STDs Expert Forum
HPV treatment question
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The STD Forum is intended only for questions and support pertaining to sexually transmitted diseases other than HIV/AIDS, including chlamydia, gonorrhea, syphilis, human papillomavirus, genital warts, trichomonas, other vaginal infections, nongonoccal urethritis (NGU), cervicitis, molluscum contagiosum, chancroid, and pelvic inflammatory disease (PID). All questions will be answered by H. Hunter Handsfield, M.D. or Edward W Hook, MD.

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HPV treatment question

hi, i am a gay male who was recently treated for HPV on my anus. i saw the doctor one week ago and he applied podofilm, it seems to have worked great and the warts on the outside of my anus were gone within a couple of days. the doctor told me to watch them, and if there were still warts to see him again in a week. what are the risks of warts being inside the anus? i was checking to see how the skin was healing and could feel two warts on one side of my anus that were inside.
how are warts that are slightly inside (around the inside sphincter area) the anus treated?
can they be treated in the same manner?
and should i be worried about this?
will they go away on their own?

its comforting to know that sites like this exist.
anything you could tell me would be appreciated. thanks for your help
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Many gay men with anal warts also have warts inside the rectum.  Treatment can be a problem.  First, it is almost impossible to see all the individual warts, even with anoscopy by an experienced doc; in part this is because much of the infected tissue can appear entirely normal.  Second, even if warts are seen, treatment often is difficult--getting the liquid nitrogen, podophyllin, or other agents to the infected warts isn't all that easy.

Having said that, it usually isn't that big a deal; and just like external 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 warts in men with anal warts--we just treat the external ones.  However, if the external ones keep recurring, sometimes a referral to a proctologist is the best bet.

Bottom line (no pun intended):  Your doctor is on the right track.  Wait and see if your warts resolve and stay resolved.  If they do, you can assume that any undetected internal warts also have cleared up.  But if you continue to feel the internal bumps that you suspect are warts--and especially if it seems they are continuing to grow--bring it to your doc's attention and follow his recommendations.

All this assumes you aren't HIV positive.  In the presence of HIV infection, especially advanced enough to have significant immune impairment, treatment can be even more difficult.  But I assume you would have mentioned it if you have HIV.

Good luck--  HHH, MD
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University of Washington
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