Clear, confidential treatment for HPV and genital warts.

Cryotherapy uses liquid nitrogen (approximately -196°C) applied to warts to freeze and destroy the affected tissue. It's the most commonly used in-clinic treatment for genital warts - fast, effective, and well-tolerated.

How it works: A spray or cotton-tipped applicator delivers liquid nitrogen directly to each wart. The wart freezes, the cells within die, and the body sloughs off the dead tissue over the following 1-2 weeks, replacing it with healthy skin.

The procedure: each session takes 10-20 minutes total; each individual wart is treated for 10-30 seconds per freeze cycle, with 1-2 freeze cycles per wart per session. Mild stinging during freezing (10-20 seconds); brief but noticeable. Typically 2-4 sessions, 1-3 weeks apart, until clearance.

Effectiveness: studies show 70-90% clearance rates with cryotherapy across treatment courses. Some warts respond quickly; others require multiple sessions. Recurrence occurs in 20-30% within 3 months but is straightforward to re-treat.

After cryotherapy: mild redness, blistering, and tenderness for 3-7 days. Avoid friction (tight clothing, sexual contact) on treated areas for ~1 week. A small scab forms; do not pick it. Healing is complete in 1-2 weeks with no scarring in most cases.

Best suited for external warts on accessible skin, single or small clusters, and patients preferring in-clinic single-visit treatment - or in combination with topical therapy for difficult-to-clear lesions. Less suitable for warts inside the urethra or anal canal, very large or extensive warts, and patients with conditions affecting healing.

Topical immune modulators stimulate the local immune system to clear warts gradually. They're self-applied at home over weeks, with periodic clinic review.

Imiquimod (Aldara): cream applied 3 times per week (e.g. Monday, Wednesday, Friday) at bedtime, washed off in the morning (6-10 hours of contact). Continue for up to 16 weeks or until warts clear. Activates local immune response to clear infected cells.

Podophyllotoxin (Wartec, Condyline): solution or cream applied twice daily for 3 days, then 4 days off; cycle repeated weekly for up to 5 weeks. Direct anti-mitotic action; doesn't stimulate immune response.

Sinecatechins (Veregen): green tea extract ointment applied 3 times daily. Continue for up to 16 weeks or until clearance. Mechanism less well understood; thought to be antioxidant and immune-modulating.

How they compare: imiquimod has the most evidence and works best for many patients but can cause significant local skin irritation. Podophyllotoxin works faster but doesn't address the underlying infection as effectively. Sinecatechins are gentler with lower clearance rates.

Effectiveness: 50-70% clearance with imiquimod, slightly lower with other topicals. Variable response - some patients clear rapidly; others need to switch to a different modality.

Side effects: local skin irritation, redness, soreness (often significant with imiquimod); mild burning during application; occasionally skin ulceration with overuse. Avoid contact with non-affected skin and with partners during use.

Best suited for multiple lesions where in-clinic treatment of each would be impractical, hard-to-reach areas, patient preference for home-based treatment over clinic visits, and combination with cryotherapy for refractory lesions.

Surgical approaches provide definitive removal of warts in a single visit, particularly suitable for stubborn or large lesions where other treatments have failed or would be inefficient.

Electrosurgery / electrocautery: a high-frequency electrical current vaporises and removes the wart tissue. Performed in-clinic under local anaesthesia. Each lesion takes 1-5 minutes; full procedure typically 20-40 minutes depending on number and extent.

Surgical excision: for very large or anatomically challenging warts, traditional surgical excision under local anaesthesia removes the lesion completely. Closed with absorbable sutures where needed.

Laser ablation: some clinics offer CO2 laser ablation as an alternative to electrosurgery. Effectiveness is comparable. Hisential coordinates referral if laser-specific treatment is preferred.

The procedure: local anaesthesia (lidocaine injection) - brief discomfort. Wart removal is generally painless after anaesthesia. Single visit, definitive removal. Healing over 2-3 weeks.

Effectiveness: 90% or higher clearance for treated lesions. Recurrence is still possible from surrounding HPV-infected skin (not from incomplete removal) - re-treatment of new lesions if they appear.

After surgical removal: keep the area clean and dry. Mild discomfort for 3-5 days (manage with paracetamol). Avoid friction on the treated area for 2 weeks. Avoid sexual contact at the treatment site until healed (typically 2-3 weeks). Small scarring is possible in some cases; usually minimal.

Best suited for large warts not responding to other treatments, patients preferring single-visit definitive treatment, anatomically challenging locations, and recurrent warts where previous topical/cryotherapy hasn't held.

HPV vaccination is the preventive intervention - protecting against future HPV infection by the most common high-risk and wart-causing strains. Available for all genders, and beneficial at any age.

What Gardasil 9 covers: the 9 most common HPV strains - types 6 and 11 (cause ~90% of genital warts), types 16 and 18 (cause ~70% of HPV-related cancers - cervical, anal, penile, throat), and types 31, 33, 45, 52, 58 (cause additional HPV-related cancers).

Effectiveness: approximately 90% effective at preventing HPV infection by the vaccine strains in people not previously exposed. Reduced effectiveness in people already infected with one or more strains, but still provides benefit by protecting against strains not yet encountered.

Three-dose schedule for adults: dose 1 at the first visit; dose 2 two months after dose 1; dose 3 six months after dose 1. Total: 3 injections over 6 months. For younger adults (typically under 15), a 2-dose schedule is sometimes sufficient.

Side effects: mild injection-site soreness for 1-2 days (most common); brief redness or swelling at the injection site; mild low-grade fever in some cases; headache or fatigue occasionally. Serious adverse events are rare.

Who should be vaccinated: everyone not previously vaccinated - ideally before sexual debut, but meaningful benefit at any age. Patients with diagnosed HPV or visible warts still benefit from protection against strains not yet encountered. Patients in higher-risk groups (new sexual relationships, multiple partners, immunocompromised) and partners of HPV-diagnosed individuals.

Vaccination alongside wart treatment: it's reasonable to start Gardasil 9 vaccination at the same time as starting treatment for visible warts. The vaccination protects against future infection by other strains, even as current strains are being treated. Cost and scheduling are discussed at consultation.