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  • 1.Preferred regimen for External Anogenital Warts (i.e., penis, groin, scrotum, vulva, perineum, external anus, and perianus)
  • 1.1 Patient-Applied::Imiquimod 3.75% or 5% cream ORPodofilox 0.5% solution or gel OR Sinecatechins 15% ointment
  • 1.2 Provider-Administered:Cryotherapy with liquid nitrogen or cryoprobe OR Surgical removal either by tangential scissor excision, tangential shave excision, curettage, laser,or electrosurgery OR Trichloroacetic acid (TCA) or Bichloroacetic acid (BCA) 80%-90% solution
  • Note(1):Many persons with external anal warts also have intra-anal warts. Thus, persons with external anal warts might benefit from an inspection of the anal canal by digital examination, standard anoscopy, or high-resolution anoscopy.
  • Note(2):Might weaken condoms and vaginal diaphragms.
  • 2.Alternative Regimens for External Genital Warts
  • 2.1 Urethral Meatus Warts
  • Regimens :Cryotherapy with liquid nitrogen OR Surgical removal
  • 2.2 Vaginal Warts
  • Regimens:Cryotherapy with liquid nitrogen. OR Surgical removal OR TCA or BCA 80%–90% solution
  • Note: The use of a cryoprobe in the vagina is not recommended because of the risk for vaginal perforation and fistula formation
  • 2.3 Cervical Warts
  • Regimen: Cryotherapy with liquid nitrogen OR Surgical removal OR TCA or BCA 80%–90% solution
  • Note: Management of cervical warts should include consultation with a specialist.For women who have exophytic cervical warts, a biopsy evaluation to exclude high-grade SIL must be performed before treatment is initiated.
  • 2.4 Intra-anal Warts
  • Regimens :Cryotherapy with liquid nitrogen OR Surgical removalOR TCA or BCA 80%–90% solution
  • Note:Management of intra-anal warts should include consultation with a specialist.

Granuloma Inguinale (Donovanosis)

  • Preferred regimen:Azithromycin 1 g PO once per week OR 500 mg PO qd for 3 weeks and until all lesions have completely healed
  • Alternative Regimen:Doxycycline 100 mg PO bid for 3 weeks ORCiprofloxacin 750 mg PO bid for 3 weeks OR

Erythromycin base 500 mg PO qid for 3 weeks OR Trimethoprim-sulfamethoxazole one double-strength (160 mg/800 mg) PO bid for 3 weeks

Pregnant and lactating women

:::*Preferred regimen:treated with a macrolide regimen (erythromycin or azithromycin). The addition of an aminoglycoside (gentamicin 1 mg/kg IV every 8 hours) can be considered if improvement is not evident within the first few days of therapy.

HIV Infection

  • Preferred regimen:Azithromycin 1 g PO once per week OR 500 mg PO qd for 3 weeks and until all lesions have completely healed
  • Alternative Regimen:Doxycycline 100 mg PO bid for 3 weeks ORCiprofloxacin 750 mg PO bid for 3 weeks OR

Erythromycin base 500 mg PO qid for 3 weeks OR Trimethoprim-sulfamethoxazole one double-strength (160 mg/800 mg) PO bid for 3 weeks

  • Note:The addition of an aminoglycoside (gentamicin 1 mg/kg IV every 8 hours) can be considered if improvement is not evident within the first few days of therapy.