Treatment with Topical Therapies

Patient-applied therapies

In some cases instead of receiving treatment in the office for warts, LSIL, or HSIL the patient will be sent home with topical treatments to use at home. It is important for the patient recieve thorough instructions on how to use their cream and that the patient strictly follows these instructions.


Aldara™ (5% imiquimod cream)

This is an immune-response modulating treatment, which acts to produce a local interferon response. This cream stimulates the immune system to recruit immune cells to the area and causes the warts to regress. It is applied to the warts and rubbed in 3x/weekly at bedtime and rinsed off in the morning. The treatment continues for 12-16 weeks.

Local irritation is expected and is a sign that the treatment is working. It can take 3-4 weeks for the treatment to start working. Occasionally the reaction is severe and the cream should be stopped until the inflammation goes away, or reduced to twice weekly. It is sometimes used post-operatively to prevent the recurrence of warts. Once the warts are clear, it may be used continuously 2x/week to prevent recurrences. It has been used experimentally intra-anally. One study showed it reduced recurrences of anal warts following surgery and was also effective as a primary treatment for anal HSIL.


External anal warts, especially primary outbreaks. The patient must be able to adequately reach the affected areas. Patients should be shown how to apply the cream correctly in the office. Safety in pregnancy is not established. Safety for internal disease is not established.

Efudex™ 5% cream (5FU)

Efudex (5FU) is a self-applied topical cream that is sent home with the patient for at-home use. It is currently prescribed off label for anal lesions although it has been used for anal warts and lesions for quite some time.  It is also used in women for lower genital tract infections that are related to HPV. Sometimes 5FU is the initial method of treatment and this treatment is followed by an ablative therapy such as hyfrecation. This course of treatment is typically prescribed if the HSIL covers a large area. The size of the HSIL is reduced with 5FU and then removed with ablation.


Patients whose HSIL covers more than 50% of the anal canal. Other patients with areas of lesions that are too large for ablation.