{
  "schema_version": 1,
  "kind": "condition",
  "id": "anogenital-warts",
  "name": "Anogenital Warts (Condylomata Acuminata)",
  "category": "infectious",
  "sources": "Warticon Cream (podophyllotoxin 0.15% w/w) SmPC section 4.2 (eMC product 1507): \"Using a fingertip, the cream should be applied twice daily morning and evening (every 12 hours) for 3 consecutive days using only enough cream to just cover each wart. The cream should then be withheld for the next 4 consecutive days. ... Residual warts should be treated with further courses of twice daily applications for three days at weekly intervals, if necessary for a total of 4 weeks of treatment.\" · BASHH National Guideline for the Management of Anogenital Warts in Adults 2024 for the indication, with the schedule from Aldara 5% Cream (imiquimod) SmPC section 4.2 (emc-aldara-5pct-imiquimod.txt): \"Imiquimod cream should be applied 3 times per week (example: Monday, Wednesday, and Friday; or Tuesday, Thursday, and Saturday) prior to normal sleeping hours, and should remain on the skin for 6 to 10 hours. Imiquimod cream treatment should continue until the clearance of visible genital or perianal warts or for a maximum of 16 weeks per episode of warts.\" · BASHH National Guideline for the Management of Anogenital Warts in Adults 2024 · Aldara (imiquimod) 5% Cream SmPC, electronic Medicines Compendium · Warticon (podophyllotoxin) 0.15% Cream SmPC, electronic Medicines Compendium",
  "review_status": "reviewed",
  "verified_against": "Warticon Cream (podophyllotoxin 0.15% w/w) SmPC section 4.2 (eMC product 1507): \"Using a fingertip, the cream should be applied twice daily morning and evening (every 12 hours) for 3 consecutive days using only enough cream to just cover each wart. The cream should then be withheld for the next 4 consecutive days. ... Residual warts should be treated with further courses of twice daily applications for three days at weekly intervals, if necessary for a total of 4 weeks of treatment.\" · BASHH National Guideline for the Management of Anogenital Warts in Adults 2024 for the indication, with the schedule from Aldara 5% Cream (imiquimod) SmPC section 4.2 (emc-aldara-5pct-imiquimod.txt): \"Imiquimod cream should be applied 3 times per week (example: Monday, Wednesday, and Friday; or Tuesday, Thursday, and Saturday) prior to normal sleeping hours, and should remain on the skin for 6 to 10 hours. Imiquimod cream treatment should continue until the clearance of visible genital or perianal warts or for a maximum of 16 weeks per episode of warts.\" · BASHH National Guideline for the Management of Anogenital Warts in Adults 2024 · Anogenital Warts (Condylomata Acuminata) - disease-level clinical article (anogenital-warts-clinical.txt)",
  "verified_date": "2026-08",
  "treatments": [
    {
      "id": 187,
      "generic": "Imiquimod",
      "line": 1,
      "is_adjunct": false,
      "form": "topical",
      "strength_mg": null,
      "adult_dose": "Apply 5% cream in a thin layer directly to wart tissue 3 times weekly, prior to normal sleeping hours, and wash off with mild soap and water after 6-10 hours",
      "adult_duration": "Continue until visible warts clear, or for a maximum of 16 weeks per episode; consider switching treatment if there is less than 50% reduction in wart volume after 8 weeks",
      "dose_source": "BASHH National Guideline for the Management of Anogenital Warts in Adults 2024 for the indication, with the schedule from Aldara 5% Cream (imiquimod) SmPC section 4.2 (emc-aldara-5pct-imiquimod.txt): \"Imiquimod cream should be applied 3 times per week (example: Monday, Wednesday, and Friday; or Tuesday, Thursday, and Saturday) prior to normal sleeping hours, and should remain on the skin for 6 to 10 hours. Imiquimod cream treatment should continue until the clearance of visible genital or perianal warts or for a maximum of 16 weeks per episode of warts.\"",
      "rationale": "Chosen as line 1 here because it is stocked in Egypt (ALDARA 5% cream); BASHH 2024 lists imiquimod and podophyllotoxin as self-applied options of comparable standing, with the choice between them normally guided by wart morphology and patient preference rather than a strict hierarchy.",
      "cautions": [
        "Salicylic acid (used for cutaneous/plantar warts) must NOT be applied to anogenital skin - imiquimod and podophyllotoxin are the appropriate topical agents for this site.",
        "May weaken latex condoms and diaphragms - advise an alternative contraceptive method during treatment.",
        "Not recommended in pregnancy or breastfeeding - no self-applied topical agent is licensed for use in pregnancy; refer for a clinician-applied ablative treatment (e.g. cryotherapy) if pregnant.",
        "Use with caution in solid-organ transplant recipients and in those with autoimmune disease - may exacerbate inflammatory skin conditions.",
        "Local inflammatory skin reactions (redness, erosion, itching, burning) at the application site are common and expected."
      ],
      "peds_mgkg_low": null,
      "peds_mgkg_high": null,
      "peds_max_mg": null,
      "peds_basis": null,
      "peds_unit": null,
      "peds_note": "Paediatric use is not recommended (not established). Anogenital warts in a child should prompt specialist referral, including consideration of non-sexual transmission (vertical transmission or autoinoculation) alongside safeguarding assessment.",
      "peds_min_weight_kg": null,
      "peds_max_weight_kg": null,
      "peds_age_min_months": null,
      "peds_age_max_months": null,
      "peds_age_bands": null,
      "peds_doses": null,
      "brands": [
        {
          "trade_name": "ALDARA 5% CREAM 12 SACHETS",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "MEDA AB > ONE PHARMA TECH",
          "price_egp": 879.0,
          "pack_count": null,
          "unit_price": null,
          "strength_mg": null,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        }
      ],
      "condition_id": "anogenital-warts"
    },
    {
      "id": 189,
      "generic": "Referral & safety-netting (no drug therapy)",
      "line": 1,
      "is_adjunct": false,
      "form": null,
      "strength_mg": null,
      "adult_dose": null,
      "adult_duration": null,
      "dose_source": "Anogenital Warts (Condylomata Acuminata) - disease-level clinical article (anogenital-warts-clinical.txt)",
      "rationale": "Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.",
      "cautions": [
        "RED FLAG - Biopsy is recommended for uncertain diagnosis, immunocompromised patients, or pigmented/ulcerated lesions.",
        "RED FLAG - Cystoscopy is recommended for glans involvement, lower urinary tract symptoms, or urethral symptoms."
      ],
      "peds_mgkg_low": null,
      "peds_mgkg_high": null,
      "peds_max_mg": null,
      "peds_basis": null,
      "peds_unit": null,
      "peds_note": null,
      "peds_min_weight_kg": null,
      "peds_max_weight_kg": null,
      "peds_age_min_months": null,
      "peds_age_max_months": null,
      "peds_age_bands": null,
      "peds_doses": null,
      "brands": [],
      "condition_id": "anogenital-warts"
    },
    {
      "id": 188,
      "generic": "Podophyllotoxin",
      "line": 2,
      "is_adjunct": false,
      "form": "topical",
      "strength_mg": null,
      "adult_dose": "Apply 0.15% cream twice daily (morning and evening) for 3 consecutive days, using only enough cream to cover each wart, then withhold for 4 days. Repeat this weekly cycle if residual warts remain, for a maximum of 4 weeks",
      "adult_duration": "Up to 4 weeks (four 3-days-on/4-days-off cycles)",
      "dose_source": "Warticon Cream (podophyllotoxin 0.15% w/w) SmPC section 4.2 (eMC product 1507): \"Using a fingertip, the cream should be applied twice daily morning and evening (every 12 hours) for 3 consecutive days using only enough cream to just cover each wart. The cream should then be withheld for the next 4 consecutive days. ... Residual warts should be treated with further courses of twice daily applications for three days at weekly intervals, if necessary for a total of 4 weeks of treatment.\"",
      "rationale": "BASHH 2024 lists the 0.5% solution as preferred for efficacy, with the 0.15% cream as an off-license alternative used where solution application is difficult (e.g. perianal warts); listed for completeness, but no Egyptian brand is registered under any of podophyllotoxin, podofilox, or podophyllin - confirm import availability before prescribing, or use imiquimod instead.",
      "cautions": [
        "CONTRAINDICATED in pregnancy and in women of childbearing potential not using reliable contraception - antimitotic agents such as podophyllotoxin are embryotoxic.",
        "Not established or licensed for use in children under 18 years.",
        "Apply only enough cream to cover each wart and avoid contact with surrounding healthy skin; do not cover with an occlusive dressing.",
        "For lesions larger than 4 cm2 in total area, treat only under the direct supervision of a healthcare professional.",
        "No Egyptian brand is registered for this drug - verify local/import availability before prescribing."
      ],
      "peds_mgkg_low": null,
      "peds_mgkg_high": null,
      "peds_max_mg": null,
      "peds_basis": null,
      "peds_unit": null,
      "peds_note": "Safety and efficacy have not been established in children under 18 years.",
      "peds_min_weight_kg": null,
      "peds_max_weight_kg": null,
      "peds_age_min_months": null,
      "peds_age_max_months": null,
      "peds_age_bands": null,
      "peds_doses": null,
      "brands": [],
      "condition_id": "anogenital-warts"
    }
  ]
}