External genital warts, caused by human papilloma virus, have a great clinical, epidemiological, and financial impact including the risk for malignant transformation. Treatment modalities include: (a) destructive (ablative); (b) cytotoxic (proapoptotic) and (c) immunomodulatory with success and recurrence rates varying from 23 to 94% and from 4.1 to 77%, respectively. Most studies evaluated only single modality therapy, with rare reports referring to a combined approach for external genital warts management. The introduction of sinecatechins ointment in the last several years has provided very low recurrence rates of 4.1–10.6%, despite lower initial clearance rates than ablative methods.

We present a retrospective review of 27 patients who underwent combined therapy for external genital warts by using one or two sessions of cryodestruction combined with 25% podophyllin as the cytotoxic agent, and post-ablation immunomodulation with topical sinecatechins 15% ointment.

This approach resulted in an excellent initial clearance rate of 96.3% with recurrence rate of 7.4% after the total period of six months of follow-up.

We emphasise the importance of combined approach in external genital warts management and with post-ablative immunomodulation to augment the immune response and combat the residual latent infection. We hope to encourage trials examining the combined approach to the treatment of external genital warts.