminata (anogenital warts): Management of external condylomata acuminata in men

Noah Scheinfeld, MD
Section Editor
Ted Rosen, MD
Deputy Editor
Abena O Ofori, MD


Condylomata acuminata (CA), also known as anogenital warts, are manifestations of anogenital human papillomavirus (HPV) infection. CA manifest as variably sized and shaped soft papules or plaques on anogenital skin (picture 1A-H).

A diagnosis of CA can have negative psychosocial effects and may be accompanied by symptoms, such as pruritus, pain, and bleeding. Some cases of CA spontaneously resolve; however, spontaneous resolution is unpredictable. Most patients desire treatment.

Effective treatment options for CA include patient-applied and clinician-administered therapies. First-line patient-applied therapies include imiquimod, podophyllotoxin, and sinecatechins. First-line clinician-administered treatments are cryotherapy, trichloroacetic acid, surgical excision, electrosurgery, and laser therapy. The selection of therapy should be individualized and based upon consideration of the extent of disease, patient preference, cost, adverse effects, treatment availability, and the response to previous treatments.

The management of external CA in adolescent and adult males will be reviewed here. The diagnosis of CA and the management of CA in women and children are reviewed separately. (See "Condylomata acuminata (anogenital warts) in adults: Epidemiology, pathogenesis, clinical features, and diagnosis" and "Treatment of vulvar and vaginal warts" and "Condylomata acuminata (anogenital warts) in children".)


A diagnosis of CA is often distressing for men and associated with concerns regarding cosmetic appearance, stigmatization, personal health, and sexual relationships. Educating affected men about human papillomavirus (HPV) infection and CA is an important component of management. Men may benefit from the following information:

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Literature review current through: Dec 2017. | This topic last updated: Jan 04, 2017.
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  1. Workowski KA, Bolan GA, Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep 2015; 64:1.
  2. Handsfield HH. Clinical presentation and natural course of anogenital warts. Am J Med 1997; 102:16.
  3. Yanofsky VR, Patel RV, Goldenberg G. Genital warts: a comprehensive review. J Clin Aesthet Dermatol 2012; 5:25.
  4. Gunter J. Genital and perianal warts: new treatment opportunities for human papillomavirus infection. Am J Obstet Gynecol 2003; 189:S3.
  5. Vender R, Bourcier M, Bhatia N, Lynde C. Therapeutic options for external genital warts. J Cutan Med Surg 2013; 17 Suppl 2:S61.
  6. Manhart LE, Koutsky LA. Do condoms prevent genital HPV infection, external genital warts, or cervical neoplasia? A meta-analysis. Sex Transm Dis 2002; 29:725.
  7. Sénécal M, Brisson M, Maunsell E, et al. Loss of quality of life associated with genital warts: baseline analyses from a prospective study. Sex Transm Infect 2011; 87:209.
  8. Dominiak-Felden G, Cohet C, Atrux-Tallau S, et al. Impact of human papillomavirus-related genital diseases on quality of life and psychosocial wellbeing: results of an observational, health-related quality of life study in the UK. BMC Public Health 2013; 13:1065.
  9. Qi SZ, Wang SM, Shi JF, et al. Human papillomavirus-related psychosocial impact of patients with genital warts in China: a hospital-based cross-sectional study. BMC Public Health 2014; 14:739.
  10. Newton DC, McCabe M. Effects of sexually transmitted infection status, relationship status, and disclosure status on sexual self-concept. J Sex Res 2008; 45:187.
  11. Silvera RJ, Smith CK, Swedish KA, Goldstone SE. Anal condyloma treatment and recurrence in HIV-negative men who have sex with men. Dis Colon Rectum 2014; 57:752.
  12. Juhl ME, Seferovic V, Antonijevic S, Krunic A. Combined treatment of anogenital HPV infection with cryodestruction, podophyllin 25% and post-ablation immunomodulation with sinecatechins 15% ointment - a retrospective analysis. Int J STD AIDS 2016; 27:1071.
  13. On SC, Linkner RV, Haddican M, et al. A single-blinded randomized controlled study to assess the efficacy of twice daily application of sinecatechins 15% ointment when used sequentially with cryotherapy in the treatment of external genital warts. J Drugs Dermatol 2014; 13:1400.
  14. Gilson RJ, Ross J, Maw R, et al. 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; 85:514.
  15. Arany I, Tyring SK, Brysk MM, et al. Correlation between pretreatment levels of interferon response genes and clinical responses to an immune response modifier (Imiquimod) in genital warts. Antimicrob Agents Chemother 2000; 44:1869.
  16. Grillo-Ardila CF, Angel-Müller E, Salazar-Díaz LC, et al. Imiquimod for anogenital warts in non-immunocompromised adults. Cochrane Database Syst Rev 2014; :CD010389.
  17. Lacey CJ, Woodhall SC, Wikstrom A, Ross J. 2012 European guideline for the management of anogenital warts. J Eur Acad Dermatol Venereol 2013; 27:e263.
  18. 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; 38:216.
  19. www.accessdata.fda.gov/drugsatfda_docs/label/2011/201153s000,022483s001lbl.pdf (Accessed on April 08, 2011).
  20. Rosen T, Nelson A, Ault K. Imiquimod cream 2.5% and 3.75% applied once daily to treat external genital warts in men. Cutis 2015; 96:277.
  21. Baker DA, Ferris DG, Martens MG, et al. 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.
  22. www.accessdata.fda.gov/drugsatfda_docs/label/2010/020723s022lbl.pdf (Accessed on June 02, 2016).
  23. www.accessdata.fda.gov/drugsatfda_docs/label/2011/201153s000,022483s001lbl.pdf (Accessed on June 02, 2016).
  24. Stefanaki C, Nicolaidou E, Hadjivassiliou M, et al. Imiquimod-induced vitiligo in a patient with genital warts. J Eur Acad Dermatol Venereol 2006; 20:755.
  25. Li W, Xin H, Ge L, et al. Induction of vitiligo after imiquimod treatment of condylomata acuminata. BMC Infect Dis 2014; 14:329.
  26. Brown T, Zirvi M, Cotsarelis G, Gelfand JM. Vitiligo-like hypopigmentation associated with imiquimod treatment of genital warts. J Am Acad Dermatol 2005; 52:715.
  27. Vidal NY, Farah RS, Wanat KA. Dramatic saxophone penis as a result of topical imiquimod use. JAMA Dermatol 2014; 150:1370.
  28. Cantisani C, Lazic T, Richetta AG, et al. Imiquimod 5% cream use in dermatology, side effects and recent patents. Recent Pat Inflamm Allergy Drug Discov 2012; 6:65.
  29. Tyring S, Edwards L, Cherry LK, et al. Safety and efficacy of 0.5% podofilox gel in the treatment of anogenital warts. Arch Dermatol 1998; 134:33.
  30. Greenberg MD, Rutledge LH, Reid R, et al. A double-blind, randomized trial of 0.5% podofilox and placebo for the treatment of genital warts in women. Obstet Gynecol 1991; 77:735.
  31. Kirby P, Dunne A, King DH, Corey L. Double-blind randomized clinical trial of self-administered podofilox solution versus vehicle in the treatment of genital warts. Am J Med 1990; 88:465.
  32. Beutner KR, Conant MA, Friedman-Kien AE, et al. Patient-applied podofilox for treatment of genital warts. Lancet 1989; 1:831.
  33. Condylox [package insert]. Parsippany, NJ: Watson Pharma; Revised March 2011.
  34. Tatti S, Stockfleth E, Beutner KR, et al. Polyphenon E: a new treatment for external anogenital warts. Br J Dermatol 2010; 162:176.
  35. Doan HQ, Nguyen HP, Rady P, Tyring SK. Expression patterns of immune-associated genes in external genital and perianal warts treated with sinecatechins. Viral Immunol 2015; 28:236.
  36. Nguyen HP, Doan HQ, Brunell DJ, et al. Apoptotic gene expression in sinecatechins-treated external genital and perianal warts. Viral Immunol 2014; 27:556.
  37. Stockfleth E, Beti H, Orasan R, et al. Topical Polyphenon E in the treatment of external genital and perianal warts: a randomized controlled trial. Br J Dermatol 2008; 158:1329.
  38. Gross G, Meyer KG, Pres H, et al. A randomized, double-blind, four-arm parallel-group, placebo-controlled Phase II/III study to investigate the clinical efficacy of two galenic formulations of Polyphenon E in the treatment of external genital warts. J Eur Acad Dermatol Venereol 2007; 21:1404.
  39. Tatti S, Swinehart JM, Thielert C, et al. Sinecatechins, a defined green tea extract, in the treatment of external anogenital warts: a randomized controlled trial. Obstet Gynecol 2008; 111:1371.
  40. www.accessdata.fda.gov/drugsatfda_docs/label/2007/021902s002lbl.pdf (Accessed on May 27, 2016).
  41. Damstra RJ, van Vloten WA. Cryotherapy in the treatment of condylomata acuminata: a controlled study of 64 patients. J Dermatol Surg Oncol 1991; 17:273.
  42. Gross G. [Clinical aspects and therapy of anogenital warts and papillomavirus-associated lesions]. Hautarzt 2001; 52:6.
  43. Zimmerman EE, Crawford P. Cutaneous cryosurgery. Am Fam Physician 2012; 86:1118.
  44. Mahrle G, Alexander W. Surgical treatment of recalcitrant warts. J Dermatol Surg Oncol 1983; 9:445.
  45. Ammori BJ, Ausobsky JR. Electrocoagulation of perianal warts: a word of caution. Dig Surg 2000; 17:296.
  46. Kofoed K, Norrbom C, Forslund O, et al. Low prevalence of oral and nasal human papillomavirus in employees performing CO2-laser evaporation of genital warts or loop electrode excision procedure of cervical dysplasia. Acta Derm Venereol 2015; 95:173.
  47. Park IU, Introcaso C, Dunne EF. Human Papillomavirus and Genital Warts: A Review of the Evidence for the 2015 Centers for Disease Control and Prevention Sexually Transmitted Diseases Treatment Guidelines. Clin Infect Dis 2015; 61 Suppl 8:S849.
  48. Abdullah AN, Walzman M, Wade A. Treatment of external genital warts comparing cryotherapy (liquid nitrogen) and trichloroacetic acid. Sex Transm Dis 1993; 20:344.
  49. Khawaja HT. Podophyllin versus scissor excision in the treatment of perianal condylomata acuminata: a prospective study. Br J Surg 1989; 76:1067.
  50. Carrozza PM, Merlani GM, Burg G, Hafner J. CO(2) laser surgery for extensive, cauliflower-like anogenital condylomata acuminata: retrospective long-term study on 19 HIV-positive and 45 HIV-negative men. Dermatology 2002; 205:255.
  51. Scheinfeld N, Lehman DS. An evidence-based review of medical and surgical treatments of genital warts. Dermatol Online J 2006; 12:5.
  52. Blokker RS, Lock TM, de Boorder T. Comparing thulium laser and Nd:YAG laser in the treatment of genital and urethral condylomata acuminata in male patients. Lasers Surg Med 2013; 45:582.
  53. Volz LR, Carpiniello VL, Malloy TR. Laser treatment of urethral condyloma: a five-year experience. Urology 1994; 43:81.
  54. Komericki P, Akkilic M, Kopera D. Pulsed dye laser treatment of genital warts. Lasers Surg Med 2006; 38:273.
  55. Tuncel A, Görgü M, Ayhan M, et al. Treatment of anogenital warts by pulsed dye laser. Dermatol Surg 2002; 28:350.
  56. Huang J, Zeng Q, Zuo C, et al. The combination of CO2 laser vaporation and photodynamic therapy in treatment of condylomata acuminata. Photodiagnosis Photodyn Ther 2014; 11:130.
  57. Lacey CJ, Goodall RL, Tennvall GR, et al. Randomised controlled trial and economic evaluation of podophyllotoxin solution, podophyllotoxin cream, and podophyllin in the treatment of genital warts. Sex Transm Infect 2003; 79:270.
  58. Batista CS, Atallah AN, Saconato H, da Silva EM. 5-FU for genital warts in non-immunocompromised individuals. Cochrane Database Syst Rev 2010; :CD006562.
  59. Orlando G, Fasolo MM, Beretta R, et al. Intralesional or topical cidofovir (HPMPC, VISTIDE) for the treatment of recurrent genital warts in HIV-1-infected patients. AIDS 1999; 13:1978.
  60. Snoeck R, Bossens M, Parent D, et al. Phase II double-blind, placebo-controlled study of the safety and efficacy of cidofovir topical gel for the treatment of patients with human papillomavirus infection. Clin Infect Dis 2001; 33:597.
  61. Matteelli A, Beltrame A, Graifemberghi S, et al. Efficacy and tolerability of topical 1% cidofovir cream for the treatment of external anogenital warts in HIV-infected persons. Sex Transm Dis 2001; 28:343.
  62. Snoeck R, Van Ranst M, Andrei G, et al. Treatment of anogenital papillomavirus infections with an acyclic nucleoside phosphonate analogue. N Engl J Med 1995; 333:943.
  63. Martinelli C, Farese A, Mistro AD, et al. Resolution of recurrent perianal condylomata acuminata by topical cidofovir in patients with HIV infection. J Eur Acad Dermatol Venereol 2001; 15:568.
  64. Stragier I, Snoeck R, De Clercq E, et al. Local treatment of HPV-induced skin lesions by Cidofovir. J Med Virol 2002; 67:241.
  65. Hengge UR, Tietze G. Successful treatment of recalcitrant condyloma with topical cidofovir. Sex Transm Infect 2000; 76:143.
  66. Coremans G, Margaritis V, Snoeck R, et al. Topical cidofovir (HPMPC) is an effective adjuvant to surgical treatment of anogenital condylomata acuminata. Dis Colon Rectum 2003; 46:1103.
  67. Orlando G, Fasolo MM, Beretta R, et al. Combined surgery and cidofovir is an effective treatment for genital warts in HIV-infected patients. AIDS 2002; 16:447.
  68. Yang J, Pu YG, Zeng ZM, et al. Interferon for the treatment of genital warts: a systematic review. BMC Infect Dis 2009; 9:156.
  69. Handley JM, Horner T, Maw RD, et al. 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; 67:297.
  70. Zhao J, Zeng W, Cao Y, et al. Immunotherapy of HPV infection-caused genital warts using low dose cyclophosphamide. Expert Rev Clin Immunol 2014; 10:791.
  71. Zhang Y, Duan Y, Zhao J, et al. Low-dose oral cyclophosphamide therapy is effective for condylomata acuminata. Chin Med J (Engl) 2013; 126:3198.
  72. Pasmatzi E, Kapranos N, Monastirli A, et al. Large benign condyloma acuminatum: successful treatment with isotretinoin and interferon alpha. Acta Derm Venereol 2012; 92:249.
  73. Yew YW, Pan JY. Complete remission of recalcitrant genital warts with a combination approach of surgical debulking and oral isotretinoin in a patient with systemic lupus erythematosus. Dermatol Ther 2014; 27:79.
  74. Olsen EA, Kelly FF, Vollmer RT, et al. Comparative study of systemic interferon alfa-nl and isotretinoin in the treatment of resistant condylomata acuminata. J Am Acad Dermatol 1989; 20:1023.
  75. Cardamakis EK, Kotoulas IG, Dimopoulos DP, et al. Comparative study of systemic interferon alfa-2a with oral isotretinoin and oral isotretinoin alone in the treatment of recurrent condylomata accuminata. Arch Gynecol Obstet 1996; 258:35.
  76. Paul S, Cheng CE, Kroshinsky D. Combination Systemic Fluorouracil and Radiation for the Treatment of Recalcitrant Condyloma with Associated Squamous Cell Carcinoma in an Immunocompromised 15-Year-Old Girl. Pediatr Dermatol 2015; 32:e148.
  77. Huo W, Li GH, Qi RQ, et al. Clinical and immunologic results of local hyperthermia at 44 °C for extensive genital warts in patients with diabetes mellitus. Int J Hyperthermia 2013; 29:17.
  78. Dhadda AS, Anand A, Boynton C, Chan S. External beam radiotherapy for extensive genital condyloma acuminate: a role in selected patients? Clin Oncol (R Coll Radiol) 2008; 20:91.
  79. Lee HJ, Kim JK, Kim DH, Yoon MS. Condyloma accuminatum treated with recombinant quadrivalent human papillomavirus vaccine (types 6, 11, 16, 18). J Am Acad Dermatol 2011; 64:e130.
  80. Kreuter A, Wieland U. Lack of efficacy in treating condyloma acuminata and preventing recurrences with the recombinant quadrivalent human papillomavirus vaccine in a case series of immunocompetent patients. J Am Acad Dermatol 2013; 68:179.
  81. Ormerod AD, van Voorst Vader PC, Majewski S, et al. Evaluation of the Efficacy, Safety, and Tolerability of 3 Dose Regimens of Topical Sodium Nitrite With Citric Acid in Patients With Anogenital Warts: A Randomized Clinical Trial. JAMA Dermatol 2015; 151:854.
  82. Kumar P, Dar L, Saldiwal S, et al. Intralesional injection of Mycobacterium w vaccine vs imiquimod, 5%, cream in patients with anogenital warts: a randomized clinical trial. JAMA Dermatol 2014; 150:1072.
  83. Cusini M, Micali G, Lacarrubba F, et al. Efficacy and tolerability of nitric-zinc complex in the treatment of external genital warts and "difficult-to-treat" warts: a "proof of concept", prospective, multicentre, open study. G Ital Dermatol Venereol 2015; 150:643.
  84. Braun SA, Gerber PA. Successful treatment of perianal condylomata acuminata with ingenol mebutate gel. J Dtsch Dermatol Ges 2016; 14:616.
  85. Schopf RE. Ingenol mebutate gel is effective against anogenital warts - a case series in 17 patients. J Eur Acad Dermatol Venereol 2016; 30:1041.
  86. Jardine D, Lu J, Pang J, et al. A randomized trial of immunotherapy for persistent genital warts. Hum Vaccin Immunother 2012; 8:623.
  87. Domínguez Gómez J, Simón RD, Abreu Daniel A, Zelenkova H. Effectiveness of glycyrrhizinic Acid (glizigen) and an immunostimulant (viusid) to treat anogenital warts. ISRN Dermatol 2012; 2012:863692.
  88. Ying Z, Li X, Dang H. 5-aminolevulinic acid-based photodynamic therapy for the treatment of condylomata acuminata in Chinese patients: a meta-analysis. Photodermatol Photoimmunol Photomed 2013; 29:149.
  89. Shi H, Zhang X, Ma C, et al. Clinical analysis of five methods used to treat condylomata acuminata. Dermatology 2013; 227:338.
  90. Mi X, Chai W, Zheng H, et al. A randomized clinical comparative study of cryotherapy plus photodynamic therapy vs. cryotherapy in the treatment of multiple condylomata acuminata. Photodermatol Photoimmunol Photomed 2011; 27:176.
  91. Bosch FX, Burchell AN, Schiffman M, et al. Epidemiology and natural history of human papillomavirus infections and type-specific implications in cervical neoplasia. Vaccine 2008; 26 Suppl 10:K1.