Mean time for genital warts (not actual virus) to disappear?

[Daisyjoy]

From first detection of genital warts as a result of HPV, what is the mean time for clearance of the warts (not the virus)?  I am applying Aldara, and I was curious if I did nothing at all how long it would take for them to go away on their own?  I've read a lot of confliciting information about this, some people say if you don't do anything to the warts, they will get bigger and worse, and they will be harder to eliminate in the future.  And then some say you can just ignore them and they will go away on their own.  I would just like to save the $200 monthly cost of these Aldara packets, and the electric needle/freezing isn't a good choice because I have so many warts, about 25 that are so tiny they look smaller than pin heads.  Any thoughts on tea tree oil, olive skin oil, aloe vera?  Thanks for your help.

[H. Hunter Handsfield, M.D.]

Unfortunately, the duration of untreated genital warts has not been carefully studied.  My best estimate is that the average is 4-6 months, with some clearing in a few weeks and others taking a year or more.  And you are right about the possibility that treatment will work less well if you delay; fresh, small warts generally respond more quickly than "mature", hardened warts.  Further, some untreated warts will continue to grow, even to giant size--in rare cases up to an inch in diameter--this isn't common, but it's not pleasant when it happen.



So as this implies, I don't think it is a wise decision to not treat and just wait for the warts to go away.  If you try it, be prepared to start treatment promptly if your warts increase in size.



If there are too many warts for freezing, other options are podofilox (trade name Condylox), which is just as effective as imiquimod (Aldara) and, depending on the pharmacy, may be less expensive; or podophyllin, although that requires serial visits to a health care provider.  But if you did that at your local health department STD clinic, the cost should be quite low.



If you haven't seen a dermatologist, that might be an option for a 2nd opinion.  Someone with a specialist's skill in wart treatment might have other options, or a different judgment about freezing, laser, or electrocautery.



The alternative treatments you mention are worthless.



Best wishes--  HHH, MD

[Daisyjoy]

Thank you very much for that answer.  One quick follow-up, how is it that Condylox is just as effective as Aldara when they attack the warts two different ways, the Aldara inside within the immune system, and the Condylox from the surface of the wart?  Also, I have heard a lot of wart sufferers sing the praises of tea tree oil, that it dries up the wart almost immediately and makes the area very dry/irritated, is this just a cosmetic change to the wart?

[H. Hunter Handsfield, M.D.]

Daisyjoy, you sound like a 3M Pharmaceuticals representative; that's the pitch they are taught to use!



Treatments based on different mechanisms or different biology aren't necessarily different in effectiveness.  Research studies show that both Aldara and Condylox have similar response rates; with either product, about 70% of patients have complete resolution of warts in 4-6 weeks.  In theory, Aldara's immunologic mechanism might result in lower risk of recurrent warts, but that supposed advantage has never been proved.



Beware of individual testimonials, especially on the web; and remember the natural human tendency to report successes more than failures.  STD experts are desperate for better wart treatments; our patients' warts are a real hassle for us.  If there were valid research showing tea tree oil to be effective, it would be in the medical literature.  But taking nothing for granted and having never heard of tea tree oil, I searched the scientific medical literature on it.  I leanred that TTO has promise as an antibacterial agent, such as a possible future ingredient in first aid creams (sort of like Neosporin).  But there is no mention of research on treatment of warts.



HHH, MD

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A related discussion, Gential Warts was started.

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A related discussion, Genital Warts was started.