Penile warts: an update on their evaluation and management

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Alexander KC Leung MBBS, FRCPC, FRCP (UK and Irel), FRCPCH, FAAP, Benjamin Barankin MD, FRCPC, Kin Fon Leong MBBS, MRCPCH, Kam Lun Hon MD, FAAP, FCCM

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Background: Penile warts are the most common sexually transmitted disease in males. Clinicians should be familiar with the proper evaluation and management of this common condition.

Objective: To provide an update on the current understanding, evaluation, and management of penile warts.

Methods: A PubMed search was completed in Clinical Queries using the key terms ‘penile warts’ and ‘genital warts’. The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews.

Results: Penile warts are caused by human papillomavirus (HPV), notably HPV-6 and HPV-11. Penile warts typically present as asymptomatic papules or plaques. Lesions may be filiform, exophytic, papillomatous, verrucous, hyperkeratotic, cerebriform, fungating, or cauliflower-like. Approximately one-third of penile warts regress without treatment and the average duration prior to resolution is approximately 9 months. Active treatment is preferable to watchful observation to speed up clearance of the lesions and to assuage fears of transmission and autoinoculation. Patient-administered therapies include podofilox (0.5%) solution or gel, imiquimod 3.75 or 5% cream, and sinecatechins (polypheron E) 15% ointment. Clinician-administered therapies include podophyllin, cryotherapy, bichloroacetic or trichloroacetic acid, oral cimetidine, surgical excision, electrocautery, and carbon dioxide laser therapy. Patients who do not respond to first-line treatments may respond to other therapies or a combination of treatment modalities. Second-line therapies include topical/intralesional/ intravenous cidofovir, topical 5-fluorouracil, and topical ingenol mebutate.

Conclusion: No single treatment has been shown to be consistently superior to other treatment modalities. The choice of the treatment method should depend on the physician’s comfort level with the various treatment options, the patient’s preference and tolerability of treatment, and the number and severity of lesions. The comparative efficacy, ease of administration, adverse effects, cost, and availability of the treatment modality should also be taken into consideration

Keywords: bichloroacetic/trichloroacetic acid, cimetidine, cryotherapy, electrocautery, human papillomavirus, imiquimod, laser, podofilox, podophyllin, sinecatechins, surgery.

Citation: Leung AKC, Barankin B, Leong KF, Hon KL. Penile warts: an update on their evaluation and management. Drugs in Context 2018; 7: 212563. DOI: 10.7573/dic.212563

Contributions: Professor Alexander KC Leung is the principal author. Dr Benjamin Barankin, Dr Kin Fon Leong, and Professor Kam Lun Hon are the coauthors who contributed and helped with the drafting of this manuscript. All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.

Disclosure and potential conflicts of interest: The authors declare that there is no conflict of interest in preparing this article. The International Committee of Medical Journal Editors (ICMJE) Potential Conflicts of Interests form for the authors are available for download at

Acknowledgments: The photo images were taken by the authors with verbal consent of the respective patient. The patients are unidentifiable and the photo images have not been previously published.

Funding declaration: There was no funding associated with the preparation of this article.

Copyright: Copyright © 2018 Leung AKC, Barankin B, Leong KF, Hon KL. Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 4.0 which allows anyone to copy, distribute, and transmit the article provided it is properly attributed in the manner specified below. No commercial use without permission.

Correct attribution: Copyright © 2018 Leung AKC, Barankin B, Leong KF, Hon KL. Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 4.0.

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Correspondence: Alexander KC Leung, The University of Calgary, Alberta Children’s Hospital, #200, 233 – 16th Avenue NW, Calgary, Alberta, Canada T2M 0H5.

Provenance: invited; externally peer reviewed.

Submitted: 21 September 2018; Peer review comments to author: 16 November 2018; Revised manuscript received: 17 November 2018; Accepted: 22 November 2018; Publication date: 19 December 2018.

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