Anal warts removal confusion

Hey Doc, you said this in regards to anal warts: "internal ones usually clear up on their own after a few weeks or months.  For all these reasons, in my STD clinic, we generally don't even look for internal anal warts - we just treat the external ones."

Well I just went to go see a rectal surgeon to have my eight tiny external warts removed, he zapped them using cautery.  He then INSISTED on inserting this eight inch long scary looking alien anal colonoscopy probe up there to look for internal warts.  I said

[H. Hunter Handsfield, M.D.]

Visible genital warts are not caused by the same HPV types that cause cancer.  The main reason to detect and treat internal warts is that they lead to recurrent external warts, not that they are likely to turn to cancer.  In any case, there is no evidence that removing visible warts inside the rectum does anything to actually cure HPV or reduce the risk of later recurrence or of cancer.  For every visible wart the rectal surgeon can see and remove, there undoubtedly is a much broader area of infected tissue, about which nothing is (or can be) done.

But different providers have different attitudes and beliefs about all this, and I can't resolve the difference between my clinic's approach and your rectal surgeon's advice.  The best I can suggest is to get yet another opinion, e.g. from an infectious diseases specialist.

Good luck--  HHH, MD