STDs Expert Forum
Internal anal Warts
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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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Internal anal Warts

Hello
I was diagnosed in July 2012 with anal warts, both external and internal. I had surgery in August and they started to return before the wounds were completely healed. I tried Aldara for 8 weeks and the warts kept growing larger. I then recieved TCA treatments and after 3 weeks the external warts are gone. My question is what would you recomend I do abaut the internal warts? I don't want to get surgery again because it was expensive and in effective.I would rather go with watchful waiting. Is this a bad idea?
Thank you.
239123_tn?1267651214
Welcome to the forum.  Thanks for your question.

Internal rectal warts are a difficult management problem.  There has not been very much systematic research; most of what we know is based on the reported experience of protologists and other who treat them.  In general, they appear to clear up within a few months, sometimes longer -- but until then, recurrences are not uncommon.  Part of the problem is that even the best experts, using anoscopy or sigmoidoscopy, cannot easily identify all internal warts -- so that what seems to be a recurrence is often just a larger wart that was missed on the previous cycle of examination and treatment.

Most of the time, there probably is no serious harm in watchful waiting, rather than repeated episodes of surgery.  However, some cases will progress to a point at which the surgery becomes more major than otherwise necessary.  If you are under the care of a proctologist or other expert, I would ask him or her the same question

For external (anal) warts -- and for external genital warts, for that matter -- the individual responses vary widely to the various treatments.  Some respond well to freezing with liquid nitrogen, others better to podofilox (Condylox) or imiquimod (Aldara), still others to trichloroacetic acid (TCA).  If the response isn't great to any partiuclar treatment, the usual approach is to try one of the others.

I know it's a frustrating problem, and I'm sorry there aren't easy answers.  But the long term prognosis is very good; you can expect the problem to eventually resolve and stop causing problems.

Best wishes--  HHH, MD
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H. Hunter Handsfield, M.D.Blank
University of Washington
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