Treatment Of Genital Warts Research Articles

Comparison of the Effectiveness of the Chemosurgery and Cryosurgery for the Treatment of Patients with Condyloma Acuminatum

Background: Condyloma acuminatum (CA) is one of the most common sexually transmitted infections. Several therapeutic modalities that can be used are chemosurgery with trichloroacetic acid and cryosurgery with liquid nitrogen. Recurrence in CA often occurs, so selecting the right therapeutic modality and eliminating the lesion also prevents recurrence. This study aimed to compare the effectiveness of chemosurgery and cryosurgery therapy in patients with CA who are treated at Dr. Moewardi Hospital, Surakarta. Subjects and Method: A retrospective cross-sectional study was conducted at the Dermatology and Venereology Polyclinic, Dr. Moewardi Hospital, Surakarta, from January 1, 2018, to December 31, 2020. The study subjects were 78 patients diagnosed with CA based on ICD-10 criteria, while chemosurgery and cryosurgery procedures were based on ICD-9. The dependent variable was healing time in weeks. The independent variables were chemosurgery and cryosurgery therapy. The data came from the patient's medical record. Data were analyzed using an independent t-test. Results: Based on univariate analysis, most patients were male (67.9%), and the age group was 20-29 years (51.28%). Most of the CA patients work as private employees (46.15%). The most sexual orientation was heterosexual (53.8%), the most common site of lesions was genital (47.4%), and 52.6% were coinfected with HIV. Most CA patients received chemosurgery (70.5%). Bivariate analysis showed that chemosurgery therapy provided faster clinical improvement (Mean= 23.34; SD= 26.45) than cryosurgery therapy (Mean= 28.69; SD= 19.84), and the difference was statistically significant (p= 0.037). Conclusion: Treatment of CA using chemosurgery provides clinical improvement faster than cryosurgery, so that faster treatment time can reduce treatment costs and improve the patient's quality of life. Keywords: chemosurgery, cryosurgery, HPV, condyloma acuminatum Correspondence: Prasetyadi Mawardi. Department of Dermatology and Venereology, Faculty of Medicine of Universitas Sebelas Maret/ Dr. Moewardi Hospital, Surakarta, Central Java, Indonesia. Email: prasetyadimawardi@gmail.com/ prasetyadi_m@staff.uns.ac.id. Mobile: +6281229750211. Indonesian Journal of Medicine (2021), 06(03): 290-297 https://doi.­org/10.26911/the­ijmed.­2021.06.03.06

Efficacy and safety of intralesional quadrivalent human papillomavirus vaccine as immunotherapy in management of recalcitrant genital warts in a tertiary health care center of North India

Background: Warts are common epidermal outgrowths caused by various strains of Human Papilloma Virus (HPV) and are spread by direct or indirect contact. Although they undergo spontaneous remission in 60–70% of cases over a period of few years, the cosmetic disfigurement, tendency to spread, and associated poor quality of life warrants intervention. Aim and Objectives: The purpose of this case study was to explore the efficacy of Intralesional quadrivalent HPV Vaccine as immunotherapy in management of genital warts. Materials and Methods: Twelve subjects of genital warts were enrolled from outpatient department of dermatology. Intralesional HPV vaccine was administered at 3 weekly intervals till three sittings or till the resolution of the lesions occurs, whichever was earlier. Results were measured in the terms of reduction in the number of the lesions, size of lesions or appearance of the new lesions. Follow-up was done at 3 weeks, 6 weeks, 9 weeks, 6 months, and 1 year. Any side effects seen during the study were recorded. Results: Eleven out of 12 patients showed complete resolution. Side effect observed was only pain and that too during the injection. Only one patient had recurrence. Conclusion: Immunotherapy is a simple, cost effective, and non-ablative mode of treatment for genital warts with better efficacy, tolerability, and less recurrence rate.

Topical and Systemic Retinoids for the Treatment of Genital Warts: A Systematic Review and Meta-Analysis

Background: Genital warts, caused by the human papillomavirus, are a common sexually transmitted disease. The warts can regress spontaneously or exhibit a persistent clinical course. Various therapeutic modalities are available, yet none is curative, and there may be recurrences. Retinoids are considered the mainstay of therapy in many dermatologic diseases. Data on their use for genital warts are limited. Objective: To systematically review the published evidence on the efficacy and safety of retinoids for the treatment of genital warts. Methods: A systematic review and meta-analysis of all publications evaluating topical or systemic retinoids for the treatment of genital warts was performed. The primary outcome was complete response (CR); the secondary outcomes were recurrence rate and adverse events. Results: Six publications were evaluated, three randomized controlled trials and three prospective cohort studies, including a total of 141 patients with genital warts treated exclusively with retinoids (90% with isotretinoin). CR rates were 100% for systemic etretinate (3 out of 3 patients, 95% CI 28–81%) and 56% for isotretinoin (95% CI 28–81%; I² = 84%). Topical etretinate did not induce CR. The most common side effect of topical agents was irritant contact dermatitis (36%) and that of systemic agents mucocutaneous disorders (80%). The relapse rate was 12% for oral isotretinoin and was unavailable for the other modalities. Conclusions: Current data suggest that unlike topical retinoids, systemic retinoids are an effective and safe treatment for genital warts. Further studies are required to determine their specific role and the most effective regimen for each derivative.

Podophyllotoxin Exposure Causes Spindle Defects and DNA Damage-Induced Apoptosis in Mouse Fertilized Oocytes and Early Embryos.

Podophyllotoxin (PPT) is a kind of lignans extracted from the roots and stems of the genus Podophyllum from the tiller family, and it has been widely used in the treatment of condyloma acuminatum, multiple superficial epithelioma in the clinics. However, PPT has been reported to be toxic and can cause liver defects and other organ poisoning. In addition, emerging evidences also indicate that PPT has reproductive toxicity and causes female reproduction disorders. In this study, we used fertilized oocytes and tried to explore the effects of PPT on the early embryonic development with the mouse model. The results showed that exposure to PPT had negative effects on the cleavage of zygotes. Further analysis indicated that PPT could disrupt the organization of spindle and chromosome arrangement at the metaphase of first cleavage. We also found that PPT exposure to the zygotes induced excessive reactive oxygen species (ROS), suggesting the occurrence of oxidative stress. Moreover, in the PPT-exposed embryos, there was positive γH2A.X and Annexin-V signals, indicating that PPT induced embryonic DNA damage and early apoptosis. In conclusion, our results suggested that PPT could affect spindle formation and chromosome alignment during the first cleavage of mouse embryos, and its exposure induced DNA damage-mediated oxidative stress which eventually led to embryonic apoptosis, indicating the toxic effects of PPT on the early embryo development.

Peripheral inflammatory biomarkers as predictors of recurrence in surgically-treated anogenital condylomata acuminata patients.

The aim of this study was to examine the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) in patients with anogenital condylomata acuminata (CA) and their association with recurrence and squamous intraepithelial neoplasia development. We conducted a descriptive study in 95 patients that had undergone surgical treatment for CA. The descriptive data, disease characteristics, and pre-treatment peripheral inflammatory biomarkers (PIBs) were recorded retrospectively. All parameters were compared in those with recurrent and non-recurrent CA. All PIBs were significantly higher in patients with the greatest genital wart size of >2 cm in the squamous intraepithelial lesion (SIL) group. Human papillomavirus (HPV) types 16, 18, 31 and 33, known to carry high risk for anogenital cancer, were significantly related to higher SII. Greater wart size, high-grade squamous intraepithelial lesion (HSIL), and higher PLR and SII values were highly associated with recurrent disease (p = 0.003, 0.006, 0.005 and 0.000, respectively). Of all recurrences, 34.1% were explained by HSIL and increased PLR and SII values. The prediction of CA recurrence is important to determine those patients at high risk. PLR and SII can be used for risk analysis in selected patient groups.

Management of Condyloma Acuminata in Pregnancy: A Review.

No clear guidelines are available for the management of pregnant women with condyloma acuminata, a human papillomavirus-associated benign neoplasm that develops in the genital tract. We performed a systematic review to gain a better understanding of the management of condyloma acuminata during pregnancy. In this review, we mainly focused on treatments. We searched PubMed, Google Scholar, and Web of Science to identify studies on the treatment of condyloma acuminata during pregnancy. Thirty articles met the inclusion criteria. The treatment methods described in the literature were laser therapy, cryotherapy, imiquimod, photodynamic therapy, trichloroacetic acid, and local hyperthermia. The most effective treatment remains unclear. Various factors must be considered when deciding how to treat. Based on our assessment of the literature, we recommend cryotherapy as the first-choice treatment and laser therapy as the second-choice treatment. Imiquimod can be considered in cases such as extensive condyloma acuminata that is not easily treated by cryotherapy or laser therapy. In such cases, sufficient informed consent must be obtained from the patient. Cryotherapy, laser therapy, and imiquimod have been administered during all 3 trimesters with no severe adverse effects, but we cautiously recommend reserving laser therapy until the third trimester because of the lower risk of recurrence before delivery. There are still many unclear points regarding the management of condyloma in pregnancy, and further research is needed.

The Bacillus Calmette-Guérin (BCG) Vaccine: Is it a better choice for the treatment of viral warts?

ObjectivesThis study aimed to compare the effectiveness of the bacillus Calmette-Guérin (BCG) vaccine with topical salicylic acid (SA) in the treatment of viral warts.MethodsThis non-randomised controlled trial was conducted at the Al-Sader Teaching Hospital, Basrah, Iraq, from January 2016 to April 2017. A total of 201 patients with viral warts were injected with an intradermal purified protein derivative. Subsequently, those with negative tuberculin test results received an intradermal BCG vaccination, while those with positive results underwent conventional treatment with topical SA. Patients were assessed for any signs of improvement at one, two and three months.ResultsOverall, 190 patients completed the trial; of these, 133 (70%) received the BCG vaccine and 57 (30%) were treated with topical SA. Complete response to treatment was observed in 9.8% and 5.3% of patients in the BCG and SA groups, respectively (P <0.001). Cure rates were significantly higher for patients with genital (22.2% versus 7.7%; P = 0.002) and common warts (8.5% versus 0%; P = 0.001) treated with the BCG vaccine; however, the reverse was true for flat warts (12.9% versus 25%; P = 0.041). A binary logistic regression analysis indicated that BCG therapy was the only significant independent predictor of positive treatment response (odds ratio: 7.56, 95% confidence interval: 3.72–15.36; P <0.001).ConclusionThe BCG vaccine was more effective than topical SA for treating viral warts, with the best response noted in the treatment of genital warts, followed by flat warts. However, plantar warts demonstrated least response to this treatment.

HPV11E7 inhibits IMQ-induced chemokine and colony-stimulating factor production in keratinocytes.

Imiquimod (IMQ) is approved as a first-line treatment for genital warts caused by human papillomavirus (HPV) infection. However, the recurrence rate is very high. HPV E7 protein plays a critical role in HPV immune escape. However, the role of HPV11 E7 protein in genital warts recurrence during IMQ treatment is not clear. Here, we found that the expression profile of NHEK cells was obviously changed after IMQ treatment, and a large number of genes encoding cytokines and genes involved in cytokine-mediated signaling pathways and cellular metabolic signaling pathways were up- or downregulated. HPV11E7 overexpression inhibited the IMQ-induced production of of multiple chemokines and colony-stimulating factors in NHEK cells. Furthermore, we found that HPV11E7 could impair the activation of mitogen-activated protein kinase (MAPK) signaling pathway. Therefore, our results suggested that HPV11 E7 diminishes the production of chemokines, colony-stimulating factors and other cytokines via inhibition of the MAPK signaling pathway, which suppresses the therapeutic effect of IMQ and promotes the recurrence of diseases, such as condyloma acuminatum.

Nonavalent human papillomavirus vaccination as alternative treatment for genital warts.

Genital warts caused by the human papillomavirus (HPV) are the most common sexually transmitted disease and have a negative impact on quality of life. Of the more than 200 different types of HPV, low-risk types 6 and 11 are mainly responsible for the development of condyloma acuminata. Despite a large arsenal of local therapies such as numerous topical agents, CO2 laser ablation, and surgical removal, genital warts tend to be recalcitrant. HPV vaccination is mainly used as a preventive strategy to prevent genital warts, cervical cancer, and other anogenital cancers. However, in a few cases, HPV vaccination has been shown to be a good treatment alternative for patients with recalcitrant skin warts. Here we report five cases of recalcitrant genital warts that responded well to treatment with the nonavalent HPV vaccine. HPV vaccines could be beneficial as a noninvasive treatment alternative for recalcitrant genital warts.

A systematic review of the use of topically applied treatment for genital warts in patients with normal immunity

British Journal of DermatologyVolume 183, Issue 1 p. e13-e13 Plain Language SummaryFree Access A systematic review of the use of topically applied treatment for genital warts in patients with normal immunity First published: 01 July 2020 https://doi.org/10.1111/bjd.19183AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Abstract The aim of this paper was to analyse the results of published studies looking at the use of topically applied medications (meaning they are applied to the skin) to treat warts on the external genitalia, to see if there was enough evidence to favour one or more treatments on the basis of good results and safety. The investigators selected 41 studies, which together involved 6371 patients. The main treatments analysed where topical podophyllotoxin (a cytotoxic agent - meaning it kills cells - applied to the surface of warts) in different strengths, sinecatechin (a product, again, used topically and derived from green tea extract), cidofovir gel and idoxuridine cream (both antiviral medications applied directly to warts), imiquimod (a topically applied medication used to increase immunity). Of the two most commonly used treatments, podophyllotoxin in a 0·5% solution was more effective than imiquimod 5% cream although it also caused more side effects such a stinging and irritation. By contrast sinecatchin was not as effective as imiquimod. The antiviral medications, idoxuridine and cidofovir, produced very similar results to those seen with imiquimod and podophyllotoxin. Generally, the rates of recurrence after therapy were similar whichever treatment was applied. The investigators concluded that there was little difference to be found between the different treatments and that selection of the most suitable in each individual case should also take into account factors such as the likelihood of irritation at the site to be treated or the length of time required to achieve cure, as some, such as imiquimod, take longer to produce results than others. Linked Article: Jung et al. Br J Dermatol 2020; 183:24–36. Volume183, Issue1July 2020Pages e13-e13 RelatedInformation

Genital Lesions Masquerading as Condyloma Acuminata: A Case Series Report

Herein we report three married women referred to Dermatology Clinic of Loghman Hakim Hospital, Tehran, Iran in 2017 for evaluation and treatment of genital warts. Two patients were complaining of flat-topped papules on their labia major and the third one was presented with asymptomatic papillary projections on her vestibule and inner aspect of both labia minora. Histological examination revealed the diagnosis of syringoma, lymphangioma circumscriptum (LC) and vestibular papillomatosis respectively. Familiarity with these uncommon conditions which clinically mimic genital warts helps to prevent labeling a patient with sexually transmitted disease before histological confirmation and prevent unnecessary treatment.

Efficacy and safety of treating anogenital warts with intralesional vitamin D3 injection: a report on 20 Egyptian patients

Background Anogenital warts (AGWs) are always resistant to traditional treatment options. Recently, vitamin D3 injection have proven its efficacy in the treatment of extragenital warts. To the best of our knowledge, there are no studies on using intralesional vitamin D3 in the treatment of genital warts. Aim To evaluate the efficacy of intralesional vitamin D3 injection in the treatment of AGWs. Patients and methods Twenty patients with AGWs were included in this study. Vitamin D3 (7.5 mg/ml) was injected into the base of the warts every 2 weeks for 2 months. Results Only two (11.11%) patients showed complete resolution; six (33.33%) patients showed moderate response, while 10 (55.55%) patients showed mild response. Recurrence has been obtained in moderate and mild responders; no adverse effects were observed. Conclusion The efficacy of using intralesional vitamin D3 in the treatment of AGWs is not as effective as its role in extragenital warts.

Treatment of Genital Warts with a Combination of Cryotherapy and 5% Imiquimod

Treatment of Genital Warts with a Combination of Cryotherapy and 5% Imiquimod

Cantharidin as an Alternative Treatment for Genital Warts: A Case Monitored With Optical Coherence Tomography.

Cantharidin as an Alternative Treatment for Genital Warts: A Case Monitored With Optical Coherence Tomography.

氨基酮戊酸-光动力疗法对尖锐湿疣组织中血管内皮生长因子和增殖细胞核抗原表达的影响

Objective To evaluate the effect of aminolevulinic acid-based photodynamic therapy (ALA-PDT) on the expression of vascular endothelial growth factor (VEGF) and proliferating cell nuclear antigen (PCNA) in condyloma acuminatum (CA) tissues. Methods A total of 56 patients with CA were enrolled from Department of Dermatology, The First Affiliated Hospital of Zhengzhou University from October 2016 to September 2017, and skin lesions were obtained before and 1 week after the first ALA-PDT treatment. Immunohistochemical SP method was used to determine the expression of VEGF and PCNA in keratinocytes in the CA tissues. Chi-square test and rank sum test were carried out to analyze differences between pre- and post-treatment expression rate and intensity of VEGF and PCNA, and Spearman correlation analysis was conducted to analyze the correlations between the protein expression of VEGF and PCNA. Results The expression rates of VEGF and PCNA in keratinocytes in the CA tissues were 71.43% (40/56) and 73.21% (41/56) respectively before ALA-PDT, and 44.64% (25/56) and 41.07% (23/46) respectively after ALA-PDT. There were significant differences between pre- and post-treatment expression rate and intensity of VEGF and PCNA (expression rate: χ2 = 8.25, 11.81 respectively, both P < 0.05; expression intensity: H = 11.29, 12.22 respectively, both P < 0.05) . The expression of VEGF was positively correlated with the expression of PCNA in the CA tissues before and after the ALA-PDT treatment (rs = 0.202, 0.273, respectively, both P < 0.05) . Conclusion The expression of VEGF and PCNA decreased in CA tissues after ALA-PDT treatment, which may be one of the mechanisms underlying the treatment of CA with ALA-PDT. Key words: Condylomata acuminata; Photochemotherapy; Aminolevulinic acid; Vascular endothelial growth factors; Proliferating cell nuclear antigen

Evaluation of human papillomavirus DNA detection-guided aminolaevulinic acid-mediated photodynamic therapy for the treatment of condyloma acuminata

Aminolaevulinic acid-mediated photodynamic therapy (ALA-PDT) is used to treat condyloma acuminata (CA), yielding a high clearance rate and low recurrence rate. Consecutive human papillomavirus (HPV) DNA detection can be used to dynamically monitor the therapeutic efficiency of PDT. Here, we evaluated the efficacy of ALA-PDT in the context of different HPV infection states. One hundred thirty-eight patients with HPV infection and visible anogenital warts were enrolled. Microwave or radiofrequency was used to remove visible lesions before PDT. HPV DNA detection was performed using real-time polymerase chain reaction before each PDT session and at follow-up. Treatment was halted after the patient showed two negative results for HPV DNA detection in a row. Of the 138 patients enrolled in the study, 72 completed treatment. Multisite HPV-infected patients required more sessions of PDT than did single-site infected patients to reach the endpoint of treatment. Compared with patients with only external CA, individuals with internal CA required more sessions to eliminate HPV infection. The total number of PDT sessions performed in the multitype HPV-infected group was significantly higher than that in the single-type infected group. Patients with non-high-risk (HR)-HPV infection required fewer PDT sessions than did those with HR-HPV infection by the end of treatment. Sixty-nine patients were followed-up for at least 6 months, only 2.9% of whom showed recurrence. Combined ALA-PDT and HPV DNA detection was an effective strategy for the treatment of CA. Patients with multisite and multitype HPV infection required more PDT sessions to eliminate the virus.

Clinical efficacy of paiteling in the treatment of condyloma acuminatum infected with different subtypes of HPV.

Condyloma acuminatum (CA) is a type of mucosal benign hyperplasia skin disease that is caused by human papillomavirus (HPV) infection, which mainly occurs in the genitalia and anus. The aim of the present study was to explore the clinical efficacy underlying the traditional Chinese medicine paiteling in the treatment of CA via the detection of HPV. One hundred CA patients were enrolled in the current study and were externally treated with paiteling for 5 weeks. HPV subtypes were examined both before the treatment and at 6 months after the treatment. After the external paiteling therapy, 92 cases were cured, and the apparent efficiency was 92.0% (92/100), while 8 cases exhibited recurrence. Before the external paiteling therapy, the numbers of cases of low-risk, high-risk, and mixed types of HPV were 40, 35, and 25, respectively. At 6 months after treatment, the numbers of negative cases of low-risk, high-risk, and mixed types of HPV were 38, 32, and 20, respectively. The results demonstrated that external paiteling treatment has a good curative effect on the treatment of CA.

Effect of 5-aminolevulinic acid photodynamic therapy on the expression of apoptosis inhibitors Bcl-2 and Survivin in keratinocytes of condyloma acuminatum.

Condyloma acuminatum is a highly infectious disease caused by the human papillomavirus. Previous studies have shown that 5-aminolevulinic acid photodynamic therapy can inhibit proliferation of condyloma acuminatum keratinocytes. However, the effect of 5-aminolevulinic acid photodynamic therapy on condyloma acuminatum tissues has not been systematically studied. Here, we investigated possible molecular mechanisms of 5-aminolevulinic acid photodynamic therapy in the treatment of condyloma acuminatum and its effect on the expression of apoptosis inhibitors Bcl-2 and Survivin. Immunohistochemistry streptavidin-peroxidase was used to detect the expression of apoptosis inhibitors Bcl-2 and Survivin in condyloma acuminatum keratinocytes before and after the therapy. The positive expression rates of Bcl-2 and Survivin in condyloma acuminatum keratinocytes before treatment were 87.50% (42/48) and 79.16% (38/48), respectively. The positive expression rates of Bcl-2 and Survivin in condyloma acuminatum keratinocytes after treatment were 37.50% (18/48) and 41.67% (20/48), respectively. The positive expression intensity of Bcl-2 and Survivin in condyloma acuminatum keratinocytes before 5-aminolevulinic acid photodynamic therapy was mostly ++ to +++, and that after treatment was mostly - to +. There were statistically significant differences in the positive expression rate and the expression intensity of Bcl-2 and Survivin in the two groups before and after 5-aminolevulinic acid photodynamic therapy (P < 0.001). There was a positive correlation between the expression of Bcl-2 and Survivin in condyloma acuminatum tissues after 5-aminolevulinic acid photodynamic therapy (r = 0.480, P < 0.05). 5-aminolevulinic acid photodynamic therapy may promote apoptosis of condyloma acuminatum cells by reducing the expression of Bcl-2 and Survivin, suggesting that this is potentially one of the molecular mechanisms of 5-aminolevulinic acid photodynamic therapy in the treatment of condyloma acuminatum.

Successful Treatment of Genital Warts with Ingenol Mebutate Monitored with Optical Coherence Tomography and Reflectance Confocal Microscopy

Ingenol mebutate (IM) is approved for the treatment of actinic keratosis and induces cell death in precancerous lesions. The efficacy of IM in the treatment of genital warts was investigated in a therapy-refractory patient. The 74-year-old male was treated with IM gel for three consecutive days. Treatment course and efficacy were evaluated by clinical inspection and non-invasive diagnostics namely optical coherence tomography (OCT) and reflectance confocal microscopy (RCM). Within 24 to 48 hours IM induced a strong local inflammatory reaction. One week later a complete response was observed. OCT and RCM showed a strong reaction after treatment with erosions, swelling of cells, and a subepidermal dark band in representative lesions. IM has the advantage of a short treatment period in contrast to other topical treatments and shows a promising clinical outcome. Larger studies are needed to validate the data.

Treatment of genital warts by using CO2 laser

Background: Genital wart is the most common viral sexually transmitted disease. In fact, its incidence is rising rapidly. It is approximated that 30%–50% of sexually active adult have human papillomavirus (HPV) infection, but only 1%–2% of them have apparent genital wart. Mostly, cervical dysplasia and cancer are associated with oncogenic HPV types. HPV types are classified into high-, intermediate-, and low-risk group. HPV Types 16 and 18 are considered as a high-risk group cancer-associated HPVs, whereas Types 6 and 11 concerned as a low risk and HPV types 31, 33, and 35 have an intermediate association with cancer. Objective: The objective of the study was designed to evaluate the activity of CO2 laser to treat genital warts of female Iraqi patients. Materials and Methods: Fifteen female patients with genital warts were involved in this study. Their age range from 22 to 49 years treated by CO2 laser at the Laser Medicine Research Clinics of Institute of Laser for Postgraduate Studies from July 2017 to end of July 2018. Application of topical lidocaine cream 10% for 30 min or local infiltration of 2% xylocaine had been performed. CO2 laser in chopped mode was used with a peak power: 151 watts and repeated time 35 s in D mode, pulse duration 1.3 ms. Treatments by vaporization of the warts were done in one session except one patient with a large number and multiple locations two sessions were done. Results: Three patients expressed mild pain during the procedure, but it could be tolerated by them. No edema or oozing observed during the 1st week. No postoperative infections or scars. Two cases of recurrence 2/15, (13.3%) after few months from treatment. Conclusion: CO2 laser vaporization is an effective and safe method for treatment of genital warts and can be done in the outpatient clinic.