Treatment of genital warts - what's the evidence?

Genital warts are usually asymptomatic, and rarely cause discomfort. Once the patient is aware of them the main symptom is their cosmetic appearance and resultant psychological consequences. The ideal treatment outcome would be complete viral eradication, but this is not possible. Treatments focus on the removal of exophytic warts, leaving the surrounding subclinical and latent human papillomavirus (HPV) infection as areas of possible transmission and recurrence. Effective treatment does reduce HPV viral load, so the infection is reduced if not completely eradicated. Treatment is often painful, inconvenient, and may produce poor clearance rates and frequent recurrences. The treatment chosen should be no worse or more dangerous than the disease itself, and should be tailored to the patients' disease and needs as well as to the available resources. Genital warts are highly infectious and sexual partners may well already be infected when a patient presents for treatment. There are no published studies showing that condom use reduces transmission of HPV from people with genital warts. However, if the sexual partner is uninfected; using a condom may protect against HPV lesions and genital warts. Condom use should be encouraged in new relationships.