Anal warts

[Marriage in jeopardy!]

My husband and I have been together 16 mos. 2 months ago I discovered a small bump in my perianal region (closer to my anal region).  I really didn't think anything of it and didn't mention it to anyone.  It started to get bigger and another showed up further back on my rectal area.  I went to the doctor and she said that it was condylloma.  
I have had LEEP performed on me in '93 due to an abnormal pap...atypical squamous cells-high grade.  My paps have all been normal since.  My doctor said it probably isn't the same type of HPV around my anal area that I had in '93! She did say that exposer most likely occured anywhere from 2-18 mos.  My husband and I have crucified each other for obvious reasons!  Being that it is an STD, neither knows who gave it to the other!  Both of us deny any extra-marital encounters!  
I now have 6 anal warts, a couple of them are just inside my rectum.  
****Where did these come from??? And why am I the only one with the outbreak???  
My husband refuses to be with me intimately without a condom for fear he may acquire them as well!  And I am afraid to let him touch me thinking that he is the one that gave this to me, and I don't want vaginal warts as well!  Naturally, this has been a strain on our relationship!  
****If this is such a common thing that everyone gets, why does it just suddenly appear out of the blue??? And how can you get rid of the internal ones if you are not supposed to use the creams internally???
PLEASE HELP!!!

[H. Hunter Handsfield, M.D.]

Relax.  You and your husband are overreacting.  It's not that big a deal.  I'll try to help.

Assuming you have had no sex partners except your husband in the past 16 months, there are 3 possibilties for the origin of your warts.  First, your doctor may be right, i.e. reactivation of a long past HPV infection.  That doesn't seem especially likely, because such delayed recurrence is uncommon, and different types of HPV usually cause pap abnormalities or warts.  But it certainly can happen; and might be due to the same HPV that caused your abnormal pap 13 years ago, or you might have been infected with more than one HPV type back then.

Second, and more likely, is that your husband is (or was) infected with asymptomatic HPV and is the source of your infection.  That doesn't mean he is to blame; millions of men and women have genital HPV and don't know it, and can transmit to their partners.

Third, you might have acquired another HPV infection in the year or so before you and your husband got together, if you had other sex partner(s) during that time.

Note that none of these scenarios implies that either you or your husband has had other sex partners since you have been together. While a calm, unemotional conversation is reasonable to make sure you're confident he isn't screwing around (and vice versa), unless there is such evidence it is wrong for either of you to play the blame game with each other.

Your husband is unlikely to acquire HPV/warts from you.  You can be sure he is already infected, either because he is the one who brought the infection into your relationship, or because he was infected from you long before you developed visible warts.  In either case, almost certainly he is now immune to the HPV type causing your warts.  (People never get second infections with the same HPV type they had before.)  He should be on the lookout for visible warts, but in their absence he should cool it.  There is no reason for you not to have sex with one another or to use condoms--which probably wouldn't work anyway, over the long run.

Finally, local spread of your warts into the vagina or elsewhere isn't going to occur as a result of sex.  Simply by having anal or genital area warts, the virus has already been smeared all over your perineum and genitals; that happened before you noticed the first wart.

Bottom line:  This is not a situation that should stress your relationship.  You're just like millions of other couples, and in the long run, this is a trivial health problem.  Your warts (both internal and external) will go away with time, faster with treatment, but even without it.  Just follow your doc's advice about treatment, but otherwise mellow out, treat your husband with kindness and understanding, and insist that he do the same with you.

Best wishes--  HHH, MD

[Brian123]

I would not find this to be a major ordeal, yet I do not find anal warts to be trivial.
I think MD HHH is being too cavalier on this issue.

I have had the same health issue you have, in the past, and I had went to 3 different Colon-Rectal Specialists (not affilliated with one another); all of whom have told me the same thing:

Just as HPV increases the risk for women with cervical cancer, anal HPV also increases the risk of certain types of anal/rectal cancer.  To be sure, it is best to have an anal pap smear done every 2 years to see if there may be any abnormal growths attributed to past HPV infection.  Though, indeed this is not a "major" health issue on the radar screens for most Americans, I would not trivialize this matter.

If suspected, most internal warts do go away on their own.Unless they are causing bleeding or blockage of stool, anal warts are not a major deal.

For the last 10 years, I have went and got an anoscopy done. A procedure that literally takes less than 5 minutes to do. Very simple, the CRS inserts a 2-4 inch tube in the anal canal, using a camera, and views the inside of the rectal canal. It does not hurt to have this performed.

Hope all goes well.

[H. Hunter Handsfield, M.D.]

I deny being cavalier about warts.  Only a tiny propotion of people with genital or anal warts have the kind of problems described by Brian.  A small proportion of a very common problem still translates into lots of affected people, but still, for the large majority of infected people warts are an inconvenience, nothing more.

Routine anal paps in gay men is an area of controversy, but the consensus is that there still is too little known about how to do it (internal, external, with or without anoscopy), the natural course, the proper treatment of pre-cancerous lesions, and how much anal cancer actually would be prevented.  CDC and its 50+ expert consultants carefully considered and debated this in preparing the new (2006) STD treatment guidelines and concluded--properly, I think--that it is premature to recommend routine anal paps until research provides better answers about the uncertainties.  Currently no major health authority in the US (or elsewhere, to my knowledge) recommends routine anal paps in gay men.

But I do endorse anoscopy periodically as a reasonable health screening intervention for sexually active men who have receptive anal sex.

HHH, MD