Aldara Cream for Genital Warts: How It Works, Results, and Side Effects

STI Treatments

Aldara Cream for Genital Warts: How It Works, Results, and Side Effects

Aldara cream (imiquimod 5%) is a prescription treatment for external genital warts that works differently from most wart treatments. Rather than destroying wart tissue directly, Aldara stimulates your immune system to fight the HPV virus causing the warts. This approach often results in lower recurrence rates compared to treatments that simply remove the visible wart.

If you’ve been diagnosed with genital warts and are considering Aldara, this guide covers how it works, how to use it, what results to expect, and the side effects to be aware of.

How Does Aldara Work?

Aldara contains imiquimod, an immune response modifier. When applied to genital warts, it triggers the local immune system to produce cytokines and other immune chemicals that attack the HPV-infected cells. In simple terms, it teaches your body to recognise and fight the virus itself.

This immune-mediated approach has two advantages over directly destructive treatments:

• It can clear warts you can’t see (subclinical HPV) in the treated area, not just visible warts
• Recurrence rates are lower (10-20%) compared to treatments like podophyllotoxin (30-40%)

The trade-off is that it takes longer to work, typically 4-16 weeks versus 4 weeks for Warticon.

How to Use Aldara Cream

1. Apply 3 times per week (e.g., Monday, Wednesday, Friday) at bedtime
2. Wash and dry the area before application
3. Apply a thin layer to each wart and a small margin of surrounding skin
4. Rub in gently until the cream disappears
5. Leave on for 6-10 hours (overnight), then wash off with mild soap and water in the morning
6. Wash your hands before and after application
7. Continue for up to 16 weeks or until warts have cleared, whichever comes first

Each sachet is for single use. Don’t save opened sachets for later. Don’t apply more than prescribed, and don’t apply to internal warts (inside the vagina, urethra, cervix, or anus).

What Results to Expect

Aldara works gradually. Here’s a typical timeline:

• Weeks 1-2: The treated area may become red and slightly sore. This is the immune response activating. Warts may not change visibly yet.
• Weeks 2-4: Warts may start to shrink, flatten, or change colour. Inflammation increases.
• Weeks 4-8: Significant reduction in wart size. Some warts may disappear completely.
• Weeks 8-16: Remaining warts continue to clear. If no improvement by week 12-16, your doctor may switch to a different treatment.

Clinical studies show Aldara completely clears genital warts in 50-75% of patients. Men tend to have slightly lower clearance rates than women.

Side Effects

Local skin reactions are expected with Aldara and are actually a sign that the immune response is working:

Common (expected) reactions

• Redness at the application site
• Swelling and tenderness
• Itching or burning
• Skin erosion or flaking
• Scabbing or crusting

These reactions are normal. If they become too severe or painful, you can take a break from treatment for a few days until the skin settles, then resume.

Less common side effects

• Flu-like symptoms (headache, fatigue, muscle aches) during the first few weeks
• Skin colour changes at the treated site (usually temporary)
• Ulceration if cream is applied too thickly or to broken skin

When to see a doctor

• Severe pain that doesn’t settle during a treatment break
• Signs of skin infection (pus, increasing redness, fever)
• Difficulty urinating due to swelling near the urethra

Who Should Not Use Aldara?

• People with autoimmune conditions (imiquimod stimulates the immune system, which can be problematic)
• People who are immunosuppressed (the drug relies on immune function to work)
• People with internal warts (vaginal, cervical, rectal, or urethral)
• Pregnancy: Aldara should not be used during pregnancy. Its effects on unborn babies are not fully established. Tell your doctor if you’re pregnant or planning to become pregnant.

Where to Get Aldara in the UK

• Sexual health clinics: Free prescription and dispensing after diagnosis
• Your GP: Prescription after examination
• Online prescription services: After online consultation with a prescriber

Aldara is prescription-only. It costs around £35-50 privately. It’s free on NHS prescription.

Read more: Warticon (podophyllotoxin) | Condyline | Genital warts guide

Frequently Asked Questions

How long does Aldara take to work?

Most people see improvement within 4-8 weeks. Complete clearance may take up to 16 weeks. If there’s no improvement after 12-16 weeks, your doctor will consider alternatives.

Can I have sex while using Aldara?

Aldara can weaken condoms and diaphragms. Avoid sexual contact while the cream is on the skin (wash it off before sex). Genital warts are contagious through skin contact regardless of treatment.

Will genital warts come back after Aldara treatment?

Aldara has a lower recurrence rate (10-20%) than some other treatments because it activates the immune system against HPV. However, recurrence is still possible. The HPV virus can persist in surrounding skin even after visible warts clear.

Is Aldara painful?

Some burning, stinging, and soreness is normal and expected. Severe pain is not. If it’s too uncomfortable, take a break for a few days and then resume. You can use a gentle moisturiser on the surrounding skin (not on the warts themselves).

Related reading

• Are Genital Warts Clearable?
• Can You Clear HPV Once You Have It?
• Cervical Screening When You Have HIV
• Genital Warts vs Herpes: What's the Difference?
• How to Prevent HPV

Sources

• NHS — Sexual health conditions
• BASHH — UK clinical guidelines for STI management
• British HIV Association (BHIVA) — HIV treatment guidelines
• Terrence Higgins Trust — sexual health information
• UK Health Security Agency — STI surveillance data

Steve Page

Steve Page is a recognised expert on Sexually Transmitted Diseases (STDs) and STD treatments, having published numerous articles in peer-reviewed journals and presented his research at conferences around the world. He has an in-depth understanding of the latest medical research on STDs, and is an advocate for the development of new treatments and protocols to improve the health of those affected. In addition to his research, he has dedicated his career to understanding the causes and symptoms of STDs, as well as how to best treat those impacted.