Genital warts are one of the most common sexually transmitted infections in the UK, caused by a virus
that doesn't always produce visible symptoms, which means it's possible to pass on the infection
without knowing you have it. When warts do appear, they can be unsettling to deal with, but there are
effective prescription treatments available as part of genital warts
care that can clear them.
Two first-line treatments are widely used in the UK: Aldara
(imiquimod 5% cream) and Warticon (podophyllotoxin cream or
solution). They work through completely different mechanisms, and the right choice will depend on the
type and location of your warts. This guide explains how each treatment works, what to expect from
using them, and why warts sometimes return after treatment has finished.
What causes genital warts?
Genital warts are caused by the human papillomavirus (HPV). Around 90% of cases are caused by the
low-risk strains HPV-6 and HPV-11.1 These strains are described as low-risk because
they're very rarely linked to cancer, unlike high-risk strains such as HPV-16 and HPV-18, which are
associated with cervical and other anogenital cancers.
The virus is transmitted through skin-to-skin contact during sexual activity. Many people infected
with HPV never develop visible warts, but the virus can still be passed on. When warts do appear,
they typically develop one to three months after infection, though the gap can be longer.
How does Aldara work?
Aldara contains imiquimod at a 5% concentration. It works as
an immune response modifier rather than a direct antiviral agent: instead of targeting the wart
directly, it stimulates your body's own immune response in the treated area. This triggers the local
production of cytokines, which are signalling proteins that prompt the immune system to attack HPV-infected
tissue and gradually break down wart cells.2
Because this mechanism relies on building an immune response, results take time to develop. Aldara is
applied three times per week (for example, on Monday, Wednesday, and Friday) before sleep, left on
the skin for 6 to 10 hours, then washed off thoroughly with mild soap and water. Treatment can
continue for up to 16 weeks per episode until visible warts have cleared.2 Each dose
comes in a single-use sachet, which should be discarded after one application.
Aldara is suitable for both soft and hard (keratinised) warts, and it's licensed for use on both
external genital warts and external perianal warts in adults, making it the more versatile option for warts in or around the anal area.2
A localised skin reaction at the application site (redness, itching, flaking, or mild burning) is
very common with Aldara and is generally a sign that the immune response is working. Rare, more
intense reactions (including skin erosion and flu-like symptoms such as fever and muscle aches) should
prompt a temporary pause in treatment and a conversation with a clinician.2
How does Warticon work?
Warticon works through a completely different mechanism. Its
active ingredient, podophyllotoxin, is a plant-derived compound that acts as an antimitotic agent: it
blocks the cell division that allows wart tissue to grow and spread, causing wart cells to die off
over time.3
Warticon is available in two forms: a cream (0.15% podophyllotoxin) applied with a fingertip, and a
solution (0.5% podophyllotoxin) that comes with a precision applicator, making it easier to target
individual warts precisely without contact with surrounding skin.
The dosing follows a seven-day cycle: apply twice daily (morning and evening, every 12 hours) for
three consecutive days, then leave untreated for four days. If warts persist, this cycle can be
repeated weekly for up to four weeks in total.3 Note that the solution is flammable, so
avoid smoking or being near an open flame during or immediately after application.
Warticon is suitable for soft, external genital warts only. It isn't licensed for hard or keratinised
warts or for treatment of perianal warts. Warticon is not recommended during pregnancy, or for people
who could become pregnant and aren't using contraception, as podophyllotoxin is known to be
embryotoxic.3
Aldara vs Warticon: choosing the right treatment
The choice between Aldara and Warticon typically comes down to wart type and location.
Aldara is the only topical option for hard (keratinised) warts and for warts in the perianal area. It
requires a longer treatment commitment of up to 16 weeks, but its three-times-a-week schedule is
manageable for most people.
Warticon suits people with soft, external genital warts who prefer a more intensive short-term
approach. The treatment period is up to four weeks, though the twice-daily application on treatment
days requires more regular attention.
Neither treatment is suitable during pregnancy. Your prescriber or Pharmica clinician will help
identify which option is appropriate based on your wart type, location, and medical history. You can
view genital warts treatments available through Pharmica.
What to expect during treatment
With Aldara, local skin reactions at the application site (redness, itching, and flaking) are very
common and expected. They're usually a sign the treatment is working rather than a reason to stop.
Treatment may take anywhere from 4 to 16 weeks to clear warts completely; if reactions become severe
at any point, take a brief break and contact your prescriber.2
With Warticon, mild irritation, redness, and burning at the application site are common, typically
appearing after two or three days of the first treatment cycle. Most people see warts begin to reduce
within the first few weeks of treatment. If warts haven't cleared after a full four-week course, a
clinician can advise on next steps.
Both treatments: it's advisable to avoid sexual intercourse during treatment. If you do have sex, use
a condom to reduce the risk of transmitting HPV to your partner and to protect them from contact with the active ingredient.
Do genital warts come back after treatment?
Recurrence after treatment is common. Around 30% of people experience a return of warts within three
months of clearance.4 This happens because neither Aldara nor Warticon eradicates the HPV virus itself: both treatments clear visible warts, but HPV can remain in the surrounding skin tissue and trigger new wart growth in subsequent months.
If warts return, the same treatment can usually be repeated. Using condoms consistently reduces the
risk of transmitting HPV to partners, though they don't eliminate it entirely since the virus can be
present on skin not covered by a condom. Your GP or sexual health clinic can advise if warts are
recurring frequently or if you'd like to explore longer-term management options.
When to seek further advice
Contact your GP or a sexual health clinic if:
- Your warts don't respond after completing a full treatment course
- New warts appear in a different area or in a hard-to-reach location
- You experience severe skin reactions, significant erosion, or flu-like symptoms during treatment
- You're pregnant or planning to become pregnant and need treatment for genital warts
- You're unsure which treatment is right for your situation
References
- Sonnex C, et al. Protocol for a randomised controlled trial of imiquimod cream
(5%) versus podophyllotoxin cream (0.15%), in combination with quadrivalent human papillomavirus
or control vaccination: HIPvac trial. BMC Medical Research Methodology. 2018;18(1):141.
doi:10.1186/s12874-018-0581-z
- Viatris (formerly Mylan or Upjohn). Aldara 5% Cream Summary of Product
Characteristics. Electronic Medicines Compendium (eMC). Updated 15 Oct 2025.
medicines.org.uk/emc/product/823/smpc
- Summary of Product Characteristics: Warticon Cream 0.15% (emc product 1507);
Warticon Solution 0.5% (emc product 1506). Electronic Medicines Compendium (eMC).
medicines.org.uk/emc/product/1507/smpc
- Unger ER, Fajman NN, Finkel DA, et al. Chapter 5: Human papillomavirus. In:
Centers for Disease Control and Prevention. Manual for the Surveillance of Vaccine-Preventable
Diseases. Updated 2021.
cdc.gov/surv-manual/chapter-5-human-papillomavirus
This article is intended for informational purposes only and does not replace professional medical
advice. Always read the patient information leaflet supplied with your medication and speak to a
healthcare professional if you have specific concerns.