Treatment of Internal warts

[DancingBrave]

I have had external warts around my anus since July. Aldara was great in the beginning, but it seems to have stopped working. Now I notice a rather large wart on the inside. Should I get it treated or wait to see what it does? What kind of doctor does a girl go see to get an anal wart removed? Thanks in advance for the help.

[H. Hunter Handsfield, M.D.]

Large internal rectal warts--large enough to feel--generally should be treated; it might help your external warts resolve.  As someone commented before I replied (below), call your local medical society for a referral to a proctologist (rectum specialist); although in many communities, some general surgeons specialize in colon and rectal problems.  Don't be tempted to use Aldara internally; it won't work and could cause painful side effects.



Good luck--- HHH, MD

[Bruse]

I'm in the same boat that you are, although i havent had anal warts for nearly as long, but if you have had problems with anal warts for this long and you know of a large one inside you should probably get a referral to a proctologist, which as far as i know is a "anal specialist"? to maybe get the inside warts removed, at least thats what iv gotten from doctor's iv talken to about this, but wait and see what the real Dr. says, good luck!

[caworrywart]

Thanks again for your help Doctor.  It's helped me a ton.  Sorry to piggyback, but on a somewhat related note, what about internal warts in the vagina?



I was diagnosed with gw a few weeks ago and was prescribed Aldara twice (I got a second opinion) even though 3M's info specifically says not to use Aldara inside the vagina.  Other sites have claimed that internal use of Aldara may lead to autoimmune problems, so I got worried and stopped using it.



These are a few medium sized gw on the lower inside of the vaginal lips, visible but close to lower hymenal opening. One is like a skin tag and the others are more the traditional cauliflower like shapes (they were also hard to apply Aldara on since they are hard to get to)



I need to decide on a treatment plan and wanted to see if you have any suggestions or recommendations, particularly if there is one treatment that may reduce risk of reoccurence.



My gynocologist doesn't offer cryo but offered excision or TCA.  What are the costs/benefits of cryo (she couldn't tell me)--should I hold out for that treatment?



I will certainly discuss a treatment plan in detail with my gyno but would greatly appreciate your thoughts.  Thanks again!

[H. Hunter Handsfield, M.D.]

Internal vaginal warts, like rectal warts, are harder to treat than external warts.  Your gynecologist is offering the standard approaches.  My greatest experience is with crytherapy with liquid nitrogen, which is somewhat more easily controlled--i.e., treating only the visible warts and not surrounding normal tissue.  Trichloroacetic acid (TCA) is a little harder to control in that regard.



But all treatments for internal warts--cryo, TCA, excisions--are imperfect and recurrence rates are high.  None is necessarily preferred over the others.  Like your gynecologist, most providers get comfortable with one or two treatments, but not necessarily all of them.  The specific treatment is less important than the providering use an approach that s/he is skilled at.  But if your doctor's approach doesn't work, or if warts reappear quickly after treatment, you might want to discuss referral for a second opinion.



Good luck-- HHH, MD

[caworrywart]

Thanks very much doctor!  I really appreciate it.

[DancingBrave]

Follow-up to my question....



Ok I called a rectal surgeon and made an appointment, but I couldn't bring myself to tell the receptionist the real reason for my appointment (I said i think I have  hemmeroids...hahah...) I know, I'm a loser. Anyway, is this gonna pose a problem for the doctor?



Also, do you have any idea why aldara worked so well for me in the beginning (cleared me about 90%) and then stopped working? Have you heard of anything like this in your own practice?



Thanks for the help