Genital-warts treatment choice: cream, GUM clinic or hyfrecation

You have usually arrived here because a lump appeared, a partner mentioned warts, or a cream from another clinic did not finish the job, and the screen then offers pharmacy gel, an NHS sexual health clinic, freezing, surgery, a vaccine, a swab and a Harley Street slot all at once. Those are not interchangeable. Picking the wrong diary is how people sit in a planned wart clinic with pelvic pain that needed gynaecology, book a vaccine when they wanted the lumps treated, or wait for a Friday they cannot use because they needed a walk-in GUM clinic now.

This clinic treats visible warts by hyfrecation

Wart removal here is consultant-led hyfrecation under local anaesthetic, done by Dr Hikmat Naoum, Consultant Gynaecologist, GMC 3047637, with genital warts treatment as the sister service. He treats men and women. No GP or urologist referral is required. The clinic sits at 117a Harley Street, London W1G 6AT, where Medical Express Clinic has practised since 1984 and is CQC-registered.

Sessions run on Fridays only, 10:00 to 16:00, with at least one day's notice, subject to capacity. This is an appointment service rather than a walk-in list, and a chaperone is available throughout.

He treats genital, anal and perianal warts, and HPV-related skin lesions in the anogenital area, including vulval, penile, scrotal and perianal sites, when removal is clinically appropriate. Many people need one session. Extensive or recurrent warts may need a follow-up. A typical session lasts 15 to 30 minutes, and healing usually takes 7 to 10 days. Those are typical timings rather than guarantees.

Hyfrecation uses a fine probe and a controlled electrical current to remove wart tissue after local anaesthetic. It is a clinician-applied ablative method. The visit remains private to Medical Express Clinic, and it is not shared with your NHS GP or another third party unless you ask.

What genital warts are, and what treatment cannot do

Genital warts are small, rough lumps that can appear around the vagina, penis or anus, on their own or in a group, and the genital warts page describes that condition. NHS pages describe them as a common sexually transmitted infection. They do not usually cause symptoms, although they may be painful, itchy or bleed. Diagnosis is usually made by looking. BASHH notes that visual inspection is usually sufficient, and NICE CKS says biopsy should not normally be performed unless the lesions are atypical.

They are usually caused by low-risk HPV types, commonly 6 and 11, spread by skin-to-skin contact, including when no wart is visible. BASHH estimates that around 90% of anogenital warts are caused by those two types. There is no cure for HPV itself. Treating a visible wart removes tissue you can see. It does not clear the virus from every patch of skin, it does not make a partner immune, and it does not replace vaccination or a typed swab.

NHS advice is that it can take weeks or months after contact for warts to appear, that you cannot usually tell who passed the infection on, and that treatment is not always needed, because warts sometimes disappear on their own within six months. NICE CKS puts the same figure as about one third of visible warts clearing spontaneously in that time. Choosing treatment is still reasonable when warts persist, distress you, catch, bleed, or sit where clothes or sex keep irritating them.

Why there is no single best treatment

There is no single best treatment, and comparing clearance and recurrence figures across trials is difficult because the studies are not built the same way.

Cream, a GUM clinic and hyfrecation are different jobs.

BASHH's 2024 national guideline is plain. Anogenital wart treatments include self-applied topical agents and clinician-applied therapies, topical or ablative. The choice depends on what is available, what you prefer, the volume and location of the lesions, and how you have already responded.

NHS pages list cream, liquid or ointment you usually apply yourself; freezing, which may need repeating; and surgery, in which warts are cut out after local anaesthetic, or removed using heat or a laser. NICE CKS, written for primary care, lists no treatment, self-applied treatments such as podophyllotoxin, imiquimod and sinecatechins, and ablative methods such as cryotherapy, excision and electrocautery, the last of those only if the practitioner is trained. Those names describe the NHS and GUM landscape, not a menu this Harley Street clinic runs.

NHS pages say it may take weeks or months for treatment to work, that warts may come back, and that sometimes treatment does not work.

If you have already used a cream

If you have previously tried prescription wart creams such as podophyllotoxin, tell Dr Naoum at the visit. He examines the area and advises whether in-clinic removal is suitable.

Do not use ordinary pharmacy wart treatments on genital skin. NHS advice is explicit: those products are not made for genital warts. If something burned, blistered or did nothing, bring the name if you still have the box.

NHS pages also ask you to say if you are pregnant or thinking of becoming pregnant, because some treatments are not suitable then. Tell him that at the start.

What happens at the Friday appointment

Dr Naoum examines the area first, checks that treatment is appropriate, and agrees how much can be treated in the session. Local anaesthetic is applied before the hyfrecator is used. He explains each part of the procedure, and you may ask him to pause.

You receive wound-care instructions. Keep the treated area dry for 24 hours unless advised otherwise.

Bring a medicine list, and say if you take medicines that affect healing or immunity, or have been told you have HIV or another condition that alters skin recovery.

Vaccination and a swab are different visits

A typed HPV swab and Gardasil 9 vaccination are separate appointments. They are not bundled into wart removal, and they do not replace it. The swab answers which strains you carry. The vaccine protects against strains you may not have met yet, including types 6 and 11, which are the usual wart types, and several high-risk types. Neither clears a wart that is already there, and neither is a cure for HPV you already carry.

If you want that testing or vaccination, it lives on the HPV testing and vaccination page, not inside this Friday diary. Private adult vaccination can still be a reasonable conversation if you missed school doses.

A partner can ask a doctor whether testing or vaccination would help them. NHS advice is to consider getting current partners checked, and to use condoms, because a condom does not cover every patch of skin.

When this booking is the wrong visit

A broader STI screen with a doctor is the sexual health clinic, not this wart list. NICE CKS treats screening for co-existing infections as part of proper sexual health care, particularly in younger people and in anyone with other genital symptoms. Wart removal is not a full screen, and it is not a way of ruling out chlamydia, gonorrhoea, syphilis, HIV or herpes.

Pelvic symptoms unrelated to warts belong with consultant gynaecology. Pain, abnormal bleeding, a fertility question or an early-pregnancy concern is not a hyfrecation booking. NICE CKS also says referral is essential if the diagnosis is uncertain, if malignancy or intraepithelial neoplasia is suspected, or if the warts are cervical, intrameatal or intra-anal in a way that needs specialist assessment beyond a planned outpatient session. If what you have does not look like an ordinary wart, say so when you call.

New, severe or rapidly worsening symptoms, heavy bleeding, difficulty passing urine, or a fever that makes you unwell now belong in same-day GP care, NHS 111, A&E or 999 according to how ill you are. This clinic is not an emergency department.

Children with anogenital warts are a safeguarding and specialist question. NICE CKS is explicit that children should be referred.

NHS sexual health clinics remain a reasonable option

NHS genital wart care usually starts at a sexual health clinic, sometimes called a GUM clinic. A GP will often refer you there. Many of those clinics offer walk-in sessions. NHS pages note that they specialise in genital and urine problems. That remains a good route if you want a full sexual health service, if you need a walk-in, or if you are pregnant and need the specialist pathway NHS pages describe.

Coming here is not a claim that NHS GUM is inadequate.

Tips and tricks

• Decide which job you want before you pick a slot.
• Visible wart removal, a typed HPV swab, Gardasil 9, a broader STI screen and consultant gynaecology are different visits.
• Write down creams you have already used.
• Say if you are pregnant or trying to conceive.
• Bring a medicine list.
• Ask for a chaperone if you want one.
• If a partner wants advice, they need their own conversation with a doctor.

Things to avoid

• Do not treat cream, freezing, surgery, vaccination and hyfrecation as the same product.
• This clinic's published method is hyfrecation under local anaesthetic.
• Do not arrive expecting cryotherapy or an imiquimod course.
• Do not use pharmacy wart treatments on genital skin.
• Do not assume one session clears HPV, because there is no cure for the virus itself.
• Do not book this slot for a full STI screen, and do not bring pelvic pain, abnormal bleeding or a pregnancy worry into a planned wart list.
• Do not expect same-day treatment from a Friday service that needs at least one day's notice.
• Do not sit on difficulty passing urine, heavy bleeding or a fever because Harley Street is in the diary later in the week.
• Do not use this adult clinic as a children's pathway.

If you do want consultant hyfrecation for genital warts at Medical Express Clinic, the details sit on the genital warts removal page, or you can call 020 7499 1991.

Related guides: adult HPV vaccination with Gardasil 9 and STI window periods and when to test.